,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #ab  ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$
 ,,/ates  ,janu>y #c1 #bjai,mr4 ,rubio  
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,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 ! ,heal? ,sav+s ,act (    
#bjai4  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--,r5am+ high d$uctible heal?         
plans,sec4 #aja4 ,high d$uctible heal?  
plans r5am$ ,,hsa-qualifi$ heal?        
plans4,,title ,,ii--,enhanc+ access to  

tax-pref]r$ heal? accounts,sec4 #bja4   
,all[ bo? sp\ses to make cat*-up        
contributions to ! same ,,hsa           
acc\nt4,sec4 #bjb4 ,provisions relat+ to
 ,m$ic>e4,sec4 #bjc4 ,individuals       
eligible = ,indian ,heal? ,s]vice       
assi/ance4,sec4 #bjd4 ,memb]s ( heal?   
c>e %>+ m9i/ries eligible to e/abli%    
heal? sav+s acc\nts4,sec4 #bje4         
,treatm5t ( direct prim>y c>e s]vice    
arrangem5ts4,sec4 #bjf4 ,individuals    
eligible = on-site m$ical cl9ic         
cov]age4,sec4 #bjg4 ,treatm5t ( emb$d$  
d$uctibles4,,title ,,iii--,improv+      
cov]age "u tax-pref]r$ heal?            
accounts,sec4 #cja4 ,all[ance (         
di/ributions = prescription &           
ov]-!-c\nt] m$ic9es & drugs4,sec4 #cjb4 
,pur*ase ( heal? insurance f ,,hsa      
acc\nt4,sec4 #cjc4 ,special rule = c]ta9
 m$ical exp5ses incurr$ be=e e/abli%m5t 
( acc\nt4,sec4 #cjd4 ,prev5tive c>e     
prescription drug cl>ification4,,title  
,,iv--,miscellane\s provisions relat+ to
 tax-pref]r$ heal? accounts,sec4 #dja4  

,,fsa & ,,hra int]action ) ,h,s,as4,sec4
 #djb4 ,equival5t bankruptcy protections
 = heal? sav+s acc\nts z retirem5t      
funds4,sec4 #djc4 ,adm9i/rative error   
correction be=e due date ( return4,sec4 
#djd4 ,reau?orization ( ,m$icaid heal?  
opportunity acc\nts4,sec4 #dje4 ,maximum
 contribution limit to heal? sav+s      
acc\nt increas$ to am\nt ( d$uctible &  
out-(-pocket limitation4,,title ,v--,o!r
 provisions,sec4 #eja4 ,c]ta9 ex]cise   
equipm5t & physical fitness programs    
treat$ z m$ical c>e4,sec4 #ejb4 ,c]ta9  
nutritional & diet>y supplem5ts to be   
treat$ z m$ical c>e4,sec4 #ejc4 ,c]ta9  
provid] fees to be treat$ z m$ical c>e4 
,i ,r5am+ high d$uctible heal? plans    
#aja4 ,high d$uctible heal? plans r5am$ 
,,hsa-qualifi$ heal? plans  7a7 ,9 g5]al
 ,section #bbc 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 ,! head+ =      
p>agraph 7#b7 ( section #bbc7;c7 is     
am5d$ by /rik+ ,high d$uctible heal?    

plan & ins]t+ ,,hsa-qualifi$ heal? plan4
  7#b7 ,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? plan2 &     
7,b7 by /rik+ ,high d$uctible heal? plan
 9 ! head+ ( subp>agraph 7,d7 & ins]t+  
,,hsa-qualifi$ heal? plan4  7#c7        
,section #ajf7;e7 is am5d$-- 7,a7 by    
/rik+ ,high d$uctible heal? plan 9 !    
head+ ( p>agraph 7#c7 & ins]t+          
,,hsa-qualifi$ heal? plan2 &  7,b7 by   
/rik+ high d$uctible heal? plan 9       
p>agraph 7#e77;,b77iii7 & ins]t+        
,,hsa-qualifi$ heal? plan4  ,,ii        
,enhanc+ access to tax-pref]r$ heal?    
acc\nts  #bja4 ,all[ bo? sp\ses to make 
cat*-up contributions to ! same ,,hsa   
acc\nt  7a7 ,9 g5]al ,p>agraph 7#e7 (   
section #bbc7;b7 is am5d$ to read z     
foll[s3  7#e7 ,special rule = m>ri$     
individuals ) family cov]age  7,a7 ,9   
g5]al ,9 ! case ( individuals :o are    
m>ri$ to ea* o!r1 if bo? sp\ses are     
eligible individuals & ei!r sp\se has   

