,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #baid  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #bc1 #bjac ,mr4  
,pauls5 introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committees on
 ! ,judici>y & ,en]gy & ,comm]ce1 = a   
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to am5d 
! ,int]nal ,rev5ue ,code ( #aihf to     
improve access to heal? c>e ?r\gh exp&$ 
heal? sav+s acc\nts1 & = o!r purposes4  
#a4 ,%ort title1 etc  7a7 ,%ort title   
,?is ,act may be cit$ z ! ,family &     
,retirem5t ,heal? ,inve/m5t ,act (      
#bjac4  7b7 ,am5dm5t ( #aihf ,code      
,except z o!rwise expressly provid$1    
:5ev] 9 ?is ,act an am5dm5t or repeal is
 express$ 9 t]ms ( an am5dm5t to1 or    
repeal (1 a section or o!r provision1 ! 
ref]5ce %all be consid]$ to be made to a
 section or o!r provision ( ! ,int]nal  
,rev5ue ,code ( #aihf4  7c7 ,table (    

cont5ts ,! table ( cont5ts is z foll[s3 
,sec4 #a4 ,%ort title1 etc4 ,title      
,i--,provisions relat+ to tax-pref]r$   
heal? acc\nts ,sec4 #aja4 ,all[ bo?     
sp\ses to make cat*-up contributions to 
! same ,,hsa acc\nt4 ,sec4 #ajb4        
,provisions relat+ to ,m$ic>e4 ,sec4    
#ajc4 ,individuals eligible = vet]ans   
b5efits = a s]vice-connect$ disability4 
,sec4 #ajd4 ,individuals eligible =     
,indian ,heal? ,s]vice assi/ance4 ,sec4 
#aje4 ,individuals eligible = ,,tric>e  
cov]age4 ,sec4 #ajf4 ,,fsa & ,,hra      
int]action ) ,h,s,as4 ,sec4 #ajg4       
,all[ance ( di/ributions = prescription 
& ov]-!-c\nt] m$ic9es & drugs4 ,sec4    
#ajh4 ,pur*ase ( heal? insurance f ,,hsa
 acc\nt4 ,sec4 #aji4 ,special rule =    
c]ta9 m$ical exp5ses incurr$ be=e       
e/abli%m5t ( acc\nt4 ,sec4 #aaj4        
,prev5tive c>e prescription drug        
cl>ification4 ,sec4 #aaa4 ,equival5t    
bankruptcy protections = heal? sav+s    
acc\nts z retirem5t funds4 ,sec4 #aab4  
,adm9i/rative error correction be=e due 

date ( return4 ,sec4 #aac4              
,reau?orization ( m$icaid heal?         
opportunity acc\nts4 ,sec4 #aad4 ,memb]s
 ( heal? c>e %>+ m9i/ries eligible to   
e/abli% heal? sav+s acc\nts4 ,sec4 #aae4
 ,high d$uctible heal? plans r5am$ ,,hsa
 qualifi$ plans4 ,sec4 #aaf4 ,treatm5t (
 direct prim>y c>e s]vice arrangem5ts4  
,sec4 #aag4 ,high d$uctible heal? plans 
) ,h,s,as treat$ z qualifi$ heal? plans4
 ,sec4 #aah4 ,c]ta9 /&-alone ,h,r,as n  
subject to prohibition on annual limits4
 ,title ,,ii--,o!r provisions ,sec4     
#bja4 ,c]ta9 ex]cise equipm5t & physical
 fitness programs treat$ z m$ical c>e4  
,sec4 #bjb4 ,c]ta9 nutritional & diet>y 
supplem5ts to be treat$ z m$ical c>e4   
,sec4 #bjc4 ,c]ta9 provid] fees to be   
treat$ z m$ical c>e4 ,sec4 #bjd4 ,repeal
 ( annual limitations on d$uctibles =   
employ]-sponsor$ plans (f]$ 9 small gr\p
 m>ket4  ,i ,provisions relat+ to       
tax-pref]r$ heal? acc\nts  #aja4 ,all[  
bo? sp\ses to make cat*-up contributions
 to ! same ,,hsa acc\nt  7a7 ,9 g5]al   

,p>agraph 7#c7 ( section #bbc7;b7 is    
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 ,special rule :]e bo?
 sp\ses are eligible individuals ) #a   
acc\nt ,if--  7i7 an individual & !     
individual's sp\se h bo? atta9$ age #ee 
be=e ! close ( ! taxable ye>1 &  7ii7 ! 
sp\se is n an acc\nt b5efici>y ( a heal?
 sav+s acc\nt z ( ! close ( su* ye>1  ! 
additional contribution am\nt %all be   
#bjj p]c5t ( ! am\nt o!rwise det]m9$ "u 
subp>agraph 7,b74  4  7b7 ,effective    
date ,! am5dm5t made by ?is section %all
 apply to taxable ye>s beg9n+ aft] !    
date ( ! enactm5t ( ?is ,act4  #ajb4    
,provisions relat+ to ,m$ic>e  7a7      
,individuals ov] age #fe only enroll$ 9 
,m$ic>e ,"p ,a ,p>agraph 7#g7 ( section 
#bbc7;b7 is am5d$ by add+ at ! end !    
foll[+3 ,?is p>agraph %all n apply to   
any individual dur+ any p]iod = :i* !   
individual's only entitlem5t to su*     
b5efits is an entitlem5t to hospital    
insurance b5efits "u "p ,a ( title      
,,xviii ( su* ,act pursuant to an       

