HSA Enhancements


Since their inception, health savings accounts (HSAs) paired with high-deductible health plans (HDHPs) have increasingly been plan designs adopted by employers. At this point, 92% of surveyed Business Group members report offering an HSA/HDHP arrangement to employees. We believe that the HSA/HDHP design—and the rules governing that design—will continue to play a significant role in the delivery of employer-sponsored health coverage.

As employers focus on providing high-quality, evidence-based benefits while lowering the overall cost of care, they have struggled with certain limitations of the HSA rules. Specifically, employers should be able to cover certain evidence-based benefits such as chronic care management and certain preventive medications before employees satisfy their HSA/HDHP deductibles.


Additional flexibility in HSA rules would allow HSA/HDHP arrangements to deliver on the design’s underlying goals—more efficient health care purchasing and increased patient engagement in health care decisions. Specifically, we support:

  • Employees’ continued ability to maintain and contribute to HSAs—the only fully portable, tax-advantaged savings vehicle for health care expenses currently available;
  • The ability to cover chronic condition management services before employees satisfy their deductibles;
  • The ability to cover onsite clinic services, telehealth, and other lower cost alternative sources of health care before employees satisfy their deductibles;
  • The ability to cover medications that manage chronic conditions before employees satisfy their deductibles;
  • The ability to use HSA dollars for fitness, wellness, and similar activities to maintain health, and
  • Flexibility to adjust how deductibles apply to certain higher-cost items or services, such as those that involve copayment assistance or copayment waivers.

We also support greater transparency in health care prices, which will enable employees to fully engage in health care purchases and decision-making.


  • Rising health care costs continue to be a major concern for employers, and HSA/HDHP arrangements remain a valuable tool for containing those costs.
  • Surveyed Business Group members identify high-cost claimants, specialty medications, and specific diseases/conditions as the most significant health care cost drivers. Having viable methods to address these costs will be critical to maintaining the utility of HSA/HDHP and other group health arrangements.

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