By: HUB's EB Compliance Team

The IRS recently released Notice 2026-5, providing guidance on the expanded Health Savings Account (“HSA”) rules under the One, Big, Beautiful Bill Act (“OBBBA”), enacted July 4, 2025. The guidance addresses telehealth services, direct primary care arrangements and individual market coverage. The Notice does not break much new ground, but a few provisions are worth noting.

Telehealth Safe Harbor Made Permanent

The OBBBA permanently extends the telehealth safe harbor that allows High Deductible Health Plans (“HDHPs”) to cover telehealth and remote care services before the deductible without disqualifying participants from HSA eligibility. This applies retroactively to plan years beginning after December 31, 2024, meaning individuals enrolled in HDHPs with pre-deductible telehealth in early 2025 remain HSA-eligible.

In the Notice, the IRS clarified that qualifying telehealth services are those on the Medicare telehealth services list published annually by HHS. This creates another potential list that employers and their service providers need to track if they intend to allow telehealth for these purposes. The Notice also states that the safe harbor does not extend to in-person services, medical equipment or prescription drugs furnished in connection with a telehealth visit, which was as expected.

Direct Primary Care Service Arrangements

Beginning in 2026, individuals enrolled in qualifying Direct Primary Care Service Arrangements (“DPCSAs”) will no longer be disqualified from HSA eligibility. To qualify, a DPCSA must provide only primary care services from primary care practitioners (physicians in family medicine, internal medicine, geriatric medicine or pediatric medicine, plus nurse practitioners, clinical nurse specialists and physician assistants) for a fixed periodic fee.

Additionally, the services cannot include procedures requiring general anesthesia, prescription drugs (other than vaccines) or laboratory services not typically administered in an ambulatory primary care setting. Monthly fee limits apply: $150 for individual coverage or $300 for coverage of more than one person, adjusted for inflation starting in 2027.

The IRS provides several clarifications including:

  • Arrangements that bill separately beyond the fixed fee generally do not qualify unless the separate service is offered for the same charge to both members and non-members in the DPCSA.
  • Whether an arrangement qualifies depends on its terms, not how an individual uses it.
  • HDHPs cannot pay DPCSA fees before the deductible and by extension DPCSA fees do not count toward the HDHP deductible or out-of-pocket maximum.
  • However, HSAs can now reimburse DPCSA fees as qualified medical expenses, though employer-paid fees (including salary reduction) are not reimbursable.

Bronze and Catastrophic Plans

The OBBBA also treats bronze and catastrophic plans available through an ACA Exchange as HDHPs for months beginning after December 31, 2025, even if they do not meet traditional HDHP deductible or out-of-pocket limits. Notice 2026-5 provides additional details on this provision, although it is not expected to have much, if any, impact on employer plans.

Conclusion

Employers sponsoring HDHPs should review their plan designs to ensure any pre-deductible telehealth benefits align with the Medicare telehealth list. Those considering DPCSA offerings should carefully evaluate whether arrangements meet the statutory requirements to avoid inadvertently disqualifying employees from HSA contributions.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.

Neither HUB International Limited nor any of its affiliated companies is a law or accounting firm, and therefore, they cannot provide legal or tax advice. The information herein is provided for general information only and is not intended to constitute legal or tax advice as to an organization's or individual's specific circumstances. It is based on HUB International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect, and HUB International does not have an obligation to update this information.