enrollm5t = su* hospital insurance      
b5efits "u section #bbf7;a77#a7 ( su*   
,act44  7b7 ,m$ic>e b5efici>ies         
p>ticipat+ 9 ,m$ic>e advantage ,,msa may
 contribute _! own money to _! ,,msa    
7#a7 ,9 g5]al ,subsection 7b7 ( section 
#ach is am5d$ by /rik+ p>agraph 7#b7 &  
by r$esignat+ p>agraphs 7#c7 & 7#d7 z   
p>agraphs 7#b7 & 7#c71 respectively4    
7#b7 ,con=m+ am5dm5t ,p>agraph 7#d7 (   
section #ach7;c7 is am5d$ by /rik+ &    
p>agraph 7#b74  7c7 ,effective date ,!  
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ! date ( !  
enactm5t ( ?is ,act4  #ajc4 ,individuals
 eligible = vet]ans b5efits = a         
s]vice-connect$ disability  7a7 ,9 g5]al
 ,p>agraph 7#a7 ( section #bbc7;c7 is   
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 ,special rule =      
individuals eligible = c]ta9 vet]ans    
b5efits ,= purposes ( subp>agraph       
7,a77ii71 an individual %all n be treat$
 z cov]$ "u a heal? plan describ$ 9 su* 
subp>agraph m]ely because ! individual  

receives p]iodic hospital c>e or m$ical 
s]vices = a s]vice-connect$ disability  
"u any law adm9i/]$ by ! ,secret>y (    
,vet]ans ,affairs b only if ! individual
 is n eligible to receive su* c>e or    
s]vices = any condition o!r ?an a       
s]vice-connect$ disability4  4  7b7     
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #ajd4 ,individuals eligible =    
,indian ,heal? ,s]vice assi/ance  7a7 ,9
 g5]al ,p>agraph 7#a7 ( section         
#bbc7;c71 z am5d$ by section #ajc1 is   
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,d7 ,special rule =      
individuals eligible = assi/ance "u     
,indian ,heal? ,s]vice programs ,=      
purposes ( subp>agraph 7,a77ii71 an     
individual %all n be treat$ z cov]$ "u a
 heal? plan describ$ 9 su* subp>agraph  
m]ely because ! individual receives     
hospital c>e or m$ical s]vices "u a     
m$ical c>e program ( ! ,indian ,heal?   
,s]vice or ( a tribal organization4  4  

7b7 ,effective date ,! am5dm5t made by  
?is section %all apply to taxable ye>s  
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #aje4 ,individuals eligible =    
,,tric>e cov]age  7a7 ,9 g5]al ,p>agraph
 7#a7 ( section #bbc7;c71 z am5d$ by    
sections #ajc & #ajd1 is am5d$ by add+  
at ! end ! foll[+ new subp>agraph3  7,e7
 ,special rule = individuals eligible = 
assi/ance "u tric>e ,= purposes (       
subp>agraph 7,a77ii71 an individual %all
 n be treat$ z cov]$ "u a heal? plan    
describ$ 9 su* subp>agraph m]ely because
 ! individual is eligible to receive    
hospital c>e1 m$ical s]vices1 or        
prescription drugs "u ,,tric>e ,extra or
 ,,tric>e ,/&>d & su* individual is n   
enroll$ 9 ,,tric>e ,prime4  4  7b7      
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #ajf4 ,,fsa & ,,hra int]action ) 
,h,s,as  7a7 ,eligible individuals      
include ,,fsa & ,,hra p>ticipants       
,subp>agraph 7,b7 ( section #bbc7;c77#a7

 is am5d$--  7#a7 by /rik+ & at ! end ( 
clause 7ii71  7#b7 by /rik+ ! p]iod at !
 end ( clause 7iii7 & ins]t+ 1 &1 &     
7#c7 by ins]t+ aft] clause 7iii7 !      
foll[+ new clause3  7iv7 cov]age "u a   
heal? flexible sp5d+ arrangem5t or a    
heal? reimbursem5t arrangem5t 9 ! plan  
ye> a qualifi$ ,,hsa di/ribution z      
describ$ 9 section #ajf7;e7 is made on  
behalf ( ! individual if aft] ! qualifi$
 ,,hsa di/ribution is made & = ! rema9+ 
duration ( ! plan ye>1 ! cov]age provid$
 "u ! heal? flexible sp5d+ arrangem5t or
 heal? reimbursem5t arrangem5t is       
conv]t$ to--  7,i7 cov]age t does n pay 
or reimburse any m$ical exp5se incurr$  
be=e ! m9imum annual d$uctible "u       
p>agraph 7#b77;,a77i7 7prorat$ = ! p]iod
 occurr+ aft] ! qualifi$ ,,hsa          
di/ribution is made7 is satisfi$1       
7,,ii7 cov]age t1 aft] ! qualifi$ ,,hsa 
di/ribution is made1 does n pay or      
reimburse any m$ical exp5se incurr$ aft]
 ! qualifi$ ,,hsa di/ribution is made   
o!r ?an prev5tive c>e z def9$ 9 p>agraph

