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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4414 Engrossed in House (EH)]

113th CONGRESS
  2d Session
                                H. R. 4414

_______________________________________________________________________

                                 AN ACT

 
 To clarify the treatment under the Patient Protection and Affordable 
     Care Act of health plans in which expatriates are the primary 
                   enrollees, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expatriate Health Coverage 
Clarification Act of 2014''.

SEC. 2. TREATMENT OF EXPATRIATE HEALTH PLANS UNDER ACA.

    (a) In General.--Subject to subsection (b), the provisions of 
(including any amendment made by) the Patient Protection and Affordable 
Care Act (Public Law 111-148) and of title I and subtitle B of title II 
of the Health Care and Education Reconciliation Act of 2010 (Public Law 
111-152) shall not apply with respect to--
            (1) expatriate health plans;
            (2) employers with respect to any such plans for which such 
        employers are acting as plan sponsors; or
            (3) expatriate health insurance issuers with respect to 
        coverage offered by such issuers under such plans.
    (b) Minimum Essential Coverage and Eligible Employer-Sponsored 
Plan.--For purposes of section 5000A(f) of the Internal Revenue Code of 
1986, and any other section of the Internal Revenue Code of 1986 that 
incorporates the definition of minimum essential coverage provided 
under such section 5000A(f) by reference, coverage under an expatriate 
health plan shall be deemed to be minimum essential coverage under an 
eligible employer-sponsored plan as defined in paragraph (2) of such 
section.
    (c) Qualified Expatriates and Dependents Not United States Health 
Risk.--
            (1) In general.--For purposes of section 9010 of the 
        Patient Protection and Affordable Care Act (26 U.S.C. 4001 note 
        prec.), for calendar years after 2014, a qualified expatriate 
        (and any dependent of such individual) enrolled in an 
        expatriate health plan shall not be considered a United States 
        health risk.
            (2) Special rule for 2014.--The fee under section 9010 of 
        such Act for calendar year 2014 with respect to any expatriate 
        health insurance issuer shall be the amount which bears the 
        same ratio to the fee amount determined by the Secretary of the 
        Treasury with respect to such issuer under such section for 
        such year (determined without regard to this paragraph) as--
                    (A) the amount of premiums taken into account under 
                such section with respect to such issuer for such year, 
                less the amount of premiums for expatriate health plans 
                taken into account under such section with respect to 
                such issuer for such year, bears to
                    (B) the amount of premiums taken into account under 
                such section with respect to such issuer for such year.
    (d) Definitions.--In this section:
            (1) Expatriate health insurance issuer.--The term 
        ``expatriate health insurance issuer'' means a health insurance 
        issuer that issues expatriate health plans.
            (2) Expatriate health plan.--The term ``expatriate health 
        plan'' means a group health plan, health insurance coverage 
        offered in connection with a group health plan, or health 
        insurance coverage offered to a group of individuals described 
        in paragraph (3)(B) (which may include dependents of such 
        individuals) that meets each of the following standards:
                    (A) Substantially all of the primary enrollees in 
                such plan or coverage are qualified expatriates, with 
                respect to such plan or coverage. In applying the 
                previous sentence, an individual shall not be taken 
                into account as a primary enrollee if the individual is 
                not a national of the United States and resides in the 
                country of which the individual is a citizen.
                    (B) Substantially all of the benefits provided 
                under the plan or coverage are not excepted benefits 
                described in section 9832(c) of the Internal Revenue 
                Code of 1986.
                    (C) The plan or coverage provides benefits for 
                items and services, in excess of emergency care, 
                furnished by health care providers--
                            (i) in the case of individuals described in 
                        paragraph (3)(A), in the country or countries 
                        in which the individual is present in 
                        connection with the individual's employment, 
                        and such other country or countries as the 
                        Secretary of Health and Human Services, in 
                        consultation with the Secretary of the Treasury 
                        and the Secretary of Labor, may designate; or
                            (ii) in the case of individuals described 
                        in paragraph (3)(B), in the country or 
                        countries as the Secretary of Health and Human 
                        Services, in consultation with the Secretary of 
                        the Treasury and the Secretary of Labor, may 
                        designate.
                    (D) In the case of an expatriate health plan that 
                is a group health plan offered by a plan sponsor that--
                            (i) also offers a qualifying minimum value 
                        domestic group health plan, the plan sponsor 
