Notice 2013-54 defines HRA as an arrangement that is funded solely by an employer and that reimburses an employee for medical care expenses (as defined under Code § 213(d)) incurred by the employee, or his spouse, dependents, and any children who, as of the end of the taxable year, have not attained age 27, up to a maximum dollar amount for a coverage period. Notice 2013-54 references IRS Notice 2002-45 and Revenue Ruling 2002-41. 

It notes that HRAs are exempt from the prohibition on annual dollar limits and cost sharing for preventive benefits if it is integrated with the employer's group health plan, of that of a spouse's employer, which meet these rules. Absent this interpretation, HRAs would generally be impossible to maintain.

An executive physical reimbursement plan under Reg. 1.105-11(g) is limited solely to employees and cannot include dependents or spouses. It is not subject to the tax rules governing self-insured medical expense reimbursement plans. 

On the other hand, Notice 2002-45 says that "to the extent an HRA is a self-insured medical expense reimbursement plan, the nondiscrimination rules under § 105(h) apply to the HRA."  Thus, Notice 2013-54 distinguishes between HRAs that are medical expense reimbursement plans and the executive physical reimbursement plan. 

In addition, the IRS differentiates diagnostic services in defining health care services, likely because compared to treatment expenses, they are minor and do not provide significant medical benefits in the treatment of a disease. 

Notice 2004-23 provides a safe harbor for preventive care benefits allowed to be provided by a high deductible health plan (HDHP) without satisfying the minimum deductible under section 223(c)(2) of the Code.  

Indeed, Notice 2004-50 Q&A 26 indicates that preventive care benefits are defined broadly and that it even includes the treatment of a related condition during that procedure comes within the safe harbor for preventive care in Notice 2004-23 where it would be unreasonable or impracticable to perform another procedure to treat the condition.

For example, removal of polyps during a diagnostic colonoscopy is preventive care that can be provided before the deductible in an HDHP has been satisfied. 

Finally, Notice 2013-54 does not alter Rev. Rul. 61-146, which allows the payment of medical expenses income tax-free to employees with employer deductible dollars.

Additionally, the logic of Notice 2013-54[3] is helpful because it provides that Employee Assistance Plans are not subject to healthcare reform as long as they do not provide significant benefits in the nature of medical care or treatment.

Excluding executive diagnostic and physical programs from healthcare reform requirements is therefore consistent with the treatment of EAPs under Notice 2013-54.