 7#b77;,c71  7,,iii7 cov]age t1 aft] !  
qualifi$ ,,hsa di/ribution is made1 pays
 or reimburses b5efits = cov]age        
describ$ 9 clause 7ii7 7b n ?r\gh       
insurance or = long-t]m c>e s]vices71   
7,,iv7 cov]age t1 aft] ! qualifi$ ,,hsa 
di/ribution is made1 pays or reimburses 
b5efits = p]mitt$ insurance or cov]age  
describ$ 9 clause 7ii7 7b n = long-t]m  
c>e s]vices71  7,v7 cov]age t1 aft] !   
qualifi$ ,,hsa di/ribution is made1 pays
 or reimburses only ^? m$ical exp5ses   
incurr$ aft] an individual's retirem5t  
7& no exp5ses incurr$ be=e retirem5t71  
or  7,,vi7 cov]age t1 aft] ! qualifi$   
,,hsa di/ribution is made1 is susp5d$1  
pursuant to an election made on or be=e 
! date ! individual elects a qualifi$   
,,hsa di/ribution or1 if lat]1 on ! date
 ( ! individual enrolls 9 a high        
d$uctible heal? plan1 t does n pay or   
reimburse1 at any "t1 any m$ical exp5se 
incurr$ dur+ ! susp5sion p]iod except z 
def9$ 9 ! prec$+ subclauses ( ?is       
clause4  4  7b7 ,qualifi$ ,,hsa         

di/ribution %all n affect flexible sp5d+
 arrangem5t ,p>agraph 7#a7 ( section    
#ajf7;e7 is am5d$ to read z foll[s3     
7#a7 ,9 g5]al ,a plan %all n fail to be 
treat$ z a heal? flexible sp5d+         
arrangem5t "u ?is section1 section #aje1
 or section #abe1 or z a heal?          
reimbursem5t arrangem5t "u ?is section  
or section #aje1 m]ely because su* plan 
provides = a qualifi$ ,,hsa di/ribution4
  4  7c7 ,,fsa balances at ye> end %all 
n =feit ,p>agraph 7#b7 ( section        
#abe7;d7 is am5d$ by add+ at ! end !    
foll[+ new subp>agraph3  7,e7 ,exception
 = qualifi$ ,,hsa di/ributions          
,subp>agraph 7,a7 %all n apply to !     
ext5t t !re is an am\nt rema9+ 9 a heal?
 flexible sp5d+ acc\nt at ! end ( a plan
 ye> t an individual elects to          
contribute to a heal? sav+s acc\nt      
pursuant to a qualifi$ ,,hsa di/ribution
 7z def9$ 9 section #ajf7;e77#b774  4   
7d7 ,simplification ( limitations on    
,,fsa & ,,hra rollov]s ,p>agraph 7#b7 ( 
section #ajf7;e7 is am5d$ to read z     

foll[s3  7#b7 ,qualifi$ ,,hsa           
di/ribution  7,a7 ,9 g5]al ,! t]m       
qualifi$ ,,hsa di/ribution means a      
di/ribution f a heal? flexible sp5d+    
arrangem5t or heal? reimbursem5t        
arrangem5t to ! ext5t t su* di/ribution 
does n exce$ ! less] (--  7i7 ! balance 
9 su* arrangem5t z ( ! date ( su*       
di/ribution1 or  7ii7 ! am\nt det]m9$ "u
 subp>agraph 7,b74  ,su* t]m %all n     
include m ?an #a di/ribution ) respect  
to any arrangem5t4  7,b7 ,doll>         
limitations  7i7 ,di/ributions f a heal?
 flexible sp5d+ arrangem5t ,a qualifi$  
,,hsa di/ribution f a heal? flexible    
sp5d+ arrangem5t %all n exce$ !         
applicable am\nt4  7ii7 ,di/ributions f 
a heal? reimbursem5t arrangem5t ,a      
qualifi$ ,,hsa di/ribution f a heal?    
reimbursem5t arrangem5t %all n exce$--  
7,i7 ! applicable am\nt divid$ by #ab1  
multipli$ by  7,,ii7 ! numb] ( mon?s    
dur+ :i* ! individual is a p>ticipant 9 
! heal? reimbursem5t arrangem5t4  7iii7 
,applicable am\nt ,= purposes ( ?is     

