,i #aacth ,,congress #ast ,session ,h4 ,r4 #baid ,,in ,,the ,,house ,,of ,,representatives ,may #bc1 #bjac ,mr4 ,paulsen introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committees on the ,judiciary and ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,internal ,revenue ,code of #aihf to improve access to health care through expanded health savings accounts1 and for other purposes4 #a4 ,short title1 etc 7a7 ,short title ,this ,act may be cited as the ,family and ,retirement ,health ,investment ,act of #bjac4 7b7 ,amendment of #aihf ,code ,except as otherwise expressly provided1 whenever in this ,act an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of the ,internal ,revenue ,code of #aihf4 7c7 ,table of contents ,the table of contents is as follows3 ,sec4 #a4 ,short title1 etc4 ,title ,i--,provisions relating to tax-preferred health accounts ,sec4 #aja4 ,allow both spouses to make catch-up contributions to the same ,,hsa account4 ,sec4 #ajb4 ,provisions relating to ,medicare4 ,sec4 #ajc4 ,individuals eligible for veterans benefits for a service-connected disability4 ,sec4 #ajd4 ,individuals eligible for ,indian ,health ,service assistance4 ,sec4 #aje4 ,individuals eligible for ,,tricare coverage4 ,sec4 #ajf4 ,,fsa and ,,hra interaction with ,h,s,as4 ,sec4 #ajg4 ,allowance of distributions for prescription and over-the-counter medicines and drugs4 ,sec4 #ajh4 ,purchase of health insurance from ,,hsa account4 ,sec4 #aji4 ,special rule for certain medical expenses incurred before establishment of account4 ,sec4 #aaj4 ,preventive care prescription drug clarification4 ,sec4 #aaa4 ,equivalent bankruptcy protections for health savings accounts as retirement funds4 ,sec4 #aab4 ,administrative error correction before due date of return4 ,sec4 #aac4 ,reauthorization of medicaid health opportunity accounts4 ,sec4 #aad4 ,members of health care sharing ministries eligible to establish health savings accounts4 ,sec4 #aae4 ,high deductible health plans renamed ,,hsa qualified plans4 ,sec4 #aaf4 ,treatment of direct primary care service arrangements4 ,sec4 #aag4 ,high deductible health plans with ,h,s,as treated as qualified health plans4 ,sec4 #aah4 ,certain stand-alone ,h,r,as not subject to prohibition on annual limits4 ,title ,,ii--,other provisions ,sec4 #bja4 ,certain exercise equipment and physical fitness programs treated as medical care4 ,sec4 #bjb4 ,certain nutritional and dietary supplements to be treated as medical care4 ,sec4 #bjc4 ,certain provider fees to be treated as medical care4 ,sec4 #bjd4 ,repeal of annual limitations on deductibles for employer-sponsored plans offered in small group market4 ,i ,provisions relating to tax-preferred health accounts #aja4 ,allow both spouses to make catch-up contributions to the same ,,hsa account 7a7 ,in general ,paragraph 7#c7 of section #bbc7;b7 is amended by adding at the end the following new subparagraph3 7,c7 ,special rule where both spouses are eligible individuals with #a account ,if-- 7i7 an individual and the individual's spouse have both attained age #ee before the close of the taxable year1 and 7ii7 the spouse is not an account beneficiary of a health savings account as of the close of such year1 the additional contribution amount shall be #bjj percent of the amount otherwise determined under subparagraph 7,b74 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ajb4 ,provisions relating to ,medicare 7a7 ,individuals over age #fe only enrolled in ,medicare ,part ,a ,paragraph 7#g7 of section #bbc7;b7 is amended by adding at the end the following3 ,this paragraph shall not apply to any individual during any period for which the individual's only entitlement to such benefits is an entitlement to hospital insurance benefits under part ,a of title ,,xviii of such ,act pursuant to an enrollment for such hospital insurance benefits under section #bbf7;a77#a7 of such ,act44 7b7 ,medicare beneficiaries participating in ,medicare advantage ,,msa may contribute their own money to their ,,msa 7#a7 ,in general ,subsection 7b7 of section #ach is amended by striking paragraph 7#b7 and by redesignating paragraphs 7#c7 and 7#d7 as paragraphs 7#b7 and 7#c71 respectively4 7#b7 ,conforming amendment ,paragraph 7#d7 of section #ach7;c7 is amended by striking and paragraph 7#b74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ajc4 ,individuals eligible for veterans benefits for a service-connected disability 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c7 is amended by adding at the end the following new subparagraph3 7,c7 ,special rule for individuals eligible for certain veterans benefits ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual receives periodic hospital