family cov]age "u an ,,hsa-qualifi$     
heal? plan z ( ! fir/ day ( any mon?--  
7i7 ! limitation "u p>agraph 7#a7 %all  
be appli$ by n tak+ into acc\nt any o!r 
,,hsa-qualifi$ heal? plan cov]age ( ei!r
 sp\se 7& if su* sp\ses bo? h family    
cov]age "u sep>ate ,,hsa-qualifi$ heal? 
plans1 only "o su* cov]age %all be tak5 
into acc\nt71  7ii7 su* limitation 7aft]
 application ( clause 7i77 %all be r$uc$
 by ! aggregate am\nt paid to ,ar*]     
,m,s,as ( su* sp\ses = ! taxable ye>1 & 
7iii7 su* limitation 7aft] application (
 clauses 7i7 & 7ii77 %all be divid$     
equally betwe5 su* sp\ses unless !y     
agree on a diff]5t division4  7,b7      
,treatm5t ( additional contribution     
am\nts ,if bo? sp\ses ref]r$ to 9       
subp>agraph 7,a7 h atta9$ age #ee be=e !
 close ( ! taxable ye>1 ! limitation    
ref]r$ to 9 subp>agraph 7,a77iii7 :i* is
 subject to division betwe5 ! sp\ses    
%all include ! additional contribution  
am\nts det]m9$ "u p>agraph 7#c7 = bo?   
sp\ses4 ,9 any o!r case1 any additional 

contribution am\nt det]m9$ "u p>agraph  
7#c7 %all n be tak5 into acc\nt "u      
subp>agraph 7,a77iii7 & %all n be       
subject to division betwe5 ! sp\ses4  4 
7b7 ,effective date ,! am5dm5t made by  
?is section %all apply to taxable ye>s  
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #bjb4 ,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;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  #bjc4 ,individuals
 eligible = ,indian ,heal? ,s]vice      
assi/ance  7a7 ,9 g5]al ,p>agraph 7#a7 (
 section #bbc7;c7 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  #bjd4 ,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 an ,,hsa-qualifi$ heal?   
plan4  4  7b7 ,effective date ,! am5dm5t
 made by ?is section %all apply to      
taxable ye>s beg9n+ aft] ! date ( !     
enactm5t ( ?is ,act4  #bje4 ,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 or paym5t = prim>y
 c>e s]vices--  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  #bjf4 ,individuals
 eligible = on-site m$ical cl9ic cov]age
  7a7 ,9 g5]al ,p>agraph 7#a7 ( section 
#bbc7;c71 z am5d$ by sections #bjc1 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,e7 ,special rule =      
individuals eligible = on-site m$ical   
cl9ic cov]age  7i7 ,9 g5]al ,= purposes 
( subp>agraph 7,a77ii71 an individual   
%all n be treat$ z cov]$ "u a heal? plan
 describ$ 9 su* subp>agraph m]ely       
because ! individual is eligible to     
receive heal? c>e b5efits f an on-site  
m$ical cl9ic ( employ] ( ! individual or
 ! individual's sp\se if su* heal? c>e  
b5efits are n significant b5efits4  7ii7
 ,includ$ b5efits ,= purposes ( clause  
7i71 ! foll[+ heal? c>e b5efits %all be 
consid]$ to be b5efits :i* are n        
significant b5efits3  7,i7 ,physicals & 
immunizations4  7,,ii7 ,inject+ antig5s 
provid$ by employees4  7,,iii7          
,m$ications available )\t a             

