Summary

Prohibits use of tax-advantaged medical accounts and employer health reimbursements to pay for or reimburse most abortion services, while allowing narrow exceptions for abortions after rape or incest or when a physician certifies the abortion is needed to save the woman’s life or to treat a serious physical illness or injury. The rule applies to Health Savings Accounts (HSAs), Archer MSAs, flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), and certain retiree health accounts, and takes effect for taxable years beginning after December 31, 2025.

• Prohibits use of HSAs, Archer MSAs, FSAs, HRAs, and certain retiree health accounts to pay for or reimburse most abortions.
• Allows narrow exceptions for abortions resulting from rape, incest, or when a physician certifies the abortion is needed to save the woman’s life or for serious physical illness/injury.
• Applies by amending multiple sections of the Internal Revenue Code to change what counts as qualified medical expenses and permitted reimbursements.
• Effective for taxable years beginning after December 31, 2025; reimbursement prohibition applies to expenses incurred after that date.
• Requires plan sponsors and administrators to update claims/reimbursement rules and may require physician certifications for exceptions.
• Likely to increase out-of-pocket costs for abortions that are not excepted, shifting payment to individuals rather than tax-advantaged accounts.
• Does not change private insurance coverage rules outside of tax-advantaged account reimbursements, but could interact with employer plan design and state laws.
• May raise privacy and administrative issues due to required certifications and new claims-denial processes.
• Could prompt legal and policy challenges based on federal preemption, tax law interpretation, or constitutional claims (not addressed in the text).