care or medical services for a service-connected disability under any law administered by the ,secretary of ,veterans ,affairs but only if the individual is not eligible to receive such care or services for any condition other than a service-connected disability4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ajd4 ,individuals eligible for ,indian ,health ,service assistance 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c71 as amended by section #ajc1 is amended by adding at the end the following new subparagraph3 7,d7 ,special rule for individuals eligible for assistance under ,indian ,health ,service programs ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual receives hospital care or medical services under a medical care program of the ,indian ,health ,service or of a tribal organization4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #aje4 ,individuals eligible for ,,tricare coverage 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c71 as amended by sections #ajc and #ajd1 is amended by adding at the end the following new subparagraph3 7,e7 ,special rule for individuals eligible for assistance under tricare ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual is eligible to receive hospital care1 medical services1 or prescription drugs under ,,tricare ,extra or ,,tricare ,standard and such individual is not enrolled in ,,tricare ,prime4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ajf4 ,,fsa and ,,hra interaction with ,h,s,as 7a7 ,eligible individuals include ,,fsa and ,,hra participants ,subparagraph 7,b7 of section #bbc7;c77#a7 is amended-- 7#a7 by striking and at the end of clause 7ii71 7#b7 by striking the period at the end of clause 7iii7 and inserting 1 and1 and 7#c7 by inserting after clause 7iii7 the following new clause3 7iv7 coverage under a health flexible spending arrangement or a health reimbursement arrangement in the plan year a qualified ,,hsa distribution as described in section #ajf7;e7 is made on behalf of the individual if after the qualified ,,hsa distribution is made and for the remaining duration of the plan year1 the coverage provided under the health flexible spending arrangement or health reimbursement arrangement is converted to-- 7,i7 coverage that does not pay or reimburse any medical expense incurred before the minimum annual deductible under paragraph 7#b77;,a77i7 7prorated for the period occurring after the qualified ,,hsa distribution is made7 is satisfied1 7,,ii7 coverage that1 after the qualified ,,hsa distribution is made1 does not pay or reimburse any medical expense incurred after the qualified ,,hsa distribution is made other than preventive care as defined in paragraph 7#b77;,c71 7,,iii7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses benefits for coverage described in clause 7ii7 7but not through insurance or for long-term care services71 7,,iv7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses benefits for permitted insurance or coverage described in clause 7ii7 7but not for long-term care services71 7,v7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses only those medical expenses incurred after an individual's retirement 7and no expenses incurred before retirement71 or 7,,vi7 coverage that1 after the qualified ,,hsa distribution is made1 is suspended1 pursuant to an election made on or before the date the individual elects a qualified ,,hsa distribution or1 if later1 on the date of the individual enrolls in a high deductible health plan1 that does not pay or reimburse1 at any time1 any medical expense incurred during the suspension period except as defined in the preceding subclauses of this clause4 4 7b7 ,qualified ,,hsa distribution shall not affect flexible spending arrangement ,paragraph 7#a7 of section #ajf7;e7 is amended to read as follows3 7#a7 ,in general ,a plan shall not fail to be treated as a health flexible spending arrangement under this section1 section #aje1 or section #abe1 or as a health reimbursement arrangement under this section or section #aje1 merely because such plan provides for a qualified ,,hsa distribution4 4 7c7 ,,fsa balances at year end shall not forfeit ,paragraph 7#b7 of section #abe7;d7 is amended by adding at the end the following new subparagraph3 7,e7 ,exception for qualified ,,hsa distributions ,subparagraph 7,a7 shall not apply to the extent that there is an amount remaining in a health flexible spending account at the end of a plan year that an individual elects to contribute to a health savings account pursuant to a qualified ,,hsa distribution 7as defined in section #ajf7;e77#b774 4 7d7 ,simplification of limitations on ,,fsa and ,,hra rollovers ,paragraph 7#b7 of section #ajf7;e7 