prescription1 su* z pa9 reliev]s &      
antihi/am9es4  7,,iv7 ,treatm5t =       
injuries occurr+ at ! employ]'s place ( 
employm5t or o!rwise 9 ! c\rse (        
employm5t4  7,v7 ,te/s = infecti\s      
diseases & conditions1 su* z            
/reptococcal sore ?roat4  7,,vi7        
,monitor+ ( *ronic conditions1 su* z    
diabetes4  7,,vii7 ,drug te/+4  7,,viii7
 ,he>+ or vision scre5+s & relat$       
s]vices4  7,,ix7 ,o!r s]vices &         
treatm5ts ( a simil> nature to ! s]vices
 describ$ 9 subclauses 7,i7 ?r\gh       
7,,viii74  7iii7 ,aggregation rules ,=  
purposes ( clause 7i71 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 ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #bjg4 ,treatm5t ( emb$d$         
d$uctibles  7a7 ,9 g5]al ,p>agraph 7#b7 
( section #bbc7;c7 is am5d$ by add+ at !
 end ! foll[+ new subp>agraph3  7,e7    

,treatm5t ( emb$d$ d$uctible ,a heal?   
plan provid+ family cov]age t has an    
annual d$uctible = all cov]$ individuals
 "u ! plan ( at lea/ ! am\nt describ$ 9 
subp>agraph 7,a77i77,,ii7 %all n fail to
 be treat$ z an ,,hsa-qualifi$ heal?    
plan solely because x cov]s exp5ses )   
respect to an individual "u t plan t    
exce$ an emb$d$ d$uctible :i* is equal  
to or 9 excess ( ! am\nt describ$ 9     
subp>agraph 7,a77i77,i74  4  7b7        
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  ,,iii ,improv+ cov]age "u        
tax-pref]r$ heal? acc\nts  #cja4        
,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$ical        
exp5ses4  4  7d7 ,effective dates  7#a7 
,di/ributions f sav+s acc\nts ,!        
am5dm5ts made by subsections 7a7 & 7b7  
%all apply to am\nts paid 9 taxable ye>s
 beg9n+ aft] ,decemb] #ca1 #bjai4  7#b7 
,reimbursem5ts ,! am5dm5t made by       
subsection 7c7 %all apply to exp5ses    
incurr$ 9 plan ye>s beg9n+ aft] ,decemb]
 #ca1 #bjai4  #cjb4 ,pur*ase ( heal?    
insurance f ,,hsa acc\nt  7a7 ,9 g5]al  
,p>agraph 7#b7 ( section #bbc7;d71 z    
am5d$ by section #cja1 is am5d$-- 7#a7  
by /rik+ & any dep5d5t 7z def9$ 9       

section #aeb1 det]m9$ )\t reg>d to      
subsections 7b77#a71 7b77#b71 &         
7d77#a77;,b7 !re(7 ( su* individual 9   
subp>agraph 7,a7 & ins]t+ any dep5d5t 7z
 def9$ 9 section #aeb1 det]m9$ )\t reg>d
 to subsections 7b77#a71 7b77#b71 &     
7d77#a77;,b7 !re(7 ( su* individual1 &  
any *ild 7z def9$ 9 section             
#aeb7;f77#a77 ( su* individual :o has n 
atta9$ ! age ( #bg be=e ! end ( su*     
individual's taxable ye>2  7#b7 by /rik+
 subp>agraph 7,b7 & ins]t+ ! foll[+3    
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  2 &  7#c7 by   
/rik+ or at ! end ( subp>agraph         
7,c77iii7 & by /rik+ subp>agraph        
7,c77iv7 & ins]t+ ! foll[+3  7iv7 an    
,,hsa-qualifi$ 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 ,! am5dm5ts made by ?is 

