,,ii #aafth ,,congress #ast ,session ,s4 #ab ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,january #c1 #bjai,mr4 ,rubio introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 ,health ,savings ,act of #bjai4 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--,renaming high deductible health plans,sec4 #aja4 ,high deductible health plans renamed ,,hsa-qualified health plans4,,title ,,ii--,enhancing access to tax-preferred health accounts,sec4 #bja4 ,allow both spouses to make catch-up contributions to the same ,,hsa account4,sec4 #bjb4 ,provisions relating to ,medicare4,sec4 #bjc4 ,individuals eligible for ,indian ,health ,service assistance4,sec4 #bjd4 ,members of health care sharing ministries eligible to establish health savings accounts4,sec4 #bje4 ,treatment of direct primary care service arrangements4,sec4 #bjf4 ,individuals eligible for on-site medical clinic coverage4,sec4 #bjg4 ,treatment of embedded deductibles4,,title ,,iii--,improving coverage under tax-preferred health accounts,sec4 #cja4 ,allowance of distributions for prescription and over-the-counter medicines and drugs4,sec4 #cjb4 ,purchase of health insurance from ,,hsa account4,sec4 #cjc4 ,special rule for certain medical expenses incurred before establishment of account4,sec4 #cjd4 ,preventive care prescription drug clarification4,,title ,,iv--,miscellaneous provisions relating to tax-preferred health accounts,sec4 #dja4 ,,fsa and ,,hra interaction with ,h,s,as4,sec4 #djb4 ,equivalent bankruptcy protections for health savings accounts as retirement funds4,sec4 #djc4 ,administrative error correction before due date of return4,sec4 #djd4 ,reauthorization of ,medicaid health opportunity accounts4,sec4 #dje4 ,maximum contribution limit to health savings account increased to amount of deductible and out-of-pocket limitation4,,title ,v--,other provisions,sec4 #eja4 ,certain exercise equipment and physical fitness programs treated as medical care4,sec4 #ejb4 ,certain nutritional and dietary supplements to be treated as medical care4,sec4 #ejc4 ,certain provider fees to be treated as medical care4 ,i ,renaming high deductible health plans #aja4 ,high deductible health plans renamed ,,hsa-qualified health plans 7a7 ,in general ,section #bbc is amended by striking high deductible health plan each place it appears and inserting ,,hsa-qualified health plan4 7b7 ,conforming amendments 7#a7 ,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#b7 ,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 plan2 and 7,b7 by striking ,high deductible health plan in the heading of subparagraph 7,d7 and inserting ,,hsa-qualified health plan4 7#c7 ,section #ajf7;e7 is amended-- 7,a7 by striking ,high deductible health plan in the heading of paragraph 7#c7 and inserting ,,hsa-qualified health plan2 and 7,b7 by striking high deductible health plan in paragraph 7#e77;,b77iii7 and inserting ,,hsa-qualified health plan4 ,,ii ,enhancing access to tax-preferred health accounts #bja4 ,allow both spouses to make catch-up contributions to the same ,,hsa account 7a7 ,in general ,paragraph 7#e7 of section #bbc7;b7 is amended to read as follows3 7#e7 ,special rule for married individuals with family coverage 7,a7 ,in general ,in the case of individuals who are married to each other1 if both spouses are eligible individuals and either spouse has family coverage under an ,,hsa-qualified health plan as of the first day of any month-- 7i7 the limitation under paragraph 7#a7 shall be applied by not taking into account any other ,,hsa-qualified health plan coverage of either spouse 7and if such spouses both have family coverage under separate ,,hsa-qualified health plans1 only one such coverage shall be taken into account71 7ii7 such limitation 7after application of clause 7i77 shall be reduced by the aggregate amount paid to ,archer ,m,s,as of such spouses for the taxable year1 and 7iii7 such limitation 7after application of clauses 7i7 and 7ii77 shall be divided equally between such spouses unless they agree on a different division4 7,b7 ,treatment of additional contribution amounts ,if both spouses referred to in subparagraph 7,a7 have attained age #ee before the close of the taxable year1 the limitation referred to in subparagraph 7,a77iii7 which is subject to division between the spouses shall include the additional contribution amounts determined under paragraph 7#c7 for both spouses4 ,in any other case1 any additional contribution amount determined under paragraph 7#c7 shall not be taken into account under subparagraph 7,a77iii7 and shall not be subject to division between the spouses4 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 ,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;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 #bjc4 ,individuals eligible for ,indian ,health ,service assistance 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c7 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 #bjd4 ,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 an ,,hsa-qualified 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 #bje4 ,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 or payment for primary care services-- 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 #bjf4 ,individuals eligible for on-site medical clinic coverage 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c71 as amended by sections #bjc1 is amended by adding at the end the following new subparagraph3 7,e7 ,special rule for individuals eligible for on-site medical clinic coverage 7i7 ,in general ,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 health care benefits from an on-site medical clinic of employer of the individual or the individual's spouse if such health care benefits are not significant benefits4 7ii7 ,included benefits ,for purposes of clause 7i71 the following health care benefits shall be considered to be benefits which are not significant benefits3 7,i7 ,physicals and immunizations4 7,,ii7 ,injecting antigens provided by employees4 7,,iii7 ,medications available without a prescription1 such as pain relievers and antihistamines4 7,,iv7 ,treatment for injuries occurring at the employer's place of employment or otherwise in the course of employment4 7,v7 ,tests for infectious diseases and conditions1 such as streptococcal sore throat4 7,,vi7 ,monitoring of chronic conditions1 such as diabetes4 7,,vii7 ,drug testing4 7,,viii7 ,hearing or vision screenings and related services4 7,,ix7 ,other services and treatments of a similar nature to the services described in subclauses 7,i7 through 7,,viii74 7iii7 ,aggregation rules ,for purposes of clause 7i71 all persons treated as a single employer under subsection 7b71 7c71 7m71 or 7o7 of section #dad shall be treated as a single employer4 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 #bjg4 ,treatment of embedded deductibles 7a7 ,in general ,paragraph 7#b7 of section #bbc7;c7 is amended by adding at the end the following new subparagraph3 7,e7 ,treatment of embedded deductible ,a health plan providing family coverage that has an annual deductible for all covered individuals under the plan of at least the amount described in subparagraph 7,a77i77,,ii7 shall not fail to be treated as an ,,hsa-qualified health plan solely because it covers expenses with respect to an individual under that plan that exceed an embedded deductible which is equal to or in excess of the amount described in subparagraph 7,a77i77,i74 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 ,,iii ,improving coverage under tax-preferred health accounts #cja4 ,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 dates 7#a7 ,distributions from savings accounts ,the amendments made by subsections 7a7 and 7b7 shall apply to amounts paid in taxable years beginning after ,december #ca1 #bjai4 7#b7 ,reimbursements ,the amendment made by subsection 7c7 shall apply to expenses incurred in plan years beginning after ,december #ca1 #bjai4 #cjb4 ,purchase of health insurance from ,,hsa account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d71 as amended by section #cja1 is amended-- 7#a7 by striking and any dependent 7as defined in section #aeb1 determined without regard to subsections 7b77#a71 7b77#b71 and 7d77#a77;,b7 thereof7 of such individual in subparagraph 7,a7 and inserting any dependent 7as defined in section #aeb1 determined without regard to subsections 7b77#a71 7b77#b71 and 7d77#a77;,b7 thereof7 of such individual1 and any child 7as defined in section #aeb7;f77#a77 of such individual who has not attained the age of #bg before the end of such individual's taxable year2 7#b7 by striking subparagraph 7,b7 and inserting the following3 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 2 and 7#c7 by striking or at the end of subparagraph 7,c77iii7 and by striking subparagraph 7,c77iv7 and inserting the following3 7iv7 an ,,hsa-qualified 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 amendments 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 #cjc4 ,special rule for certain medical expenses incurred before establishment of account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d7 is amended by adding at the end the following new subparagraph3 7,d7 ,treatment of certain medical expenses incurred before establishment of account ,if a health savings account is established during the #fj-;day period beginning on the date that coverage of the account beneficiary under an ,,hsa-qualified health plan begins1 then1 solely for purposes of determining