is amended to read as follows3 7#b7 ,qualified ,,hsa distribution 7,a7 ,in general ,the term qualified ,,hsa distribution means a distribution from a health flexible spending arrangement or health reimbursement arrangement to the extent that such distribution does not exceed the lesser of-- 7i7 the balance in such arrangement as of the date of such distribution1 or 7ii7 the amount determined under subparagraph 7,b74 ,such term shall not include more than #a distribution with respect to any arrangement4 7,b7 ,dollar limitations 7i7 ,distributions from a health flexible spending arrangement ,a qualified ,,hsa distribution from a health flexible spending arrangement shall not exceed the applicable amount4 7ii7 ,distributions from a health reimbursement arrangement ,a qualified ,,hsa distribution from a health reimbursement arrangement shall not exceed-- 7,i7 the applicable amount divided by #ab1 multiplied by 7,,ii7 the number of months during which the individual is a participant in the health reimbursement arrangement4 7iii7 ,applicable amount ,for purposes of this subparagraph1 the applicable amount is-- 7,i7 #b1bej in the case of an eligible individual who has self-only coverage under a high deductible health plan at the time of such distribution1 and 7,,ii7 #d1ejj in the case of an eligible individual who has family coverage under a high deductible health plan at the time of such distribution4 4 7e7 ,elimination of additional tax for failure ,to maintain high deductible health plan coverage ,subsection 7e7 of section #ajf is amended-- 7#a7 by striking paragraph 7#c7 and redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#c7 and 7#d71 respectively1 and 7#b7 by striking subparagraph 7,a7 of paragraph 7#c71 as so redesignated1 and redesignating subparagraphs 7,b7 and 7,c7 of such paragraph as subparagraphs 7,a7 and 7,b7 thereof1 respectively4 7f7 ,limited purpose ,f,s,as and ,h,r,as ,subsection 7e7 of section #ajf1 as amended by this section1 is amended by adding at the end the following new paragraph3 7#e7 ,limited purpose ,f,s,as and ,h,r,as ,a plan shall not fail to be a health flexible spending arrangement or health reimbursement arrangement under this section or section #aje merely because the plan converts coverage for individuals who enroll in a high deductible health plan described in section #bbc7;c77#b7 to coverage described in section #bbc7;c77#a77;,b77iv74 ,coverage for such individuals may be converted as of the date of enrollment in the high deductible health plan1 without regard to the period of coverage under the health flexible spending arrangement or health reimbursement arrangement1 and without requiring any change in coverage to individuals who do not enroll in a high deductible health plan4 4 7g7 ,distribution amounts adjusted for cost-of-,living ,subsection 7e7 of section #ajf1 as amended by this section1 is amended by adding at the end the following new paragraph3 7#f7 ,cost-of-living adjustment 7,a7 ,in general ,in the case of any taxable year beginning in a calendar year after #bjac1 each of the dollar amounts in paragraph 7#b77;,b77iii7 shall be increased by an amount equal to such dollar amount1 multiplied by the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year in which such taxable year begins by substituting calendar year #bjab for calendar year #aiib in subparagraph 7,b7 thereof4 7,b7 ,rounding ,if any increase under paragraph 7#a7 is not a multiple of #ej1 such increase shall be rounded to the nearest multiple of #ej4 4 7h7 ,disclaimer of disqualifying coverage ,subparagraph 7,b7 of section #bbc7;c77#a71 as amended by this section1 is amended-- 7#a7 by striking and at the end of clause 7iii71 7#b7 by striking the period at the end of clause 7iv7 and inserting 1 and1 and 7#c7 by inserting after clause 7iv7 the following new clause3 7v7 any coverage 7including prospective coverage7 under a health plan that is not a high deductible health plan which is disclaimed in writing1 at the time of the creation or organization of the health savings account1 including by execution of a trust described in subsection 7d77#a7 through a governing instrument that includes such a disclaimer1 or by acceptance of an amendment to such a trust that includes such a disclaimer4 4 7i7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ajg4 ,allowance of distributions for prescription and over-the-counter medicines and drugs 7a7 ,h,s,as ,section #bbc7;d77#b77;,a7 is amended by striking the last sentence thereof and inserting the following3 ,such term shall include an amount paid for any prescription or over-the-counter medicine or drug44 7b7 ,archer ,m,s,as ,section #bbj7;d77#b77;,a7 is amended by striking the