section %all apply ) respect to         
insurance pur*as$ aft] ! date ( !       
enactm5t ( ?is ,act 9 taxable ye>s      
beg9n+ aft] su* date4  #cjc4 ,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;d7 is    
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,d7 ,treatm5t ( c]ta9    
m$ical exp5ses incurr$ be=e e/abli%m5t (
 acc\nt ,if a heal? sav+s acc\nt is     
e/abli%$ dur+ ! #fj-;day p]iod beg9n+ on
 ! date t cov]age ( ! acc\nt b5efici>y  
"u an ,,hsa-qualifi$ heal? plan beg9s1  
!n1 solely = purposes ( det]m9+ :e!r an 
am\nt paid is us$ = a qualifi$ m$ical   
exp5se1 su* acc\nt %all be treat$ z hav+
 be5 e/abli%$ on ! date t su* cov]age   
beg9s4  4  7b7 ,effective date ,!       
am5dm5t made by ?is section %all apply )
 respect to cov]age beg9n+ aft] ! date (
 ! enactm5t ( ?is ,act4  #cjd4          
,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 #bjai4  ,,iv  
,miscellane\s provisions relat+ to      
tax-pref]r$ heal? acc\nts  #dja4 ,,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$--  7#a7 by
 /rik+ & at ! end ( clause 7ii72  7#b7  
by /rik+ ! p]iod at ! end ( clause 7iii7
 & ins]t+ 1 &2 &  7#c7 by ins]t+ aft]   
clause 7iii7 ! foll[+ new clause3  7iv7 
cov]age "u a heal? flexible sp5d+       
arrangem5t or a heal? reimbursem5t      
arrangem5t 9 ! plan ye> a qualifi$ ,,hsa
 di/ribution z describ$ 9 section       
#ajf7;e7 is made on behalf ( !          

individual if1 aft] ! qualifi$ ,,hsa    
di/ribution is made & = ! rema9+        
duration ( ! plan ye>1 ! cov]age provid$
 "u ! arrangem5t is conv]t$ solely to "o
 or m ( ! foll[+3  7,i7 ,po/-d$uctible  
,,fsa or ,,hra ,a heal? flexible sp5d+  
arrangem5t or a heal? reimbursem5t      
arrangem5t t does n pay or reimburse any
 m$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$4  7,,ii7 ,prev5tative 
c>e ,a heal? flexible sp5d+ arrangem5t  
or a heal? reimbursem5t arrangem5t t1   
aft] ! qualifi$ ,,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;,c74       
7,,iii7 ,limit$ purpose heal? ,,fsa ,a  
heal? flexible sp5d+ arrangem5t 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]vices74   
7,,iv7 ,limit$ purpose ,,hra ,a heal?   
reimbursem5t arrangem5t 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]vices74  7,v7
 ,retirem5t ,,hra ,a heal? reimbursem5t 
arrangem5t 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 retirem5t74  7,,vi7        
,susp5d$ ,,hra ,a heal? reimbursem5t    
arrangem5t 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 an            
,,hsa-qualifi$ heal? plan1 t does n pay 
or reimburse1 at any "t1 any m$ical     
exp5se incurr$ dur+ ! susp5sion p]iod   
except z describ$ 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-- 7,a7 a heal? flexible sp5d+  
arrangem5t "u ?is section1 section #aje1
 or section #abe1  7,b7 a heal?         
reimbursem5t arrangem5t "u ?is section  
or section #aje1 or  7,c7 an accid5t or 
heal? plan1  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 directly to a heal? sav+s    
acc\nt ( ! employee 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  
an ,,hsa-qualifi$ heal? plan at ! "t (  
su* di/ribution1 &  7,,ii7 #d1ejj 9 !   
case ( an eligible individual :o has    
family cov]age "u an ,,hsa-qualifi$     
heal? plan at ! "t ( su* di/ribution4  4
  7e7 ,elim9ation ( additional tax =    
failure ,to ma9ta9 ,,hsa-,qualifi$ heal?
 plan cov]age ,subsection 7e7 ( section 
#ajf1 z am5d$ by section #aja1 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 respectively2 &  
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+ arrangem5t1 a heal?
 reimbursem5t arrangem5t1 or an accid5t 
or heal? plan "u ?is section or section 
#aje m]ely because ! plan conv]ts       
cov]age = individuals :o enroll 9 an    
,,hsa-qualifi$ heal? plan describ$ 9    
section #bbc7;c77#b7 to cov]age describ$
 9 subclause 7,i71 7,,ii71 7,,iii71     
7,,iv71 7,v71 or 7,,vi7 ( section       
#bbc7;c77#a77;,b77iv74 ,cov]age = su*   
individuals may be conv]t$ z ( ! date ( 
enrollm5t 9 ! ,,hsa-qualifi$ 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 an ,,hsa-qualifi$ 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] #bjai1 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> #bjah =   
cal5d> ye> #bjaf 9 subp>agraph 7,a77ii7 
!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$--  7#a7 by /rik+ & at 
! end ( clause 7iii72  7#b7 by /rik+ !  
p]iod at ! end ( clause 7iv7 & ins]t+ 1 
&2 &  7#c7 by ins]t+ aft] clause 7iv7 ! 
foll[+ new clause3  7v7 any cov]age     
7includ+ prospective cov]age7 "u a heal?
 plan t is n an ,,hsa-qualifi$ 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  #djb4 ,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  #djc4 ,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]ical1 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$4  4  7b7 ,effective date ,!     
am5dm5t made by ?is section %all take   
effect on ! date ( ! enactm5t ( ?is     
,act4  #djd4 ,reau?orization ( ,m$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 ,! ,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$4  #dje4 ,maximum      
contribution limit to heal? sav+s acc\nt
 increas$ to am\nt ( d$uctible &        
out-(-pocket limitation  7a7 ,self-,only
 cov]age ,section #bbc7;b77#b77;,a7 is  
am5d$ by /rik+ #b1bej & ins]t+ ! am\nt 9
 effect "u subsection                   
7c77#b77;,a77ii77,i74  7b7 ,family      
,cov]age ,section #bbc7;b77#b77;,b7 is  
am5d$ by /rik+ #d1ejj & ins]t+ ! am\nt 9
 effect "u subsection                   
7c77#b77;,a77ii77,,ii74  7c7 ,con=m+    
,am5dm5ts ,section #bbc7;g77#a7 is      
am5d$--  7#a7 by /rik+ subsections      
7b77#b7 & bo? places x appe>s & ins]t+  
subsection2 &  7#b7 by /rik+ det]m9$ by 
9 subp>agraph 7,b7 !re( & all t foll[s  
?r\gh cal5d> ye> #bjjc4 & ins]t+ det]m9$

