to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provi-
sion of the Internal Revenue Code of 1986. 
(c) TABLE OF CONTENTS.—The table of contents is 
as follows: 
Sec. 1. Short title, etc. 
TITLE I—RENAMING HIGH DEDUCTIBLE HEALTH PLANS 
Sec. 101. High deductible health plans renamed HSA-qualified health plans. 
TITLE II—ENHANCING ACCESS TO TAX-PREFERRED HEALTH 
ACCOUNTS 
Sec. 201. Allow both spouses to make catch-up contributions to the same HSA 
account. 
Sec. 202. Provisions relating to Medicare. 
Sec. 203. Individuals eligible for Indian Health Service assistance. 
Sec. 204. Members of health care sharing ministries eligible to establish health 
savings accounts. 
Sec. 205. Treatment of direct primary care service arrangements. 
Sec. 206. Individuals eligible for on-site medical clinic coverage. 
Sec. 207. Treatment of embedded deductibles. 
TITLE III—IMPROVING COVERAGE UNDER TAX-PREFERRED 
HEALTH ACCOUNTS 
Sec. 301. Purchase of health insurance from HSA account. 
Sec. 302. Special rule for certain medical expenses incurred before establish-
ment of account. 
Sec. 303. Preventive care prescription drug clarification. 
TITLE IV—MISCELLANEOUS PROVISIONS RELATING TO TAX- 
PREFERRED HEALTH ACCOUNTS 
Sec. 401. FSA and HRA interaction with HSAs. 
Sec. 402. Equivalent bankruptcy protections for health savings accounts as re-
tirement funds. 
Sec. 403. Administrative error correction before due date of return. 
Sec. 404. Reauthorization of Medicaid health opportunity accounts. 
Sec. 405. Maximum contribution limit to health savings account increased to 
amount of deductible and out-of-pocket limitation. 
TITLE V—OTHER PROVISIONS 
Sec. 501. Certain exercise equipment and physical fitness programs treated as 
medical care. 
Sec. 502. Certain nutritional and dietary supplements to be treated as medical 
care. 
Sec. 503. Certain provider fees to be treated as medical care. 
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TITLE I—RENAMING HIGH 
DEDUCTIBLE HEALTH PLANS 
SEC. 101. HIGH DEDUCTIBLE HEALTH PLANS RENAMED 
HSA-QUALIFIED HEALTH PLANS. 
(a) IN GENERAL.—Section 223 is amended by strik-
ing ‘‘high deductible health plan’’ each place it appears 
and inserting ‘‘HSA-qualified health plan’’. 
(b) CONFORMING AMENDMENTS.— 
(1) The heading for paragraph (2) of section 
223(c) is amended by striking ‘‘HIGH DEDUCTIBLE 
HEALTH
PLAN’’ and inserting ‘‘HSA-QUALIFIED 
HEALTH PLAN’’. 
(2) Section 408(d)(9) is amended— 
(A) by striking ‘‘high deductible health 
plan’’ each place it appears in subparagraph 
(C) and inserting ‘‘HSA-qualified health plan’’; 
and 
(B) 
by 
striking 
‘‘HIGH
DEDUCTIBLE 
HEALTH PLAN’’ in the heading of subparagraph 
(D) and inserting ‘‘HSA-QUALIFIED
HEALTH 
PLAN’’. 
(3) Section 106(e) is amended— 
(A) 
by 
striking 
‘‘HIGH
DEDUCTIBLE 
HEALTH PLAN’’ in the heading of paragraph (3) 
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and 
inserting 
‘‘HSA-QUALIFIED
HEALTH 
PLAN’’; and 
(B) by striking ‘‘high deductible health 
plan’’ in paragraph (5)(B)(ii) and inserting 
‘‘HSA-qualified health plan’’. 
TITLE II—ENHANCING ACCESS 
TO TAX-PREFERRED HEALTH 
ACCOUNTS 
SEC. 201. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CON-
TRIBUTIONS TO THE SAME HSA ACCOUNT. 
