Affordable Care Act (ACA), expanding preventive care coverage and clarifying Health Savings Account (HSA) eligibility. These updates impact employers offering group health plans and emphasize the need to stay informed to remain compliant. Below, we break down the key changes and what they mean for your business.
What’s New? A Summary of Key Updates
- Expanded HSA-Eligible Preventive Care
The IRS has broadened the scope of preventive care eligible for HSA contributions. As outlined in IRS Notice 2024-75, the following now qualify as preventive care:- Over-the-Counter Contraceptives: Includes birth control pills and emergency contraception, even without a prescription.
- Male Condoms: Covered regardless of the purchaser’s gender or whether a prescription is provided.
- Breast Cancer Screenings: Coverage now explicitly includes MRIs, ultrasounds, and similar services.
- Insulin and Glucose Monitors: All types of insulin and devices for administering insulin, as well as continuous glucose monitors, are considered preventive.
- Coverage for PrEP Medications
Starting with plan years on or after September 1, 2024, non-grandfathered group health plans must provide no-cost coverage for all FDA-approved pre-exposure prophylaxis (PrEP) medications, along with baseline and monitoring services. Importantly, no medical management techniques may restrict access to specific PrEP formulations. - Women’s Health & Cancer Rights Act (WHCRA) Updates
WHCRA guidance now clarifies that group health plans covering mastectomies must include coverage for all stages of breast reconstruction, prostheses, and treatments for physical complications. This includes chest wall reconstruction with aesthetic flat closure when elected by the patient. These services are not considered preventive and remain subject to applicable plan cost-sharing terms. - Proposed Rules for 2026: Expanded OTC Contraceptive Coverage
Looking ahead to 2026, the agencies have proposed requiring group health plans to:- Cover over-the-counter (OTC) contraceptives without cost-sharing, even without a prescription.
- Ensure reasonable medical management techniques allow for individualized exceptions when medically necessary.
- Preventive Care Coding and Coverage
Employers are reminded of their responsibility to ensure that preventive care items are coded and covered appropriately under their group health plans. Carriers and TPAs should be reviewing the latest preventive care recommendations to ensure proper claim processing.
Stay Ahead of Compliance: Key Updates on Preventive Care and HSA-Eligible Coverage for Employers
Recent federal guidance introduces important changes to health plan requirements under the Affordable Care Act (ACA), expanding preventive care coverage and clarifying Health Savings Account (HSA) eligibility. These updates impact employers offering group health plans and emphasize the need to stay informed to remain compliant. Below, we break down the key changes and what they mean for your business.
What’s New? A Summary of Key Updates
- Expanded HSA-Eligible Preventive Care
The IRS has broadened the scope of preventive care eligible for HSA contributions. As outlined in IRS Notice 2024-75, the following now qualify as preventive care:- Over-the-Counter Contraceptives: Includes birth control pills and emergency contraception, even without a prescription.
- Male Condoms: Covered regardless of the purchaser’s gender or whether a prescription is provided.
- Breast Cancer Screenings: Coverage now explicitly includes MRIs, ultrasounds, and similar services.
- Insulin and Glucose Monitors: All types of insulin and devices for administering insulin, as well as continuous glucose monitors, are considered preventive.
- Coverage for PrEP Medications
Starting with plan years on or after September 1, 2024, non-grandfathered group health plans must provide no-cost coverage for all FDA-approved pre-exposure prophylaxis (PrEP) medications, along with baseline and monitoring services. Importantly, no medical management techniques may restrict access to specific PrEP formulations. - Women’s Health & Cancer Rights Act (WHCRA) Updates
WHCRA guidance now clarifies that group health plans covering mastectomies must include coverage for all stages of breast reconstruction, prostheses, and treatments for physical complications. This includes chest wall reconstruction with aesthetic flat closure when elected by the patient. These services are not considered preventive and remain subject to applicable plan cost-sharing terms. - Proposed Rules for 2026: Expanded OTC Contraceptive Coverage
Looking ahead to 2026, the agencies have proposed requiring group health plans to:- Cover over-the-counter (OTC) contraceptives without cost-sharing, even without a prescription.
- Ensure reasonable medical management techniques allow for individualized exceptions when medically necessary.
- Preventive Care Coding and Coverage
Employers are reminded of their responsibility to ensure that preventive care items are coded and covered appropriately under their group health plans. Carriers and TPAs should be reviewing the latest preventive care recommendations to ensure proper claim processing.