whether an amount paid is used for a qualified medical expense1 such account shall be treated as having been established on the date that such coverage begins4 4 7b7 ,effective date ,the amendment made by this section shall apply with respect to coverage beginning after the date of the enactment of this ,act4 #cjd4 ,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 #bjai4 ,,iv ,miscellaneous provisions relating to tax-preferred health accounts #dja4 ,,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 7ii72 7#b7 by striking the period at the end of clause 7iii7 and inserting 1 and2 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 if1 after the qualified ,,hsa distribution is made and for the remaining duration of the plan year1 the coverage provided under the arrangement is converted solely to one or more of the following3 7,i7 ,post-deductible ,,fsa or ,,hra ,a health flexible spending arrangement or a health reimbursement arrangement 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 satisfied4 7,,ii7 ,preventative care ,a health flexible spending arrangement or a health reimbursement arrangement 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;,c74 7,,iii7 ,limited purpose health ,,fsa ,a health flexible spending arrangement 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 services74 7,,iv7 ,limited purpose ,,hra ,a health reimbursement arrangement 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 services74 7,v7 ,retirement ,,hra ,a health reimbursement arrangement 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 retirement74 7,,vi7 ,suspended ,,hra ,a health reimbursement arrangement 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 an ,,hsa-qualified health plan1 that does not pay or reimburse1 at any time1 any medical expense incurred during the suspension period except as described 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-- 7,a7 a health flexible spending arrangement under this section1 section #aje1 or section #abe1 7,b7 a health reimbursement arrangement under this section or section #aje1 or 7,c7 an accident or health plan1 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 directly to a health savings account of the employee 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 an ,,hsa-qualified health plan at the time of such distribution1 and 7,,ii7 #d1ejj in the case of an eligible individual who has family coverage under an ,,hsa-qualified health plan at the time of such distribution4 4 7e7 ,elimination of additional tax for failure ,to maintain ,,hsa-,qualified health plan coverage ,subsection 7e7 of section #ajf1 as amended by section #aja1 is amended-- 7#a7 by striking paragraph 7#c7 and redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#c7 and 7#d71 respectively2 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 arrangement1 a health reimbursement arrangement1 or an accident or health plan under this section or section #aje merely because the plan converts coverage for individuals who enroll in an ,,hsa-qualified health plan described in section #bbc7;c77#b7 to coverage described in subclause 7,i71 7,,ii71 7,,iii71 7,,iv71 7,v71 or 7,,vi7 of section #bbc7;c77#a77;,b77iv74 ,coverage for such individuals may be converted as of the date of enrollment in the ,,hsa-qualified 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 an ,,hsa-qualified 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 #bjai1 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 #bjah for calendar year #bjaf in subparagraph 7,a77ii7 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 7iii72 7#b7 by striking the period at the end of clause 7iv7 and inserting 1 and2 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 an ,,hsa-qualified 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 #djb4 ,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 #djc4 ,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 clerical1 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 #djd4 ,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 ,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 #dje4 ,maximum contribution limit to health savings account increased to amount of deductible and out-of-pocket limitation 7a7 ,self-,only coverage ,section #bbc7;b77#b77;,a7 is amended by striking #b1bej and inserting the amount in effect under subsection 7c77#b77;,a77ii77,i74 7b7 ,family ,coverage ,section #bbc7;b77#b77;,b7 is amended by striking #d1ejj and inserting the amount in effect under subsection 7c77#b77;,a77ii77,,ii74 7c7 ,conforming ,amendments ,section #bbc7;g77#a7 is amended-- 7#a7 by striking subsections 7b77#b7 and both places it appears and inserting subsection2 and 7#b7 by striking determined by in subparagraph 7,b7 thereof