subp>agraph1 ! applicable am\nt is--    
7,i7 #b1bej 9 ! case ( an eligible      
individual :o has self-only cov]age "u a
 high d$uctible heal? plan at ! "t ( su*
 di/ribution1 &  7,,ii7 #d1ejj 9 ! case 
( an eligible individual :o has family  
cov]age "u a high d$uctible heal? plan  
at ! "t ( su* di/ribution4  4  7e7      
,elim9ation ( additional tax = failure  
,to ma9ta9 high d$uctible heal? plan    
cov]age ,subsection 7e7 ( section #ajf  
is am5d$--  7#a7 by /rik+ p>agraph 7#c7 
& r$esignat+ p>agraphs 7#d7 & 7#e7 z    
p>agraphs 7#c7 & 7#d71 respectively1 &  
7#b7 by /rik+ subp>agraph 7,a7 (        
p>agraph 7#c71 z s r$esignat$1 &        
r$esignat+ subp>agraphs 7,b7 & 7,c7 (   
su* p>agraph z subp>agraphs 7,a7 & 7,b7 
!re(1 respectively4  7f7 ,limit$ purpose
 ,f,s,as & ,h,r,as ,subsection 7e7 (    
section #ajf1 z am5d$ by ?is section1 is
 am5d$ by add+ at ! end ! foll[+ new    
p>agraph3  7#e7 ,limit$ purpose ,f,s,as 
& ,h,r,as ,a plan %all n fail to be a   
heal? flexible sp5d+ arrangem5t or heal?

 reimbursem5t arrangem5t "u ?is section 
or section #aje m]ely because ! plan    
conv]ts cov]age = individuals :o enroll 
9 a high d$uctible heal? plan describ$ 9
 section #bbc7;c77#b7 to cov]age        
describ$ 9 section                      
#bbc7;c77#a77;,b77iv74 ,cov]age = su*   
individuals may be conv]t$ z ( ! date ( 
enrollm5t 9 ! high d$uctible heal? plan1
 )\t reg>d to ! p]iod ( cov]age "u !    
heal? flexible sp5d+ arrangem5t or heal?
 reimbursem5t arrangem5t1 & )\t requir+ 
any *ange 9 cov]age to individuals :o d 
n enroll 9 a high d$uctible heal? plan4 
4  7g7 ,di/ribution am\nts adju/$ =     
co/-(-,liv+ ,subsection 7e7 ( section   
#ajf1 z am5d$ by ?is section1 is am5d$  
by add+ at ! end ! foll[+ new p>agraph3 
7#f7 ,co/-(-liv+ adju/m5t  7,a7 ,9 g5]al
 ,9 ! case ( any taxable ye> beg9n+ 9 a 
cal5d> ye> aft] #bjac1 ea* ( ! doll>    
am\nts 9 p>agraph 7#b77;,b77iii7 %all be
 increas$ by an am\nt equal to su* doll>
 am\nt1 multipli$ by ! co/-(-liv+       
adju/m5t det]m9$ "u section #a7;f77#c7 =

 ! cal5d> ye> 9 :i* su* taxable ye>     
beg9s by sub/itut+ cal5d> ye> #bjab =   
cal5d> ye> #aiib 9 subp>agraph 7,b7     
!re(4  7,b7 ,r\nd+ ,if any increase "u  
p>agraph 7#a7 is n a multiple ( #ej1 su*
 increase %all be r\nd$ to ! ne>e/      
multiple ( #ej4  4  7h7 ,disclaim] (    
disqualify+ cov]age ,subp>agraph 7,b7 ( 
section #bbc7;c77#a71 z am5d$ by ?is    
section1 is am5d$--  7#a7 by /rik+ & at 
! end ( clause 7iii71  7#b7 by /rik+ !  
p]iod at ! end ( clause 7iv7 & ins]t+ 1 
&1 &  7#c7 by ins]t+ aft] clause 7iv7 ! 
foll[+ new clause3  7v7 any cov]age     
7includ+ prospective cov]age7 "u a heal?
 plan t is n a high d$uctible heal? plan
 :i* is disclaim$ 9 writ+1 at ! "t ( !  
creation or organization ( ! heal? sav+s
 acc\nt1 includ+ by execution ( a tru/  
describ$ 9 subsection 7d77#a7 ?r\gh a   
gov]n+ in/rum5t t includes su* a        
disclaim]1 or by acceptance ( an am5dm5t
 to su* a tru/ t includes su* a         
disclaim]4  4  7i7 ,effective date ,!   
am5dm5ts made by ?is section %all apply 