 by sub/itut+ cal5d> ye> #bjjc = cal5d> 
ye> #bjaf 9 subp>agraph 7,a77ii7 !re(44 
7d7 ,effective ,date ,! am5dm5ts made by
 ?is section %all apply to taxable ye>s 
beg9n+ aft] ,decemb] #ca1 #bjai4  ,v    
,o!r provisions  #eja4 ,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 activity  7,a7 ,9 g5]al ,! t]m  
m$ical c>e %all include am\nts paid--   
7i7 = equipm5t = use 9 a program        
7includ+ a self-direct$ program7 (      
physical ex]cise or physical activity1  
7ii7 to p>ticipate1 or receive          
in/ruction1 9 a program ( physical      
ex]cise1 nutrition1 or heal? coa*+      
7includ+ a self-direct$ program71 &     
7iii7 = memb]%ip at a fitness facility4 
7,b7 ,ov]all doll> limitation  7i7 ,9   
g5]al ,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  7ii7 ,exception ,clause 7i7 %all n
 apply = purposes ( det]m9+ :e!r exp5ses
 reimburs$ ?r\gh a heal? flexible sp5d+ 
arrangem5t subject to section           
#abe7;i77#a7 are incurr$ = m$ical c>e4  
7,c7 ,limitations relat$ to sports &    
fitness equipm5t ,am\nts paid = equipm5t
 describ$ 9 subp>agraph 7,a77i7 %all be 
treat$ z m$ical c>e only--  7i7 if su*  
equipm5t is utiliz$ exclusively =       
p>ticipation 9 fitness1 ex]cise1 sport1 
or o!r physical activity programs1  7ii7
 if su* equipm5t is n app>el or footwe>1
 &  7iii7 9 ! case ( any item ( sports  
equipm5t 7o!r ?an ex]cise equipm5t71 )  
respect to s mu* ( ! am\nt paid = su*   
item z does n exce$ #bej4  7,d7 ,fitness
 facility def9$ ,= purposes (           
subp>agraph 7,a77iii71 ! t]m fitness    
facility means a facility--  7i7 provid+
 in/ruction 9 a program ( physical      
ex]cise1 (f]+ facilities = !            
pres]vation1 ma9t5ance1 enc\ragem5t1 or 
developm5t ( physical fitness1 or s]v+ z
 ! site ( su* a program ( a ,/ate or    