Why These Updates Matter to Employers
Staying compliant with these updated rules is crucial to avoid penalties, maintain employee satisfaction, and uphold your company’s reputation as an employer of choice. Missteps in coding or coverage of preventive care can lead to disputes, audits, or penalties. Additionally, by embracing expanded preventive coverage, employers can support the health and well-being of their workforce, which translates to higher productivity and morale.
What Should Employers Do Next?
- Review Your Current Health Plan
Ensure your carrier or TPA has implemented the required changes for preventive care and HSA-eligible expenses. - Communicate with Employees
Keep employees informed about their benefits, including newly covered services such as over-the-counter contraceptives and insulin-related items. - Prepare for Future Requirements
Plan for compliance with proposed rules for 2026, particularly around OTC contraceptives and medical management techniques. - Partner with Experts
At Cypress Benefit Solutions, we specialize in helping employers like you navigate the complexities of compliance while optimizing your benefits package.
Stay Ahead of Compliance: Key Updates on Preventive Care and HSA-Eligible Coverage for Employers
Recent federal guidance introduces important changes to health plan requirements under the Affordable Care Act (ACA), expanding preventive care coverage and clarifying Health Savings Account (HSA) eligibility. These updates impact employers offering group health plans and emphasize the need to stay informed to remain compliant. Below, we break down the key changes and what they mean for your business.
What’s New? A Summary of Key Updates
- Expanded HSA-Eligible Preventive Care
The IRS has broadened the scope of preventive care eligible for HSA contributions. As outlined in IRS Notice 2024-75, the following now qualify as preventive care:- Over-the-Counter Contraceptives: Includes birth control pills and emergency contraception, even without a prescription.
- Male Condoms: Covered regardless of the purchaser’s gender or whether a prescription is provided.
- Breast Cancer Screenings: Coverage now explicitly includes MRIs, ultrasounds, and similar services.
- Insulin and Glucose Monitors: All types of insulin and devices for administering insulin, as well as continuous glucose monitors, are considered preventive.
- Coverage for PrEP Medications
Starting with plan years on or after September 1, 2024, non-grandfathered group health plans must provide no-cost coverage for all FDA-approved pre-exposure prophylaxis (PrEP) medications, along with baseline and monitoring services. Importantly, no medical management techniques may restrict access to specific PrEP formulations. - Women’s Health & Cancer Rights Act (WHCRA) Updates
WHCRA guidance now clarifies that group health plans covering mastectomies must include coverage for all stages of breast reconstruction, prostheses, and treatments for physical complications. This includes chest wall reconstruction with aesthetic flat closure when elected by the patient. These services are not considered preventive and remain subject to applicable plan cost-sharing terms. - Proposed Rules for 2026: Expanded OTC Contraceptive Coverage
Looking ahead to 2026, the agencies have proposed requiring group health plans to:- Cover over-the-counter (OTC) contraceptives without cost-sharing, even without a prescription.
- Ensure reasonable medical management techniques allow for individualized exceptions when medically necessary.
- Preventive Care Coding and Coverage
Employers are reminded of their responsibility to ensure that preventive care items are coded and covered appropriately under their group health plans. Carriers and TPAs should be reviewing the latest preventive care recommendations to ensure proper claim processing.
Why These Updates Matter to Employers
Staying compliant with these updated rules is crucial to avoid penalties, maintain employee satisfaction, and uphold your company’s reputation as an employer of choice. Missteps in coding or coverage of preventive care can lead to disputes, audits, or penalties. Additionally, by embracing expanded preventive coverage, employers can support the health and well-being of their workforce, which translates to higher productivity and morale.
What Should Employers Do Next?
- Review Your Current Health Plan
Ensure your carrier or TPA has implemented the required changes for preventive care and HSA-eligible expenses. - Communicate with Employees
Keep employees informed about their benefits, including newly covered services such as over-the-counter contraceptives and insulin-related items. - Prepare for Future Requirements
Plan for compliance with proposed rules for 2026, particularly around OTC contraceptives and medical management techniques. - Partner with Experts
At Cypress Benefit Solutions, we specialize in helping employers like you navigate the complexities of compliance while optimizing your benefits package.
Stay Compliant and Competitive with Cypress Benefit Solutions
Understanding and implementing these updates can feel overwhelming, but you don’t have to navigate them alone. Cypress Benefit Solutions is here to ensure your benefits package meets all federal requirements while supporting your employees’ health needs.
Contact us today to learn how we can help you stay ahead of compliance while building a benefits program that works for your business.