last sentence thereof and inserting the following3 ,such term shall include an amount paid for any prescription or over-the-counter medicine or drug44 7c7 ,health flexible spending arrangements and health reimbursement arrangements ,subsection 7f7 of section #ajf is amended to read as follows3 7f7 ,reimbursements for all medicines and drugs ,for purposes of this section and section #aje1 reimbursement for expenses incurred for any prescription or over-the-counter medicine or drug shall be treated as a reimbursement for medical expenses4 4 7d7 ,effective date 7#a7 ,distributions from savings accounts ,the amendments made by subsections 7a7 and 7b7 shall apply to amounts paid with respect to taxable years beginning after ,december #ca1 #bjab4 7#b7 ,reimbursements ,the amendment made by subsection 7c7 shall apply to expenses incurred with respect to taxable years beginning after ,december #ca1 #bjab4 #ajh4 ,purchase of health insurance from ,,hsa account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d7 is amended to read as follows3 7#b7 ,qualified medical expenses 7,a7 ,in general ,the term qualified medical expenses means1 with respect to an account beneficiary1 amounts paid by such beneficiary for medical care 7as defined in section #bac7;d77 for any individual covered by a high deductible health plan of the account beneficiary1 but only to the extent such amounts are not compensated for by insurance or otherwise4 7,b7 ,health insurance may not be purchased from account ,except as provided in subparagraph 7,c71 subparagraph 7,a7 shall not apply to any payment for insurance4 7,c7 ,exceptions ,subparagraph 7,b7 shall not apply to any expense for coverage under-- 7i7 a health plan during any period of continuation coverage required under any ,federal law1 7ii7 a qualified long-term care insurance contract 7as defined in section #ggjb;,b7b771 7iii7 a health plan during any period in which the individual is receiving unemployment compensation under any ,federal or ,state law1 7iv7 a high deductible health plan1 or 7v7 any health insurance under title ,,xviii of the ,social ,security ,act1 other than a ,medicare supplemental policy 7as defined in section #ahhb of such ,act74 4 7b7 ,effective date ,the amendment made by this section shall apply with respect to insurance purchased after the date of the enactment of this ,act in taxable years beginning after such date4 #aji4 ,special rule for certain medical expenses incurred before establishment of account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d71 as amended by section #ajh1 is amended by adding at the end the following new subparagraph3 7,d7 ,certain medical expenses incurred before establishment of account treated as qualified ,an expense shall not fail to be treated as a qualified medical expense solely because such expense was incurred before the establishment of the health savings account if such expense was incurred-- 7i7 during either-- 7,i7 the taxable year in which the health savings account was established1 or 7,,ii7 the preceding taxable year in the case of a health savings account established after the taxable year in which such expense was incurred but before the time prescribed by law for filing the return for such taxable year 7not including extensions thereof71 and 7ii7 for medical care of an individual during a period that such individual was covered by a high deductible health plan and met the requirements of subsection 7c77#a77;,a77ii7 7after application of subsection 7c77#a77;,b774 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #aaj4 ,preventive care prescription drug clarification 7a7 ,clarify use of drugs in preventive care ,subparagraph 7,c7 of section #bbc7;c77#b7 is amended by adding at the end the following3 ,preventive care shall include prescription and over-the-counter drugs and medicines which have the primary purpose of preventing the onset of1 further deterioration from1 or complications associated with chronic conditions1 illnesses1 or diseases44 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjjc4 #aaa4 ,equivalent bankruptcy protections for health savings accounts as retirement funds 7a7 ,in general ,section #ebb of title #aa1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7r7 ,treatment of health savings accounts ,for purposes of this section1 any health savings account 7as described in section #bbc of the ,internal ,revenue ,code of #aihf7 shall be treated in the same manner as an individual retirement account described in section #djh of such ,code4 4 7b7 ,effective date ,the amendment made by this section shall apply to cases commencing under title #aa1 ,united ,states ,code1 after the date of the enactment of