(a) IN GENERAL.—Paragraph (5) of section 223(b) 
is amended to read as follows: 
‘‘(5) SPECIAL RULE FOR MARRIED INDIVIDUALS 
WITH FAMILY COVERAGE.— 
‘‘(A) IN GENERAL.—In the case of individ-
uals who are married to each other, 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— 
‘‘(i) the limitation under paragraph 
(1) shall be applied by not taking into ac-
count any other HSA-qualified health plan 
coverage of either spouse (and if such 
spouses both have family coverage under 
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separate HSA-qualified health plans, only 
one such coverage shall be taken into ac-
count), 
‘‘(ii) such limitation (after application 
of clause (i)) shall be reduced by the ag-
gregate amount paid to Archer MSAs of 
such spouses for the taxable year, and 
‘‘(iii) such limitation (after application 
of clauses (i) and (ii)) shall be divided 
equally between such spouses unless they 
agree on a different division. 
‘‘(B) TREATMENT
OF
ADDITIONAL
CON-
TRIBUTION AMOUNTS.—If both spouses referred 
to in subparagraph (A) have attained age 55 
before the close of the taxable year, the limita-
tion referred to in subparagraph (A)(iii) which 
is subject to division between the spouses shall 
include the additional contribution amounts de-
termined under paragraph (3) for both spouses. 
In any other case, any additional contribution 
amount determined under paragraph (3) shall 
not be taken into account under subparagraph 
(A)(iii) and shall not be subject to division be-
tween the spouses.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
SEC. 202. PROVISIONS RELATING TO MEDICARE. 
(a) INDIVIDUALS OVER AGE 65 ONLY ENROLLED IN 
MEDICARE PART A.—Paragraph (7) of section 223(b) is 
amended by adding at the end the following: ‘‘This para-
graph 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 226(a) 
of such Act.’’. 
(b) MEDICARE BENEFICIARIES PARTICIPATING
IN 
MEDICARE ADVANTAGE MSA MAY CONTRIBUTE THEIR 
OWN MONEY TO THEIR MSA.—Subsection (b) of section 
138 is amended by striking paragraph (2) and by redesig-
nating paragraphs (3) and (4) as paragraphs (2) and (3), 
respectively. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
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SEC. 203. INDIVIDUALS ELIGIBLE FOR INDIAN HEALTH 
SERVICE ASSISTANCE. 
(a) IN GENERAL.—Paragraph (1) of section 223(c) 
is amended by adding at the end the following new sub-
paragraph: 
‘‘(E) SPECIAL RULE FOR INDIVIDUALS EL-
IGIBLE
FOR
ASSISTANCE
UNDER
INDIAN 
HEALTH SERVICE PROGRAMS.—For purposes of 
subparagraph (A)(ii), an individual shall not be 
treated as covered under a health plan de-
scribed 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 organiza-
tion.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
SEC. 204. MEMBERS OF HEALTH CARE SHARING MIN-
ISTRIES ELIGIBLE TO ESTABLISH HEALTH 
SAVINGS ACCOUNTS. 
(a) IN GENERAL.—Section 223 is amended by adding 
at the end the following new subsection: 
‘‘(i) APPLICATION TO HEALTH CARE SHARING MIN-
ISTRIES.—For purposes of this section, membership in a 
health care sharing ministry (as defined in section 
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5000A(d)(2)(B)(ii)) shall be treated as coverage under an 
HSA-qualified health plan.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
SEC. 205. TREATMENT OF DIRECT PRIMARY CARE SERVICE 
ARRANGEMENTS. 
(a) IN GENERAL.—Section 223(c) is amended by 
adding at the end the following new paragraph: 
‘‘(6) 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 peri-
odic fee or payment for primary care services— 
‘‘(A) shall not be treated as a health plan 
for purposes of paragraph (1)(A)(ii), and 
‘‘(B) shall not be treated as insurance for 
purposes of subsection (d)(2)(B).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
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SEC. 206. INDIVIDUALS ELIGIBLE FOR ON-SITE MEDICAL 
CLINIC COVERAGE. 
(a) IN GENERAL.—Paragraph (1) of section 223(c), 
as amended by sections 203, is amended by adding at the 
end the following new subparagraph: 
‘‘(F) SPECIAL RULE FOR INDIVIDUALS EL-
IGIBLE
FOR
ON-SITE
MEDICAL
CLINIC
COV-
ERAGE.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A)(ii), an individual shall 
not be treated as covered under a health 
plan described in such subparagraph mere-
ly because the individual is eligible to re-
ceive 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 benefits. 