to taxable ye>s beg9n+ aft] ! date ( !  
enactm5t ( ?is ,act4  #ajg4 ,all[ance ( 
di/ributions = prescription &           
ov]-!-c\nt] m$ic9es & drugs  7a7 ,h,s,as
 ,section #bbc7;d77#b77;,a7 is am5d$ by 
/rik+ ! la/ s5t5ce !re( & ins]t+ !      
foll[+3 ,su* t]m %all include an am\nt  
paid = any prescription or ov]-!-c\nt]  
m$ic9e or drug44  7b7 ,ar*] ,m,s,as     
,section #bbj7;d77#b77;,a7 is am5d$ by  
/rik+ ! la/ s5t5ce !re( & ins]t+ !      
foll[+3 ,su* t]m %all include an am\nt  
paid = any prescription or ov]-!-c\nt]  
m$ic9e or drug44  7c7 ,heal? flexible   
sp5d+ arrangem5ts & heal? reimbursem5t  
arrangem5ts ,subsection 7f7 ( section   
#ajf is am5d$ to read z foll[s3  7f7    
,reimbursem5ts = all m$ic9es & drugs ,= 
purposes ( ?is section & section #aje1  
reimbursem5t = exp5ses incurr$ = any    
prescription or ov]-!-c\nt] m$ic9e or   
drug %all be treat$ z a reimbursem5t =  
m$ical exp5ses4  4  7d7 ,effective date 
7#a7 ,di/ributions f sav+s acc\nts ,!   
am5dm5ts made by subsections 7a7 & 7b7  

%all apply to am\nts paid ) respect to  
taxable ye>s beg9n+ aft] ,decemb] #ca1  
#bjab4  7#b7 ,reimbursem5ts ,! am5dm5t  
made by subsection 7c7 %all apply to    
exp5ses incurr$ ) respect to taxable    
ye>s beg9n+ aft] ,decemb] #ca1 #bjab4   
#ajh4 ,pur*ase ( heal? insurance f ,,hsa
 acc\nt  7a7 ,9 g5]al ,p>agraph 7#b7 (  
section #bbc7;d7 is am5d$ to read z     
foll[s3  7#b7 ,qualifi$ m$ical exp5ses  
7,a7 ,9 g5]al ,! t]m qualifi$ m$ical    
exp5ses means1 ) respect to an acc\nt   
b5efici>y1 am\nts paid by su* b5efici>y 
= m$ical c>e 7z def9$ 9 section         
#bac7;d77 = any individual cov]$ by a   
high d$uctible heal? plan ( ! acc\nt    
b5efici>y1 b only to ! ext5t su* am\nts 
are n comp5sat$ = by insurance or       
o!rwise4  7,b7 ,heal? insurance may n be
 pur*as$ f acc\nt ,except z provid$ 9   
subp>agraph 7,c71 subp>agraph 7,a7 %all 
n apply to any paym5t = insurance4  7,c7
 ,exceptions ,subp>agraph 7,b7 %all n   
apply to any exp5se = cov]age "u--  7i7 
a heal? plan dur+ any p]iod (           

cont9uation cov]age requir$ "u any      
,f$]al law1  7ii7 a qualifi$ long-t]m   
c>e insurance contract 7z def9$ 9       
section #ggjb;,b7b771  7iii7 a heal?    
plan dur+ any p]iod 9 :i* ! individual  
is receiv+ unemploym5t comp5sation "u   
any ,f$]al or ,/ate law1  7iv7 a high   
d$uctible heal? plan1 or  7v7 any heal? 
insurance "u title ,,xviii ( ! ,social  
,security ,act1 o!r ?an a ,m$ic>e       
supplem5tal policy 7z def9$ 9 section   
#ahhb ( su* ,act74  4  7b7 ,effective   
date ,! am5dm5t made by ?is section %all
 apply ) respect to insurance pur*as$   
aft] ! date ( ! enactm5t ( ?is ,act 9   
taxable ye>s beg9n+ aft] su* date4      
#aji4 ,special rule = c]ta9 m$ical      
exp5ses incurr$ be=e e/abli%m5t ( acc\nt
  7a7 ,9 g5]al ,p>agraph 7#b7 ( section 
#bbc7;d71 z am5d$ by section #ajh1 is   
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,d7 ,c]ta9 m$ical exp5ses
 incurr$ be=e e/abli%m5t ( acc\nt treat$
 z qualifi$ ,an exp5se %all n fail to be
 treat$ z a qualifi$ m$ical exp5se      

solely because su* exp5se 0 incurr$ be=e
 ! e/abli%m5t ( ! heal? sav+s acc\nt if 
su* exp5se 0 incurr$--  7i7 dur+ ei!r-- 
7,i7 ! taxable ye> 9 :i* ! heal? sav+s  
acc\nt 0 e/abli%$1 or  7,,ii7 ! prec$+  
taxable ye> 9 ! case ( a heal? sav+s    
acc\nt e/abli%$ aft] ! taxable ye> 9 :i*
 su* exp5se 0 incurr$ b be=e ! "t       
prescrib$ by law = fil+ ! return = su*  
taxable ye> 7n includ+ ext5sions !re(71 
&  7ii7 = m$ical c>e ( an individual    
dur+ a p]iod t su* individual 0 cov]$ by
 a high d$uctible heal? plan & met !    
requirem5ts ( subsection                
7c77#a77;,a77ii7 7aft] application (    
subsection 7c77#a77;,b774  4  7b7       
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #aaj4 ,prev5tive c>e prescription
 drug cl>ification  7a7 ,cl>ify use (   
drugs 9 prev5tive c>e ,subp>agraph 7,c7 
( section #bbc7;c77#b7 is am5d$ by add+ 
at ! end ! foll[+3 ,prev5tive c>e %all  
include prescription & ov]-!-c\nt] drugs

