,,ii #aae? ,,congress #b;d ,session ,h4 ,r4 #faii ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #bf1 #bjah,receiv$ ,,an ,,act ,to am5d ! ,int]nal ,rev5ue ,code ( #aihf to include c]ta9 ov]-!-c\nt] m$ical products z qualifi$ m$ical exp5ses4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,re/or+ ,access to ,m$ication & ,mod]niz+ ,heal? ,sav+s ,acc\nts ,act ( #bjah4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,fir/ doll> cov]age flexibility = high d$uctible heal? plans4 ,sec4 #c4 ,treatm5t ( direct prim>y c>e s]vice arrangem5ts4 ,sec4 #d4 ,c]ta9 employm5t relat$ s]vices n treat$ z disqualify+ cov]age = purposes ( heal? sav+s acc\nts4 ,sec4 #e4 ,contributions p]mitt$ if sp\se has a heal? flexible sp5d+ acc\nt4 ,sec4 #f4 ,,fsa & ,,hra t]m9ations or conv]sions to fund ,h,s,as4 ,sec4 #g4 ,inclusion ( c]ta9 ov]-!-c\nt] m$ical products z qualifi$ m$ical exp5ses4 ,sec4 #h4 ,c]ta9 am\nts paid = physical activity1 fitness1 & ex]cise treat$ z am\nts paid = m$ical c>e4 #b4 ,fir/ doll> cov]age flexibility = high d$uctible heal? plans 7a7 ,9 g5]al ,section #bbc7;c77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,fir/ doll> cov]age flexibility 7i7 ,9 g5]al ,a plan %all n fail to be treat$ z a high d$uctible heal? plan by reason ( fail+ to h a d$uctible = n m ?an #bej ( specifi$ s]vices = self-only cov]age 7twice su* am\nt 9 ! case ( family cov]age7 dur+ a plan ye>4 7ii7 ,specifi$ s]vices ,= purposes ( ?is subp>agraph1 ! t]m specifi$ s]vices means1 ) respect to a plan1 s]vices o!r ?an prev5tive c>e 7)9 ! mean+ ( subp>agraph 7,c77 id5tifi$ "u ! t]ms ( ! plan z be+ s]vices to :i* clause 7i7 applies4 4 7b7 ,inflation adju/m5t ,section #bbc7;g77#a7 ( su* ,code is am5d$-- 7#a7 by /rik+ & 7c77#b77;,a7 ea* place x appe>s & ins]t+ 1 7c77#b77;,a71 & 7c77#b77;,e71 & 7#b7 9 subp>agraph 7,b7-- 7,a7 by /rik+ su* taxable ye> 9 ! matt] prec$+ clause 7i7 & ins]t+ ! taxable ye> 7plan ye> 9 ! case ( ! doll> am\nt 9 subsection 7c77#b77;,e771 & 7,b7 by /rik+ clause 7ii7 & ins]t+ clauses 7ii7 & 7iii7 9 clause 7i71 by /rik+ & at ! end ( clause 7i71 by /rik+ ! p]iod at ! end ( clause 7ii7 & ins]t+ 1 &1 & by ins]t+ aft] clause 7ii7 ! foll[+ new clause3 7iii7 9 ! case ( ! doll> am\nt 9 subsection 7c77#b77;,e7 = plan ye>s beg9n+ 9 cal5d> ye>s aft] #bjai1 cal5d> ye> #bjah4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjah4 #c4 ,treatm5t ( direct prim>y c>e s]vice arrangem5ts 7a7 ,9 g5]al ,section #bbc7;c77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,treatm5t ( direct prim>y c>e s]vice arrangem5ts 7i7 ,9 g5]al ,a direct prim>y c>e s]vice arrangem5t %all n be treat$ z a heal? plan = purposes ( subp>agraph 7,a77ii74 7ii7 ,direct prim>y c>e s]vice arrangem5t ,= purposes ( ?is p>agraph-- 7,i7 ,9 g5]al ,! t]m direct prim>y c>e s]vice arrangem5t means1 ) respect to any individual1 an arrangem5t "u :i* su* individual is provid$ m$ical c>e 7z def9$ 9 section #bac7;d77 consi/+ solely ( prim>y c>e s]vices provid$ by prim>y c>e practition]s 7z def9$ 9 section #ahcc7x77#b77;,a7 ( ! ,social ,security ,act1 det]m9$ )\t reg>d to clause 7ii7 !re(71 if ! sole comp5sation = su* c>e is a fix$ p]iodic