‘‘(ii) INCLUDED BENEFITS.—For pur-
poses of clause (i), the following health 
care benefits shall be considered to be ben-
efits which are not significant benefits: 
‘‘(I) Physicals and immuniza-
tions. 
‘‘(II) Injecting antigens provided 
by employees. 
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‘‘(III) Medications available with-
out a prescription, such as pain reliev-
ers and antihistamines. 
‘‘(IV) Treatment for injuries oc-
curring at the employer’s place of em-
ployment or otherwise in the course of 
employment. 
‘‘(V) Tests for infectious diseases 
and conditions, such as streptococcal 
sore throat. 
‘‘(VI) Monitoring of chronic con-
ditions, such as diabetes. 
‘‘(VII) Drug testing. 
‘‘(VIII) 
Hearing 
or 
vision 
screenings and related services. 
‘‘(IX) Other services and treat-
ments of a similar nature to the serv-
ices 
described 
in 
subclauses 
(I) 
through (VIII). 
‘‘(iii) 
AGGREGATION
RULES.—For 
purposes of clause (i), all persons treated 
as a single employer under subsection (b), 
(c), (m), or (o) of section 414 shall be 
treated as a single employer.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
SEC. 207. TREATMENT OF EMBEDDED DEDUCTIBLES. 
(a) IN GENERAL.—Paragraph (2) of section 223(c) 
is amended by adding at the end the following new sub-
paragraph: 
‘‘(H) TREATMENT
OF
EMBEDDED
DE-
DUCTIBLE.—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 
(A)(i)(II) shall not fail to be treated as an 
HSA-qualified health plan solely because it cov-
ers expenses with respect to an individual under 
that plan that exceed an embedded deductible 
which is equal to or in excess of the amount de-
scribed in subparagraph (A)(i)(I).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
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TITLE 
III—IMPROVING 
COV-
ERAGE 
UNDER 
TAX-PRE-
FERRED HEALTH ACCOUNTS 
SEC. 301. PURCHASE OF HEALTH INSURANCE FROM HSA 
ACCOUNT. 
(a) IN GENERAL.—Paragraph (2) of section 223(d) 
is amended— 
(1) by striking ‘‘and any dependent (as defined 
in section 152, determined without regard to sub-
sections (b)(1), (b)(2), and (d)(1)(B) thereof) of 
such individual’’ in subparagraph (A) and inserting 
‘‘any dependent (as defined in section 152, deter-
mined without regard to subsections (b)(1), (b)(2), 
and (d)(1)(B) thereof) of such individual, and any 
child (as defined in section 152(f)(1)) of such indi-
vidual who has not attained the age of 27 before the 
end of such individual’s taxable year’’; 
(2) by striking subparagraph (B) and inserting 
the following: 
‘‘(B) HEALTH
INSURANCE
MAY
NOT
BE 
PURCHASED FROM ACCOUNT.—Except as pro-
vided in subparagraph (C), subparagraph (A) 
shall not apply to any payment for insurance.’’; 
and 
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‘‘(i) if such equipment is utilized ex-
clusively for participation in fitness, exer-
cise, sport, or other physical activity pro-
grams, 
‘‘(ii) if such equipment is not apparel 
or footwear, and 
‘‘(iii) in the case of any item of sports 
equipment (other than exercise equip-
ment), with respect to so much of the 
amount paid for such item as does not ex-
ceed $250. 
‘‘(D) FITNESS
FACILITY
DEFINED.—For 
purposes of subparagraph (A)(iii), the term ‘fit-
ness facility’ means a facility— 
‘‘(i) providing instruction in a pro-
gram of physical exercise, offering facilities 
for the preservation, maintenance, encour-
agement, or development of physical fit-
ness, or serving as the site of such a pro-
gram of a State or local government, 
‘‘(ii) which is not a private club owned 
and operated by its members, 
‘‘(iii) which does not offer golf, hunt-
ing, sailing, or riding facilities, 
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