medical expenses means, with respect to an account beneficiary, amounts paid by such beneficiary for medical care, but only to the extent such amounts are not compensated for by insurance or otherwise— (i) for— (I) such individual, (II) the spouse of such individual, (III) any dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof) of such individual, and (IV) any individual who bears a relationship to the account beneficiary that is described in subparagraph (C) or (D) of section 152(d) if the account beneficiary is or was a dependent of such individual for any taxable year ending before or with the taxable year in which the individual attained 18 years of age, and (ii) if, on the date such medical care was provided, such individual, spouse or dependent to whom such care was provided was covered under the qualified health insurance of the account beneficiary. (B) Modified definition of medical care For purposes of subparagraph (A), the term medical care has the meaning given such term by section 213(d), except that such term includes— (i) direct pay arrangements with primary physicians, and (ii) predetermined level of access to care from an integrated health plan. (3) Account beneficiary The term account beneficiary means the individual on whose behalf the Medisave account was established. (4) Certain rules to apply Rules similar to the following rules shall apply for purposes of this section: (A) Section 219(d)(2) (relating to no deduction for rollovers). (B) Section 219(f)(3) (relating to time when contributions deemed made). (C) Except as provided in section 106(d), section 219(f)(5) (relating to employer payments). (D) Section 408(g) (relating to community property laws). (E) Section 408(h) (relating to custodial accounts). (b) Limitations (1) Annual limitation (A) In general The limitation amount specified in this paragraph is— (i) $10,000 in the case of a qualified health plan with an actuarial value of less than 55 percent, (ii) $8,600 in the