 & m$ic9es :i* h ! prim>y purpose (     
prev5t+ ! onset (1 fur!r det]ioration f1
 or complications associat$ ) *ronic    
conditions1 illnesses1 or diseases44    
7b7 ,effective date ,! am5dm5t made by  
?is section %all apply to taxable ye>s  
beg9n+ aft] ,decemb] #ca1 #bjjc4  #aaa4 
,equival5t bankruptcy protections =     
heal? sav+s acc\nts z retirem5t funds   
7a7 ,9 g5]al ,section #ebb ( title #aa1 
,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+ new subsection3  7r7    
,treatm5t ( heal? sav+s acc\nts ,=      
purposes ( ?is section1 any heal? sav+s 
acc\nt 7z describ$ 9 section #bbc ( !   
,int]nal ,rev5ue ,code ( #aihf7 %all be 
treat$ 9 ! same mann] z an individual   
retirem5t acc\nt describ$ 9 section #djh
 ( su* ,code4  4  7b7 ,effective date ,!
 am5dm5t made by ?is section %all apply 
to cases comm5c+ "u title #aa1 ,unit$   
,/ates ,code1 aft] ! date ( ! enactm5t (
 ?is ,act4  #aab4 ,adm9i/rative error   
correction be=e due date ( return  7a7  
,9 g5]al ,p>agraph 7#d7 ( section       

#bbc7;f7 is am5d$ by add+ at ! end !    
foll[+ new subp>agraph3  7,d7 ,exception
 = adm9i/rative errors correct$ be=e due
 date ( return ,subp>agraph 7,a7 %all n 
apply if any paym5t or di/ribution is   
made to correct an adm9i/rative1 cl]ical
 or payroll contribution error & if--   
7i7 su* di/ribution is receiv$ by !     
individual on or be=e ! la/ day         
prescrib$ by law 7includ+ ext5sions (   
"t7 = fil+ su* individual's return = su*
 taxable ye>1 &  7ii7 su* di/ribution is
 accompani$ by ! am\nt ( net income     
attributable to su* contribution4  ,any 
net income describ$ 9 clause 7ii7 %all  
be includ$ 9 ! gross income ( !         
individual = ! taxable ye> 9 :i* x is   
receiv$4  4  7b7 ,effective date ,!     
am5dm5t made by ?is section %all take   
effect on ! date ( ! enactm5t ( ?is     
,act4  #aac4 ,reau?orization ( m$icaid  
heal? opportunity acc\nts  7a7 ,9 g5]al 
,section #aich ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acifu-#h7 is       
am5d$--  7#a7 9 subsection 7a7--  7,a7  

by /rik+ p>agraph 7#b7 & ins]t+ !       
foll[+3  7#b7 ,initial demon/ration ,!  
demon/ration program "u ?is section %all
 beg9 on ,janu>y #a1 #bjjg4 ,! ,secret>y
 %all approve ,/ates to conduct         
demon/ration programs "u ?is section = a
 #e-ye> p]iod1 ) ea* ,/ate demon/ration 
program cov]+ "o or m geographic areas  
specifi$ by ! ,/ate4 ,) respect to a    
,/ate1 aft] ! initial #e-ye> p]iod ( any
 demon/ration program conduct$ "u ?is   
section by ! ,/ate1 unless ! ,secret>y  
f9ds1 tak+ into acc\nt co/-effectiv5ess 
& quality ( c>e1 t ! ,/ate demon/ration 
program has be5 unsuccessful1 !         
demon/ration program may be ext5d$ or   
made p]man5t 9 ! ,/ate4  2 &  7,b7 9    
p>agraph 7#c71 9 ! matt] prec$+         
subp>agraph 7,a7--  7i7 by /rik+ n2 &   
7ii7 by /rik+ unless & ins]t+ if 2  7#b7
 9 subsection 7b7--  7,a7 9 p>agraph    
7#c71 by ins]t+ clause 7i7 ?r\gh 7vii71 
7viii7 7)\t reg>d to ! am5dm5t made by  
section #bjjd7;c77#b7 ( ,public ,law    
#aaa-adh71 7x71 or 7xi7 ( aft] describ$ 