this ,act4 #aab4 ,administrative error correction before due date of return 7a7 ,in general ,paragraph 7#d7 of section #bbc7;f7 is amended by adding at the end the following new subparagraph3 7,d7 ,exception for administrative errors corrected before due date of return ,subparagraph 7,a7 shall not apply if any payment or distribution is made to correct an administrative1 clerical or payroll contribution error and if-- 7i7 such distribution is received by the individual on or before the last day prescribed by law 7including extensions of time7 for filing such individual's return for such taxable year1 and 7ii7 such distribution is accompanied by the amount of net income attributable to such contribution4 ,any net income described in clause 7ii7 shall be included in the gross income of the individual for the taxable year in which it is received4 4 7b7 ,effective date ,the amendment made by this section shall take effect on the date of the enactment of this ,act4 #aac4 ,reauthorization of medicaid health opportunity accounts 7a7 ,in general ,section #aich of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#h7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,initial demonstration ,the demonstration program under this section shall begin on ,january #a1 #bjjg4 ,the ,secretary shall approve ,states to conduct demonstration programs under this section for a #e-year period1 with each ,state demonstration program covering one or more geographic areas specified by the ,state4 ,with respect to a ,state1 after the initial #e-year period of any demonstration program conducted under this section by the ,state1 unless the ,secretary finds1 taking into account cost-effectiveness and quality of care1 that the ,state demonstration program has been unsuccessful1 the demonstration program may be extended or made permanent in the ,state4 2 and 7,b7 in paragraph 7#c71 in the matter preceding subparagraph 7,a7-- 7i7 by striking not2 and 7ii7 by striking unless and inserting if 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#c71 by inserting clause 7i7 through 7vii71 7viii7 7without regard to the amendment made by section #bjjd7;c77#b7 of ,public ,law #aaa-adh71 7x71 or 7xi7 of after described in 2 and 7,b7 by striking paragraphs 7#d71 7#e71 and 7#f72 7#c7 in subsection 7c7-- 7,a7 by striking paragraphs 7#c7 and 7#d72 7,b7 by redesignating paragraphs 7#e7 through 7#h7 as paragraphs 7#c7 through 7#f71 respectively2 and 7,c7 in paragraph 7#d7 7as redesignated by subparagraph 7,b771 by striking ,subject to subparagraphs 7,d7 and 7,e7 and inserting ,subject to subparagraph 7,d72 and 7#d7 in subsection 7d7-- 7,a7 in paragraph 7#b71 by striking subparagraph 7,e72 and 7,b7 in paragraph 7#c7-- 7i7 in subparagraph 7,a77ii71 by striking ,subject to subparagraph 7,b77ii71 in and inserting ,in2 and 7ii7 by striking subparagraph 7,b7 and inserting the following3 7,b7 ,maintenance of health opportunity account after becoming ineligible for public benefit ,notwithstanding any other provision of law1 if an account holder of a health opportunity account becomes ineligible for benefits under this title because of an increase in income or assets-- 7i7 no additional contribution shall be made into the account under paragraph 7#b77;,a77i72 and 7ii7 the account shall remain available to the account holder for #c years after the date on which the individual becomes ineligible for such benefits for withdrawals under the same terms and conditions as if the account holder remained eligible for such benefits1 and such withdrawals shall be treated as medical assistance in accordance with subsection 7c77#d74 4 7b7 ,conforming amendment ,section #fac of ,public ,law #aaa-c is repealed4 #aad4 ,members of health care sharing ministries eligible to establish health savings accounts 7a7 ,in general ,section #bbc is amended by adding at the end the following new subsection3 7i7 ,application to health care sharing ministries ,for purposes of this section1 membership in a health care sharing ministry 7as defined in section #ejjj;,a7d77#b77;,b77ii77 shall be treated as coverage under a high deductible health plan4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #aae4 ,high deductible health plans renamed ,,hsa qualified plans 7a7 ,in general ,section #bbc1 as amended by this ,act1 is amended by striking high deductible health plan each place it appears and inserting ,,hsa qualified health plan4 7b7 ,conforming amendments 7#a7 ,section #ajf7;e71 as amended by this ,act1 is amended by striking high deductible health plan each place it appears and inserting ,,hsa qualified health plan4 7#b7 ,the heading for paragraph 7#b7 of section #bbc7;c7 is amended by striking ,high deductible