and all that follows through calendar year #bjjc4 and inserting determined by substituting calendar year #bjjc for calendar year #bjaf in subparagraph 7,a77ii7 thereof44 7d7 ,effective ,date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjai4 ,v ,other provisions #eja4 ,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 activity 7,a7 ,in general ,the term medical care shall include amounts paid-- 7i7 for equipment for use in a program 7including a self-directed program7 of physical exercise or physical activity1 7ii7 to participate1 or receive instruction1 in a program of physical exercise1 nutrition1 or health coaching 7including a self-directed program71 and 7iii7 for membership at a fitness facility4 7,b7 ,overall dollar limitation 7i7 ,in general ,amounts treated as medical care under subparagraph 7,a7 shall not exceed #a1jjj with respect to any individual for any taxable year4 7ii7 ,exception ,clause 7i7 shall not apply for purposes of determining whether expenses reimbursed through a health flexible spending arrangement subject to section #abe7;i77#a7 are incurred for medical care4 7,c7 ,limitations related to sports and fitness equipment ,amounts paid for equipment described in subparagraph 7,a77i7 shall be treated as medical care only-- 7i7 if such equipment is utilized exclusively for participation in fitness1 exercise1 sport1 or other physical activity programs1 7ii7 if such equipment is not apparel or footwear1 and 7iii7 in the case of any item of sports equipment 7other than exercise equipment71 with respect to so much of the amount paid for such item as does not exceed #bej4 7,d7 ,fitness facility defined ,for purposes of subparagraph 7,a77iii71 the term fitness facility means a facility-- 7i7 providing instruction in a program of physical exercise1 offering facilities for the preservation1 maintenance1 encouragement1 or development of physical fitness1 or serving as the site of such a program of a ,state or local government1 7ii7 which is not a private club owned and operated by its members1 7iii7 which does not offer golf1 hunting1 sailing1 or riding facilities1 7iv7 whose health or fitness facility is not incidental to its overall function and purpose1 and 7v7 which is fully compliant with the ,state of jurisdiction and ,federal anti-discrimination laws4 4 7b7 ,limitation not ,to apply for certain purposes 7#a7 ,health savings accounts ,subparagraph 7,a7 of section #bbc7;d77#b7 is amended by inserting 1 determined without regard to paragraph 7#ab77;,b7 thereof after medical care 7as defined in section #bac7;d74 7#b7 ,archer ,m,s,as ,subparagraph 7,a7 of section #bbj7;d77#b7 is amended by inserting 1 determined without regard to paragraph 7#ab77;,b7 thereof after medical care 7as defined in section #bac7;d74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #ejb4 ,certain nutritional and dietary supplements to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by section #eja1 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 7,d7 ,exception ,subparagraph 7,b7 shall not apply for purposes of determining whether expenses reimbursed through a health flexible spending arrangement subject to section #abe7;i77#a7 are incurred for medical care4 4 7b7 ,limitation not ,to apply for certain purposes 7#a7 ,health savings accounts ,subparagraph 7,a7 of section #bbc7;d77#b71 as amended by section #eja1 is amended by striking paragraph 7#ab77;,b7 and inserting paragraphs 7#ab77;,b7 and 7#ac77;,b74 7#b7 ,archer ,m,s,as ,subparagraph 7,a7 of section #bbj7;d77#b71 as amended by section #eja1 is amended by striking paragraph 7#ab77;,b7 and inserting paragraphs 7#ab77;,b7 and 7#ac77;,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 #ejc4 ,certain provider fees to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by sections #eja and #ejb1 is amended by adding at the end the following new paragraph3 7#ad7 ,periodic provider fees ,the term medical care shall include-- 7,a7 periodic fees paid to a primary care physician for a defined set of medical services or the right to receive medical services on an as-needed basis1 and 7,b7 pre-paid primary care services designed to screen for1 diagnose1 cure1 mitigate1 treat1 or prevent disease and promote wellness4 4 7b7 ,exception for flexible spending accounts ,section #abe is amended by redesignating subsections 7k7 and 7l7 as subsections 7l7 and 7m71 respectively1 and by inserting after subsection 7j7 the following new subsection3 7k7 ,special rule with respect to health flexible spending arrangements ,for purposes of applying this with respect to any health flexible spending arrangement1 amounts described in section #bac7;d77#ad7 shall not be considered insurance4 4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4