Blog 3/7/2018

Coverage of Male Contraception as Preventive Care Under HDHP Negates Eligibility for HSA Participation/Opportunity to Comment on Preventive Care

The IRS recently released guidance clarifying that a health plan covering male sterilization or male contraceptives at 100%, or with a deductible below the minimum deductible for a high deductible health plan (HDHP) under Section 223(c)(2)(A), is not an HDHP.

The guidance comes in response to a request from the state of Maryland, where a new state law (the Maryland Contraceptive Equity Act), requires coverage of vasectomies as a preventive service (under fully insured plans). However, federal law does not treat vasectomy as preventive care, and federal law is what governs Health Savings Account (HSA) rules. HSA eligibility requires a person to be covered by a qualified high deductible health plan (HDHP), and HDHPs cannot provide coverage of services before the deductible unless they meet the preventive care requirements under the ACA.

The notice, which can be found here:, provides transition relief for periods before 2020 during which coverage has been provided for male sterilization or male contraceptives without a deductible, or with a deductible below the minimum deductible for an HDHP.

Opportunity for Comment

While this situation affects a very limited number of employers and plans, it’s worth pointing out that the notices includes a request for comment on how to expand the use and flexibility of HSAs and HDHPs (in particular, the appropriate standards for determining what benefits and services should and should not be considered preventive care) and other issues related to the provision of preventive care under an HDHP.

This is an outstanding opportunity to make your opinions on preventive care known.

Comments should include a reference to Notice 2018-12. Send submissions to:

CC:PA:LPD:PR (Notice 2018-12)
Room 5203
Internal Revenue Service
P.O. Box 7604
Ben Franklin Station, 54
Washington, DC 20044.

Submissions may be hand delivered Monday through Friday between the hours of 8 a.m. and 4 p.m. to CC:PA:LPD:PR (Notice 2018-12), Courier’s Desk, Internal Revenue Service, 1111 Constitution Avenue, NW, Washington, DC 20224, or sent electronically, via the following e-mail address: Please include “Notice 2018-12” in the subject line of any electronic communication.

All material submitted will be available for public inspection and copying.

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