health plan and inserting ,,hsa qualified health plan4 7#c7 ,section #djh7;d77#i7 is amended-- 7,a7 by striking high deductible health plan each place it appears in subparagraph 7,c7 and inserting ,,hsa qualified health plan1 and 7,b7 by striking ,high deductible health plan in the heading of subparagraph 7,d7 and inserting ,,hsa qualified health plan4 #aaf4 ,treatment of direct primary care service arrangements 7a7 ,in general ,section #bbc7;c7 is amended by adding at the end the following new paragraph3 7#f7 ,treatment of direct primary care service arrangements ,an arrangement under which an individual is provided coverage restricted to primary care services in exchange for a fixed periodic fee-- 7,a7 shall not be treated as a health plan for purposes of paragraph 7#a77;,a77ii71 and 7,b7 shall not be treated as insurance for purposes of subsection 7d77#b77;,b74 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #aag4 ,high deductible health plans with ,h,s,as treated as qualified health plans ,section #acja of the ,patient ,protection and ,affordable ,care ,act is amended by adding at the end the following new subsection3 7e7 ,high deductible health plan with health savings account ,a health plan not providing a bronze1 silver1 gold1 or platinum level of coverage shall be treated as meeting the requirements of subsection 7d7 with respect to any plan year for any enrollee if the plan meets the requirements for a high deductible health plan under section #bbc7;c77#b7 of the ,internal ,revenue ,code of #aihf and such enrollee has established a health savings account 7as defined in section #bbc7;d77#a7 of such ,code7 in relation to such plan4 4 #aah4 ,certain stand-alone ,h,r,as not subject to prohibition on annual limits ,section #bgaa7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa7;a77 is amended by adding at the end the following new paragraph3 7#c7 ,exception for health reimbursement arrangements ,paragraph 7#a77;,a7 shall not apply to any health reimbursement arrangement which permits the purchase of a qualified health plan through an ,exchange established under section #acaa of the ,patient ,protection and ,affordable ,care ,act4 4 ,,ii ,other provisions #bja4 ,certain exercise equipment and physical fitness programs treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac is amended by adding at the end the following new paragraph3 7#ab7 ,exercise equipment and physical fitness programs 7,a7 ,in general ,the term medical care shall include amounts paid-- 7i7 to purchase or use equipment used in a program 7including a self-directed program7 of physical exercise1 7ii7 to participate1 or receive instruction1 in a program of physical exercise1 and 7iii7 for membership dues in a fitness club the primary purpose of which is to provide access to equipment and facilities for physical exercise4 7,b7 ,limitation ,amounts treated as medical care under subparagraph 7,a7 shall not exceed #a1jjj with respect to any individual for any taxable year4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bjb4 ,certain nutritional and dietary supplements to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by section #bja1 is amended by adding at the end the following new paragraph3 7#ac7 ,nutritional and dietary supplements 7,a7 ,in general ,the term medical care shall include amounts paid to purchase herbs1 vitamins1 minerals1 homeopathic remedies1 meal replacement products1 and other dietary and nutritional supplements4 7,b7 ,limitation ,amounts treated as medical care under subparagraph 7,a7 shall not exceed #a1jjj with respect to any individual for any taxable year4 7,c7 ,meal replacement product ,for purposes of this paragraph1 the term meal replacement product means any product that-- 7i7 is permitted to bear labeling making a claim described in section #djc7r77#c7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and 7ii7 is permitted to claim under such section that such product is low in fat and is a good source of protein1 fiber1 and multiple essential vitamins and minerals4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bjc4 ,certain provider fees to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by sections #bja and #bjb1 is amended by adding at the end the following new paragraph3 7#ad7 ,periodic provider fees ,the term medical care shall include periodic fees paid to a primary care physician for the right to receive medical services on an as-needed basis4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bjd4 ,repeal of annual limitations on deductibles for employer-sponsored plans offered in small group market ,section #acjb7;c77#b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 is repealed4