Springfield Office
320 W. Washington Street
Springfield, Illinois 62767
(217) 782-4515
Chicago Office
122 S. Michigan Ave., 19
th
Floor
Chicago, Illinois 60603
(312) 814-2420
Illinois Department of Insurance
JB PRITZKER
Governor
DANA POPISH SEVERINGHAUS
Acting Director
TO: All Companies Writing Accident and Health Insurance and Managed Care Plans in
Illinois
FROM: Dana Popish Severinghaus, Director
DATE: May 2, 2022
RE: Company Bulletin 2022-06
Comprehensive Update on High-Deductible Health Plans (HDHPs)
In Company Bulletin 2021-11, the Illinois Department of Insurance (“Department”) cautioned that state-
regulated, private health insurance coverage would not satisfy the criteria for a high-deductible health plan
pursuant to 26 U.S.C. § 223 if it contained policy language in compliance with 215 ILCS 134/30(d) as in
effect in 2021. Per 26 U.S.C. § 223, an individual is not eligible to contribute to a health savings account
(“HSA”) or to have an employer make contributions on their behalf unless the individual is enrolled in an
HDHP. To protect consumers from misleading information about their coverage, the Department
instructed health insurance issuers that intended to market a plan as an HDHP or for use with an HSA to
remove language compliant with 215 ILCS 134/30(d), and to remove any indicia that a plan is an HDHP
or HSA-intended if the plan fully complied with 215 ILCS 134/30(d).
Subsequently, Company Bulletin 2021-13 (revised)
announced that, in 2022, the Department temporarily
would not enforce the provisions of 215 ILCS 134/30(d) with respect to policies satisfying the definition
of a high-deductible health plan under 26 U.S.C. § 223 until the minimum deductible provided under that
statute had been met. For 2022, those minimum deductible amounts are $1,400 for self-only coverage and
$2,800 for family coverage. The Department also stated that, in the absence of a change in federal or state
law prior to the submission deadlines for the 2023 Plan Year, the Department would begin to enforce the
provisions of 215 ILCS 134/30(d).
Pursuant to [Pub. Act 102-0704
], effective April 22, 2022, to the extent that application of 215 ILCS
134/30(d) would result in HSA ineligibility under 26 U.S.C. § 223, the Illinois requirement to apply the
amount of any third-party payments, financial assistance, discount, product vouchers, or any other
reduction in out-of-pocket expenses toward a covered individual’s cost-sharing responsibility will not
apply with respect to the deductible of an HDHP until the covered individual has satisfied the minimum
deductible under 26 U.S.C. § 223. However, with respect to items or services that are preventive care
pursuant to 26 U.S.C. § 223(c)(2)(C), the Illinois requirement will apply at all times regardless of whether
the minimum deductible has been satisfied. Based on this change to 215 ILCS 134/30(d), HDHPs may
be filed and marketed in Illinois for Plan Year 2023 and for the foreseeable future. HDHPs already in
effect for the 2022 Plan Year must continue to comply with 215 ILCS 134/30(d) after the enrollee meets
the statutory minimum deductible of $1,400 for self-only coverage or $2,800 for family coverage.
Issuers should continue to ensure that plans marketed to individuals and employers as HDHPs or as HSA-
Eligible satisfy both 26 U.S.C. § 223 and Illinois state benefit requirements. To ensure the efficient
navigation of all applicable requirements, the Department offers the following:
Springfield Office
320 W. Washington Street
Springfield, Illinois 62767
(217) 782-4515
Chicago Office
122 S. Michigan Ave., 19
th
Floor
Chicago, Illinois 60603
(312) 814-2420
• To ensure that the Department properly recognizes an issuer’s basis for using a statutory
exemption, SERFF form filings should clearly identify in the cover letter which forms are intended
to be used for plans marketed as an HDHP or for use with an HSA. For large group plans, if the
policy form includes variable language dependent on whether the policy will be issued as an
HDHP, the changes in policy language should be explained in the statement of variability.
• If a plan pays partially or completely for any covered health care service, other than preventive
care, before the statutory minimum deductible set under 26 U.S.C. § 223 has been met, the plan
does not satisfy the definition of an HDHP and should not be marketed to consumers as an HDHP
or for use with an HSA. For purposes of the definition of an HDHP, “preventive care” is not limited
to “preventive health services” under Section 2713 of the Public Health Service Act but includes
additional services described by the U.S. Department of the Treasury in guidance.
• Under 215 ILCS 134/30(d), plans marketed as HDHPs or for use with an HSA must not apply any
third-party payments, financial assistance, discount, product vouchers, or any other reduction in
out-of-pocket expenses made by or on behalf of such insured for prescription drugs to the insured’s
deductible until the statutory minimum deductible set under 26 U.S.C. § 223 has been met.