9 2 &  7,b7 by /rik+ p>agraphs 7#d71    
7#e71 & 7#f72  7#c7 9 subsection 7c7--  
7,a7 by /rik+ p>agraphs 7#c7 & 7#d72    
7,b7 by r$esignat+ p>agraphs 7#e7 ?r\gh 
7#h7 z p>agraphs 7#c7 ?r\gh 7#f71       
respectively2 &  7,c7 9 p>agraph 7#d7 7z
 r$esignat$ by subp>agraph 7,b771 by    
/rik+ ,subject to subp>agraphs 7,d7 &   
7,e7 & ins]t+ ,subject to subp>agraph   
7,d72 &  7#d7 9 subsection 7d7--  7,a7 9
 p>agraph 7#b71 by /rik+ subp>agraph    
7,e72 &  7,b7 9 p>agraph 7#c7--  7i7 9  
subp>agraph 7,a77ii71 by /rik+ ,subject 
to subp>agraph 7,b77ii71 9 & ins]t+ ,92 
&  7ii7 by /rik+ subp>agraph 7,b7 &     
ins]t+ ! foll[+3  7,b7 ,ma9t5ance (     
heal? opportunity acc\nt aft] becom+    
ineligible = public b5efit ,not)/&+ any 
o!r provision ( law1 if an acc\nt hold] 
( a heal? opportunity acc\nt becomes    
ineligible = b5efits "u ?is title       
because ( an increase 9 income or       
assets--  7i7 no additional contribution
 %all be made into ! acc\nt "u p>agraph 
7#b77;,a77i72 &  7ii7 ! acc\nt %all     

rema9 available to ! acc\nt hold] = #c  
ye>s aft] ! date on :i* ! individual    
becomes ineligible = su* b5efits =      
)drawals "u ! same t]ms & conditions z  
if ! acc\nt hold] rema9$ eligible = su* 
b5efits1 & su* )drawals %all be treat$ z
 m$ical assi/ance 9 accordance )        
subsection 7c77#d74  4  7b7 ,con=m+     
am5dm5t ,section #fac ( ,public ,law    
#aaa-c is repeal$4  #aad4 ,memb]s (     
heal? c>e %>+ m9i/ries eligible to      
e/abli% heal? sav+s acc\nts  7a7 ,9     
g5]al ,section #bbc is am5d$ by add+ at 
! end ! foll[+ new subsection3  7i7     
,application to heal? c>e %>+ m9i/ries  
,= purposes ( ?is section1 memb]%ip 9 a 
heal? c>e %>+ m9i/ry 7z def9$ 9 section 
#ejjj;,a7d77#b77;,b77ii77 %all be treat$
 z cov]age "u a high d$uctible heal?    
plan4  4  7b7 ,effective date ,! am5dm5t
 made by ?is section %all apply to      
taxable ye>s beg9n+ aft] ! date ( !     
enactm5t ( ?is ,act4  #aae4 ,high       
d$uctible heal? plans r5am$ ,,hsa       
qualifi$ plans  7a7 ,9 g5]al ,section   

#bbc1 z am5d$ by ?is ,act1 is am5d$ by  
/rik+ high d$uctible heal? plan ea*     
place x appe>s & ins]t+ ,,hsa qualifi$  
heal? plan4  7b7 ,con=m+ am5dm5ts  7#a7 
,section #ajf7;e71 z am5d$ by ?is ,act1 
is am5d$ by /rik+ high d$uctible heal?  
plan ea* place x appe>s & ins]t+ ,,hsa  
qualifi$ heal? plan4  7#b7 ,! head+ =   
p>agraph 7#b7 ( section #bbc7;c7 is     
am5d$ by /rik+ ,high d$uctible heal?    
plan & ins]t+ ,,hsa qualifi$ heal? plan4
  7#c7 ,section #djh7;d77#i7 is am5d$-- 
7,a7 by /rik+ high d$uctible heal? plan 
ea* place x appe>s 9 subp>agraph 7,c7 & 
ins]t+ ,,hsa qualifi$ heal? plan1 &     
7,b7 by /rik+ ,high d$uctible heal? plan
 9 ! head+ ( subp>agraph 7,d7 & ins]t+  
,,hsa qualifi$ heal? plan4  #aaf4       
,treatm5t ( direct prim>y c>e s]vice    
arrangem5ts  7a7 ,9 g5]al ,section      
#bbc7;c7 is am5d$ by add+ at ! end !    
foll[+ new p>agraph3  7#f7 ,treatm5t (  
direct prim>y c>e s]vice arrangem5ts ,an
 arrangem5t "u :i* an individual is     
provid$ cov]age re/rict$ to prim>y c>e  

s]vices 9 ex*ange = a fix$ p]iodic fee--
  7,a7 %all n be treat$ z a heal? plan =
 purposes ( p>agraph 7#a77;,a77ii71 &   
7,b7 %all n be treat$ z insurance =     
purposes ( subsection 7d77#b77;,b74  4  
7b7 ,effective date ,! am5dm5t made by  
?is section %all apply to taxable ye>s  
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #aag4 ,high d$uctible heal? plans
 ) ,h,s,as treat$ z qualifi$ heal? plans
 ,section #acja ( ! ,pati5t ,protection 
& ,af=dable ,c>e ,act is am5d$ by add+  
at ! end ! foll[+ new subsection3  7e7  
,high d$uctible heal? plan ) heal? sav+s
 acc\nt ,a heal? plan n provid+ a       
bronze1 silv]1 gold1 or plat9um level ( 
cov]age %all be treat$ z meet+ !        
requirem5ts ( subsection 7d7 ) respect  
to any plan ye> = any enrollee if ! plan
 meets ! requirem5ts = a high d$uctible 
heal? plan "u section #bbc7;c77#b7 ( !  
,int]nal ,rev5ue ,code ( #aihf & su*    
enrollee has e/abli%$ a heal? sav+s     
acc\nt 7z def9$ 9 section #bbc7;d77#a7 (
 su* ,code7 9 relation to su* plan4  4  