local gov]nm5t1  7ii7 :i* is n a private
 club own$ & op]at$ by its memb]s1      
7iii7 :i* does n (f] golf1 hunt+1 sail+1
 or rid+ facilities1  7iv7 ^: heal? or  
fitness facility is n incid5tal to its  
ov]all function & purpose1 &  7v7 :i* is
 fully compliant ) ! ,/ate (            
jurisdiction & ,f$]al anti-discrim9ation
 laws4  4  7b7 ,limitation n ,to apply =
 c]ta9 purposes  7#a7 ,heal? sav+s      
acc\nts ,subp>agraph 7,a7 ( section     
#bbc7;d77#b7 is am5d$ by ins]t+ 1       
det]m9$ )\t reg>d to p>agraph 7#ab77;,b7
 !re( aft] m$ical c>e 7z def9$ 9 section
 #bac7;d74  7#b7 ,ar*] ,m,s,as          
,subp>agraph 7,a7 ( section #bbj7;d77#b7
 is am5d$ by ins]t+ 1 det]m9$ )\t reg>d 
to p>agraph 7#ab77;,b7 !re( aft] m$ical 
c>e 7z def9$ 9 section #bac7;d74  7c7   
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4  #ejb4 ,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 #eja1 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  
7,d7 ,exception ,subp>agraph 7,b7 %all n
 apply = purposes ( det]m9+ :e!r exp5ses
 reimburs$ ?r\gh a heal? flexible sp5d+ 
arrangem5t subject to section           

#abe7;i77#a7 are incurr$ = m$ical c>e4  
4  7b7 ,limitation n ,to apply = c]ta9  
purposes  7#a7 ,heal? sav+s acc\nts     
,subp>agraph 7,a7 ( section             
#bbc7;d77#b71 z am5d$ by section #eja1  
is am5d$ by /rik+ p>agraph 7#ab77;,b7 & 
ins]t+ p>agraphs 7#ab77;,b7 &           
7#ac77;,b74  7#b7 ,ar*] ,m,s,as         
,subp>agraph 7,a7 ( section             
#bbj7;d77#b71 z am5d$ by section #eja1  
is am5d$ by /rik+ p>agraph 7#ab77;,b7 & 
ins]t+ p>agraphs 7#ab77;,b7 &           
7#ac77;,b74  7c7 ,effective date ,!     
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ! date ( !  
enactm5t ( ?is ,act4  #ejc4 ,c]ta9      
provid] fees to be treat$ z m$ical c>e  
7a7 ,9 g5]al ,subsection 7d7 ( section  
#bac1 z am5d$ by sections #eja & #ejb1  
is am5d$ by add+ at ! end ! foll[+ new  
p>agraph3  7#ad7 ,p]iodic provid] fees  
,! t]m m$ical c>e %all include-- 7,a7   
p]iodic fees paid to a prim>y c>e       
physician = a def9$ set ( m$ical s]vices
 or ! "r to receive m$ical s]vices on an

 z-ne$$ basis1 &  7,b7 pre-paid prim>y  
c>e s]vices design$ to scre5 =1         
diagnose1 cure1 mitigate1 treat1 or     
prev5t disease & promote wellness4  4   
7b7 ,exception = flexible sp5d+ acc\nts 
,section #abe is am5d$ by r$esignat+    
subsections 7k7 & 7l7 z subsections 7l7 
& 7m71 respectively1 & by ins]t+ aft]   
subsection 7j7 ! foll[+ new subsection3 
7k7 ,special rule ) respect to heal?    
flexible sp5d+ arrangem5ts ,= purposes (
 apply+ ?is ) respect to any heal?      
flexible sp5d+ arrangem5t1 am\nts       
describ$ 9 section #bac7;d77#ad7 %all n 
be consid]$ insurance4  4  7c7          
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act4