fee4 7,,ii7 ,limitation ,) respect to any individual = any mon?1 su* t]m %all n include any arrangem5t if ! aggregate fees = all direct prim>y c>e s]vice arrangem5ts 7det]m9$ )\t reg>d to ?is subclause7 ) respect to su* individual = su* mon? exce$ #aej 7twice su* doll> am\nt 9 ! case ( an individual ) any direct prim>y c>e s]vice arrangem5t 7z s det]m9$7 t cov]s m ?an "o individual74 7iii7 ,c]ta9 s]vices specifically exclud$ f treatm5t z prim>y c>e s]vices ,= purposes ( ?is p>agraph1 ! t]m prim>y c>e s]vices %all n include-- 7,i7 proc$ures t require ! use ( g5]al ane/hesia1 7,,ii7 prescription drugs 7o!r ?an vacc9es71 & 7,,iii7 laboratory s]vices n typically adm9i/]$ 9 an ambulatory prim>y c>e sett+4 ,! ,secret>y1 aft] consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 %all issue regulations or o!r guidance reg>d+ ! application ( ?is clause4 4 7b7 ,direct prim>y c>e s]vice arrangem5t fees treat$ z m$ical exp5ses ,section #bbc7;d77#b77;,c7 is am5d$ by /rik+ or at ! end ( clause 7iii71 by /rik+ ! p]iod at ! end ( clause 7iv7 & ins]t+ 1 or1 & by add+ at ! end ! foll[+ new clause3 7v7 any direct prim>y c>e s]vice arrangem5t4 4 7c7 ,inflation adju/m5t ,section #bbc7;g77#a7 ( su* ,code1 z am5d$ by section #b7;b71 is am5d$-- 7#a7 by ins]t+ 7c77#a77;,d77ii77,,ii71 aft] 7b77#b71 ea* place x appe>s1 & 7#b7 9 subp>agraph 7,b71 by /rik+ & 7iii7 & ins]t+ 1 7iii7 & 7iv7 9 clause 7i71 by /rik+ & at ! end ( clause 7ii71 by /rik+ ! p]iod at ! end ( clause 7iii7 & ins]t+ 1 &1 & by ins]t+ aft] clause 7iii7 ! foll[+ new clause3 7iv7 9 ! case ( ! doll> am\nt 9 subsection 7c77#a77;,d77ii77,,ii7 = taxable ye>s beg9n+ 9 cal5d> ye>s aft] #bjai1 cal5d> ye> #bjah4 4 7d7 ,report+ ( direct prim>y c>e s]vice arrangem5t fees on ,w-#b ,section #fjea7;a7 ( su* ,code is am5d$ by /rik+ & at ! end ( p>agraph 7#af71 by /rik+ ! p]iod at ! end ( p>agraph 7#ag7 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph 7#ag7 ! foll[+ new p>agraph3 7#ah7 9 ! case ( a direct prim>y c>e s]vice arrangem5t 7z def9$ 9 section #bbc7;c77#a77;,d77ii77 :i* is provid$ 9 connection ) employm5t1 ! aggregate fees = su* arrangem5t = su* employee4 4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjah1 9 taxable ye>s end+ aft] su* date4 #d4 ,c]ta9 employm5t relat$ s]vices n treat$ z disqualify+ cov]age = purposes ( heal? sav+s acc\nts 7a7 ,9 g5]al ,section #bbc7;c77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z am5d$ by section #c7;a71 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,special rule = qualifi$ items & s]vices 7i7 ,9 g5]al ,an individual %all n be treat$ z cov]$ "u a heal? plan = purposes ( subp>agraph 7,a77ii7 m]ely because ! individual1 9 connection ) ! employm5t ( ! individual or ! individual's sp\se1 receives 7or is eligible to receive7 qualifi$ items & s]vices at-- 7,i7 a heal?c>e facility locat$ at a facility own$ or leas$ by ! employ] ( ! individual 7or ( ! individual's sp\se71 or op]at$ prim>ily = ! b5efit ( su* employ]'s employees1 or 7,,ii7 a heal?c>e facility locat$ )9 a sup]m>ket1 ph>macy1 or simil> retail e/abli%m5t4 7ii7 ,qualifi$ items & s]vices def9$ ,= purposes ( ?is subp>agraph1 ! t]m qualifi$ items & s]vices means ! foll[+3 7,i7 ,physical exam9ations4 7,,ii7 ,immunizations1 includ+ injections ( antig5s provid$ by employees4 7,,iii7 ,drugs o!r ?an a prescrib$ drug 7z su* t]m is def9$ 9 section #bac7;d77#c774 7,,iv7 ,treatm5t = injuries occurr+ 9 ! c\rse ( employm5t4 7,v7 ,drug te/+1 if requir$ z a condition ( employm5t4 7,,vi7 ,he>+ or vision scre5+s4 7,,vii7 ,o!r simil> items & s]vices t d n provide significant b5efits 9 ! nature ( m$ical c>e4 7iii7 ,aggregation ,= purposes ( clause 7i77,i71 all p]sons treat$ z a s+le employ] "u subsection 7b71 7c71 7m71 or 7o7 ( section #dad %all be treat$ z a s+le employ]4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjah1 9 taxable ye>s end+ aft] su* date4 #e4 ,contributions p]mitt$ if sp\se has a heal? flexible sp5d+ acc\nt 7a7 ,contributions p]mitt$ if sp\se has a heal? flexible sp5d+ acc\nt ,section #bbc7;c77#a77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ & at ! end ( clause 7ii71 by /rik+ ! p]iod at ! end ( clause 7iii7 & ins]t+ 1 &1 & by ins]t+ aft] clause 7iii7 ! foll[+ new clause3 7iv7 cov]age "u a heal? flexible sp5d+ arrangem5t ( ! sp\se ( ! individual = any plan ye> ( su* arrangem5t if ! aggregate reimbursem5ts "u su* arrangem5t = su* ye> d n exce$ ! aggregate exp5ses :i* w\ld be eligible = reimbursem5t "u su* arrangem5t if su* exp5ses 7 det]m9$ )\t reg>d to any exp5ses paid or incurr$ ) respect to su* individual4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjah4 #f4 ,,fsa & ,,hra t]m9ations or conv]sions to fund ,h,s,as 7a7 ,9 g5]al ,section #ajf7;e77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7#b7 ,qualifi$ ,,hsa di/ribution ,= purposes ( ?is subsection-- 7,a7 ,9 g5]al ,! t]m qualifi$ ,,hsa di/ribution means1 ) respect to any employee1 a di/ribution f a heal? flexible sp5d+ arrangem5t or heal? reimbursem5t arrangem5t ( su* employee directly to a heal? sav+s acc\nt ( su* employee if-- 7i7 su* di/ribution is made 9 connection ) su* employee e/abli%+ cov]age "u a high d$uctible heal? plan 7z def9$ 9 section #bbc7;c77#b77 aft] a significant p]iod ( n hav+ su* cov]age1 & 7ii7 su* arrangem5t is describ$ 9 section #bbc7;c77#a77;,b77iii7 ) respect to ! portion ( ! plan ye> aft] su* di/ribution is made4 7,b7 ,doll> limitation ,! aggregate am\nt ( di/ributions f heal? flexible sp5d+ arrangem5ts & heal? reimbursem5t arrangem5ts ( any employee :i* may be treat$ z qualifi$ ,,hsa di/ributions 9 connection ) an e/abli%m5t ( cov]age describ$ 9 subp>agraph 7,a77i7 %all n exce$ ! doll> am\nt 9 effect "u section #abe7;i77#a7 7twice su* am\nt 9 ! case ( cov]age :i* is describ$ 9 section #bbc7;b77#b77;,b774 4 7b7 ,p>tial r$uction ( limitation on d$uctible ,,hsa contributions ,section #bbc7;b77#d7 ( su* ,code is am5d$ by /rik+ & at ! end ( subp>agraph 7,b71 by /rik+ ! p]iod at ! end ( subp>agraph 7,c7 & ins]t+ 1 &1 & by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 s mu* ( any qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b77 made to a heal? sav+s acc\nt ( su* individual dur+ ! taxable ye> z does n exce$ ! aggregate increases 9 ! balance ( ! arrangem5t f :i* su* di/ribution is