#aah4 ,c]ta9 /&-alone ,h,r,as n subject 
to prohibition on annual limits ,section
 #bgaa7;a7 ( ! ,public ,heal? ,s]vice   
,act 7#db ,u4,s4,c4 #cjj;gg-#aa7;a77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#c7 ,exception = heal?      
reimbursem5t arrangem5ts ,p>agraph      
7#a77;,a7 %all n apply to any heal?     
reimbursem5t arrangem5t :i* p]mits !    
pur*ase ( a qualifi$ heal? plan ?r\gh an
 ,ex*ange e/abli%$ "u section #acaa ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act4  4  ,,ii ,o!r provisions  #bja4   
,c]ta9 ex]cise equipm5t & physical      
fitness programs treat$ z m$ical c>e    
7a7 ,9 g5]al ,subsection 7d7 ( section  
#bac is am5d$ by add+ at ! end ! foll[+ 
new p>agraph3  7#ab7 ,ex]cise equipm5t &
 physical fitness programs  7,a7 ,9     
g5]al ,! t]m m$ical c>e %all include    
am\nts paid--  7i7 to pur*ase or use    
equipm5t us$ 9 a program 7includ+ a     
self-direct$ program7 ( physical        
ex]cise1  7ii7 to p>ticipate1 or receive
 in/ruction1 9 a program ( physical     

ex]cise1 &  7iii7 = memb]%ip dues 9 a   
fitness club ! prim>y purpose ( :i* is  
to provide access to equipm5t &         
facilities = physical ex]cise4  7,b7    
,limitation ,am\nts treat$ z m$ical c>e 
"u subp>agraph 7,a7 %all n exce$ #a1jjj 
) respect to any individual = any       
taxable ye>4  4  7b7 ,effective date ,! 
am5dm5t made by ?is section %all apply  
to taxable ye>s beg9n+ aft] ! date ( !  
enactm5t ( ?is ,act4  #bjb4 ,c]ta9      
nutritional & diet>y supplem5ts to be   
treat$ z m$ical c>e  7a7 ,9 g5]al       
,subsection 7d7 ( section #bac1 z am5d$ 
by section #bja1 is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#ac7       
,nutritional & diet>y supplem5ts  7,a7  
,9 g5]al ,! t]m m$ical c>e %all include 
am\nts paid to pur*ase h]bs1 vitam9s1   
m9]als1 homeopa?ic rem$ies1 meal        
replacem5t products1 & o!r diet>y &     
nutritional supplem5ts4  7,b7           
,limitation ,am\nts treat$ z m$ical c>e 
"u subp>agraph 7,a7 %all n exce$ #a1jjj 
) respect to any individual = any       

taxable ye>4  7,c7 ,meal replacem5t     
product ,= purposes ( ?is p>agraph1 !   
t]m meal replacem5t product means any   
product t--  7i7 is p]mitt$ to be>      
label+ mak+ a claim describ$ 9 section  
#djc7r77#c7 ( ! ,f$]al ,food1 ,drug1 &  
,cosmetic ,act1 &  7ii7 is p]mitt$ to   
claim "u su* section t su* product is l[
 9 fat & is a good s\rce ( prote91 fib]1
 & multiple ess5tial vitam9s & m9]als4  
4  7b7 ,effective date ,! am5dm5t made  
by ?is section %all apply to taxable    
ye>s beg9n+ aft] ! date ( ! enactm5t (  
?is ,act4  #bjc4 ,c]ta9 provid] fees to 
be treat$ z m$ical c>e  7a7 ,9 g5]al    
,subsection 7d7 ( section #bac1 z am5d$ 
by sections #bja & #bjb1 is am5d$ by    
add+ at ! end ! foll[+ new p>agraph3    
7#ad7 ,p]iodic provid] fees ,! t]m      
m$ical c>e %all include p]iodic fees    
paid to a prim>y c>e physician = ! "r to
 receive m$ical s]vices on an z-ne$$    
basis4  4  7b7 ,effective date ,!       
am5dm5t made by ?is section %all apply  
to taxable ye>s beg9n+ aft] ! date ( !  

enactm5t ( ?is ,act4  #bjd4 ,repeal (   
annual limitations on d$uctibles =      
employ]-sponsor$ plans (f]$ 9 small gr\p
 m>ket ,section #acjb7;c77#b7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh7 is repeal$4