Thereafter, such reductions in out-of-pocket expenses must apply toward all cost-sharing
requirements for the covered prescription drug.
• Some Illinois statutes prohibit or limit cost-sharing for a health care service that is not preventive
care under 26 U.S.C. § 223 but contain an exemption for HDHPs to the extent that compliance
with the statute would prevent HSA eligibility. Policy language for plans marketed as HDHPs or
for use with an HSA must incorporate all such exemptions when the health care service is not
preventive care in order to satisfy the definition of a high-deductible health plan, but the
exemptions only apply until the statutory minimum deductible under 26 U.S.C. § 223 has been
met. Besides 215 ILCS 134/30(d), the following provisions exempt HDHPs , which apply to non-
preventive care as listed below:
o 215 ILCS 5/356g(a) and 125/4-6.1(a) - diagnostic mammograms.
o 215 ILCS 5/356z.4(a)(4) - voluntary male sterilization.
o 215 ILCS 5/356z.23(a-5) (for policies amended, delivered, issued, or renewed after January 1,
2024 per HB 4408) - naloxone hydrochloride. Please note that subsection (a-5) only pro h ibits
the use of copayments, not deductibles, for this benefit. Any plan that imposes a pre-de duc tible
copayment for prescription drugs as a class (rather than only for specific prescription drugs)
would never satisfy the definition of a high-deductible health plan in 26 U.S.C. § 223 because,
even if the plan did not pay for the naloxone hydrocholoride before the statutory minimum
deductible had been met, the plan would pay for some expenses on other drugs that are not
preventive care before passing that threshold. As a result, the exemption in subsection (a-5)
would never apply to such plans.
o 215 ILCS 5/356u(c) (for policies amended, delivered, issued, or renewed after January 1, 2024
per HB 5318
) - follow-up tests to initial prostate cancer screenings. Because IRS Notice 2004-
23 expressly recognizes prostate cancer screenings, such as a prostate-specific antigen test, as
preventive care under 26 U.S.C. § 223, this exemption cannot apply to prostate cancer
screening tests that are initial tests, such as prostate-specific antigen tests and digital rectal
Springfield Office
320 W. Washington Street
Springfield, Illinois 62767
(217) 782-4515
Chicago Office
122 S. Michigan Ave., 19
th
Floor
Chicago, Illinois 60603
(312) 814-2420
exams. Subsequent follow-up tests that are diagnostic in nature, such as urinary analysis, serum
biomarkers, and medical imaging, may be subject to the exemption.
• The following Illinois statutes prohibit or limit cost-sharing for certain health care services that
are considered preventive care within the meaning of 26 U.S.C. § 223 but exempt HDHPs to the
extent that compliance with the statute would prevent HSA eligibility. . Because these health care
services are preventive care, compliance with the statutes would not prevent HSA eligibility.
Therefore, no exemption will be allowed for HDHPs under the following statutes:
o 215 ILCS 5/356z.37 - annual office visits for whole body skin examinations. IRS Notice 2004-
23 specifically recognizes skin cancer screenings as preventive care. Whole body skin
examinations are the only skin cancer screening test to be evaluated by the United States
Preventive Services Task Force. See
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/skin-cancer-
screening. The U.S. Department of the Treasury has affirmed in IRS Notice 2013-57 that
preventive care for purposes of 26 U.S.C. § 223 includes “anything that is preventive care
under Notice 2004-23 and Notice 2004-50 without regard to whether it would constitute
preventive care for purposes of section 2713 of the PHS Act.” Subsequent IRS guidance has
affirmed IRS Notice 2013-57.
o 215 ILCS 5/356z.43 - colonoscopies that are a follow-up to an initial screen. See Company
Bulletin 2022-02.
• With respect to 215 ILCS 134/45.3, no HDHP may be counted towards an insurance carrier’s
obligation to ensure that a minimum percentage or number of its plans have a flat-dollar copayment
structure for the entire drug benefit. The drug benefits for plans that comply with this statute will
include pre-deductible coverage for at least some drugs that are not preventive care. Therefore, the
pre-deductible application of a copayment will prevent these plans from satisfying the federal
definition of a high-deductible health plan.
• The U.S. Department of the Treasury has several publications with guidance on the requirements
for HDHPs. To the extent that issuers may wish to offer plan designs with more generous or
innovative cost-sharing provisions than Illinois law requires, the following publications assist in
determining whether a plan qualifies as an HDHP:
o Publication 969
o IRS Notice 2004-23
o IRS Notice 2004-50
o IRS Notice 2013-57
o IRS Notice 2018-12
o IRS Notice 2019-45
o FAQS About Affordable Care Act Implementation Part 40 (Aug. 26, 2019)
Questions about this Company Bulletin should be directed to DOI.InfoDesk@illinois.gov
.