made :i* occur dur+ ! portion ( ! plan ye> :i* prec$es su* di/ribution 7o!r ?an any balance c>ri$ ov] to su* plan ye> & det]m9$ )\t reg>d to any decrease 9 su* balance dur+ su* portion ( ! plan ye>74 4 7c7 ,conv]sion to ,,hsa-compatible arrangem5t = rema9d] ( plan ye> ,section #bbc7;c77#a77;,b77iii7 ( su* ,code1 z am5d$ by section #e7;a71 is am5d$ to read z foll[s3 7iii7 cov]age "u a heal? flexible sp5d+ arrangem5t or heal? reimbursem5t arrangem5t = ! portion ( ! plan ye> aft] a qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b7 det]m9$ )\t reg>d to subp>agraph 7,a77ii7 !re(7 is made1 if ! t]ms ( su* arrangem5t :i* apply = su* portion ( ! plan ye> are su* t1 if su* t]ms appli$ = ! entire plan ye>1 !n su* arrangem5t w\ld n be tak5 into acc\nt "u subp>agraph 7,a77ii7 ( ?is p>agraph = su* plan ye>1 & 4 7d7 ,inclusion ( qualifi$ ,,hsa di/ributions on ,w-#b 7#a7 ,9 g5]al ,section #fjea7;a7 ( su* ,code1 z am5d$ by section #c7;d71 is am5d$ by /rik+ & at ! end ( p>agraph 7#ag71 by /rik+ ! p]iod at ! end ( p>agraph 7#ah7 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph 7#ah7 ! foll[+ new p>agraph3 7#ai7 ! am\nt ( any qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b77 ) respect to su* employee4 4 7#b7 ,con=m+ am5dm5t ,section #fjea7;a77#ab7 ( su* ,code is am5d$ by ins]t+ 7o!r ?an any qualifi$ ,,hsa di/ribution1 z def9$ 9 section #ajf7;e77#b77 be=e ! comma at ! end4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to di/ributions made aft] ,decemb] #ca1 #bjah1 9 taxable ye>s end+ aft] su* date4 #g4 ,inclusion ( c]ta9 ov]-!-c\nt] m$ical products z qualifi$ m$ical exp5ses 7a7 ,h,s,as ,section #bbc7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 by /rik+ ! la/ s5t5ce ( subp>agraph 7,a7 & ins]t+ ! foll[+3 ,= purposes ( ?is subp>agraph1 am\nts paid = m5/rual c>e products %all be treat$ z paid = m$ical c>e41 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,m5/rual c>e product ,= purposes ( ?is p>agraph1 ! t]m m5/rual c>e product means a tampon1 pad1 l9]1 cup1 sponge1 or simil> product us$ by wom5 ) respect to m5/ruation or o!r g5ital-tract secretions4 4 7b7 ,ar*] ,m,s,as ,section #bbj7;d77#b77;,a7 ( su* ,code is am5d$ by /rik+ ! la/ s5t5ce & ins]t+ ! foll[+3 ,= purposes ( ?is subp>agraph1 am\nts paid = m5/rual c>e products 7z def9$ 9 section #bbc7;d77#b77;,d77 %all be treat$ z paid = m$ical c>e44 7c7 ,heal? flexible sp5d+ arrangem5ts & heal? reimbursem5t arrangem5ts ,section #ajf ( su* ,code is am5d$ by /rik+ subsection 7f7 & ins]t+ ! foll[+ new subsection3 7f7 ,reimbursem5ts = m5/rual c>e products ,= purposes ( ?is section & section #aje1 exp5ses incurr$ = m5/rual c>e products 7z def9$ 9 section #bbc7;d77#b77;,d77 %all be treat$ z incurr$ = m$ical c>e4 4 7d7 ,effective dates 7#a7 ,di/ributions f heal? sav+s acc\nts ,! am5dm5ts made by subsections 7a7 & 7b7 %all apply to am\nts paid aft] ,decemb] #ca1 #bjah4 7#b7 ,reimbursem5ts ,! am5dm5t made by subsection 7c7 %all apply to exp5ses incurr$ aft] ,decemb] #ca1 #bjah4 #h4 ,c]ta9 am\nts paid = physical activity1 fitness1 & ex]cise treat$ z am\nts paid = m$ical c>e 7a7 ,9 g5]al ,section #bac7;d77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ or at ! end ( subp>agraph 7,c71 by /rik+ ! p]iod at ! end ( subp>agraph 7,d7 & ins]t+ 1 or1 & by add+ at ! end ! foll[+ new subp>agraph3 7,e7 = qualifi$ sports & fitness exp5ses4 4 7b7 ,qualifi$ sports & fitness exp5ses ,section #bac7;d7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ p>agraph3 7#ab7 ,qualifi$ sports & fitness exp5ses 7,a7 ,9 g5]al ,! t]m qualifi$ sports & fitness exp5ses means am\nts paid =-- 7i7 memb]%ip at a fitness facility1 7ii7 p>ticipation or in/ruction 9 a program ( qualifi$ physical activity1 or 7iii7 safety equipm5t = use 9 a program 7includ+ a self-direct$ program7 ( qualifi$ physical activity4 7,b7 ,limitations 7i7 ,ov]all doll> limitation ,! aggregate am\nt treat$ z qualifi$ sports & fitness exp5ses ) respect to any taxpay] = any taxable ye> %all n exce$ #ejj 7twice su* am\nt 9 ! case ( a jo9t return or a head ( h\sehold 7z def9$ 9 section #b7;b7774 7ii7 ,doll> limitation on safety equipm5t ,! am\nt treat$ z qualifi$ sports & fitness exp5ses ) respect to any item ( safety equipm5t describ$ 9 subp>agraph 7,a77iii7 %all n exce$ #bej4 7iii7 ,exclusion ( ex]cise videos1 etc ,qualifi$ sports & fitness exp5ses %all n include videos1 books1 or simil> mat]ials4 7,c7 ,qualifi$ physical activity ,= purposes ( ?is p>agraph-- 7i7 ,9 g5]al ,except z provid$ 9 clause 7ii71 ! t]m qualifi$ physical activity means any physical ex]cise or physical activity4 7ii7 ,exclusions ,! ,secret>y1 aft] consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 %all issue guidance to det]m9e = purposes ( ?is p>agraph :at does n con/itute a qualifi$ physical activity1 includ+ golf1 hunt+1 sail+1 horseback rid+1 & o!r simil> activities4 7,d7 ,fitness facility def9$ ,= purposes ( subp>agraph 7,a77i71 ! t]m fitness facility means a facility-- 7i7 provid+ in/ruction 9 a program ( qualifi$ physical activity or facilities = qualifi$ physical activity1 7ii7 :i* is n a private club own$ & op]at$ by its memb]s1 7iii7 ^: heal? or fitness facility is n incid5tal to its ov]all function & purpose1 & 7iv7 :i* is fully compliant ) applicable ,/ate & ,f$]al anti-discrim9ation laws4 7,e7 ,programs :i* include compon5ts o!r qualifi$ physical activity ,rules simil> to ! rules ( p>agraph 7#f7 %all apply 9 ! case ( any program or facility t includes qualifi$ physical activity 7or facilities !re=e7 & also o!r compon5ts4 ,= purposes ( ! prec$+ s5t5ce1 travel & accommodations %all be treat$ z an o!r compon5t4 7,f7 ,inflation adju/m5t ,9 ! case ( any taxable ye> beg9n+ 9 a cal5d> ye> aft] #bjai1 ! #ejj am\nt 9 subp>agraph 7,b77i7 & ! #bej am\nt 9 subp>agraph 7,b77ii7 %all ea* be increas$ by an am\nt equal to-- 7i7 su* doll> am\nt1 multipli$ by 7ii7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye> 9 :i* su* taxable ye> beg9s1 det]m9$ by sub/itut+ cal5d> ye> #bjah = cal5d> ye> #bjaf 9 subp>agraph 7,a77ii7 !re(4 ,if any increase det]m9$ "u ! prec$+ s5t5ce is n a multiple ( #aj1 su* increase %all be r\nd$ to ! next l[e/ multiple ( #aj4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjah4 ,pass$ ! ,h\se ( ,repres5tatives ,july #be1 #bjah4,k>5 ,l4 ,haas1,cl]k