                        reasonably believes that the benefits provided 
                        by the expatriate health plan are actuarially 
                        similar to, or better than, the benefits 
                        provided under a qualifying minimum value 
                        domestic group health plan offered by that plan 
                        sponsor; or
                            (ii) does not also offer a qualifying 
                        minimum value domestic group health plan, the 
                        plan sponsor reasonably believes that the 
                        benefits provided by the expatriate health plan 
                        are actuarially similar to, or better than, the 
                        benefits provided under a qualifying minimum 
                        value domestic group health plan.
                    (E) If the plan or coverage provides dependent 
                coverage of children, the plan or coverage makes such 
                dependent coverage available for adult children until 
                the adult child turns 26 years of age, unless such 
                individual is the child of a child receiving dependent 
                coverage.
                    (F) The plan or coverage--
                            (i) is issued by an expatriate health plan 
                        issuer, or administered by an administrator, 
                        that maintains, with respect to such plan or 
                        coverage--
                                    (I) network provider agreements 
                                with health care providers that are 
                                outside of the United States; and
                                    (II) call centers in more than one 
                                country and accepts calls from 
                                customers in multiple languages; and
                            (ii) offers reimbursements for items or 
                        services under such plan or coverage in more 
                        than two currencies.
                    (G) The plan or coverage, and the plan sponsor or 
                expatriate health insurance issuer with respect to such 
                plan or coverage, satisfies the provisions of title 
                XXVII of the Public Health Service Act (42 U.S.C. 300gg 
                et seq.), chapter 100 of the Internal Revenue Code of 
                1986, and part 7 of subtitle B of title I of the 
                Employee Retirement Income Security Act of 1974 (29 
                U.S.C. 1181 et seq.), which would otherwise apply to 
                such a plan or coverage, and sponsor or issuer, if not 
                for the enactment of the Patient Protection and 
                Affordable Care Act and title I and subtitle B of title 
                II of the Health Care and Education Reconciliation Act 
                of 2010.
            (3) Qualified expatriate.--The term ``qualified 
        expatriate'' means any of the following individuals:
                    (A) Workers.--An individual who is a participant in 
                a group health plan, who is an alien residing outside 
                the United States, a national of the United States, 
                lawful permanent resident, or nonimmigrant for whom 
                there is a good faith expectation by the plan sponsor 
                of the plan that, in connection with the individual's 
                employment, the individual is abroad for a total of not 
                less than 180 days during any period of 12 consecutive 
                months.
                    (B) Other individuals abroad.--An individual, such 
                as a student or religious missionary, who is abroad, 
                and who is a member of a group determined appropriate 
                by the Secretary of Health and Human Services, in 
                consultation with the Secretary of the Treasury and the 
                Secretary of Labor.
            (4) Qualifying minimum value domestic group health plan.--
        The term ``qualifying minimum value domestic group health 
        plan'' means a group health plan that is offered in the United 
        States that meets the following requirements:
                    (A) Substantially all of the primary enrollees in 
                the plan are not qualified expatriates, with respect to 
                such plan.
                    (B) Substantially all of the benefits provided 
                under the plan are not excepted benefits described in 
                section 9832(c) of the Internal Revenue Code of 1986.
                    (C) The application of section 36B(c)(2)(C)(ii) of 
                such Code to such plan would not prevent an employee 
                eligible for coverage under such plan from being 
                treated as eligible for minimum essential coverage for 
                purposes of section 36B(c)(2)(B) of such Code.
            (5) Abroad.--
                    (A) United states nationals.--
                            (i) In general.--Except as provided in 
                        clause (ii), for purposes of applying paragraph 
                        (3) to a national of the United States, the 
                        term ``abroad'' means outside the 50 States, 
                        the District of Columbia, and Puerto Rico.
                            (ii) Special rule.--For purposes of 
                        applying paragraph (3) to a national of the 
                        United States who resides in the United States 
                        Virgin Islands, the Commonwealth of the 
                        Northern Mariana Islands, American Samoa, or 
                        Guam, the term ``abroad'' means outside of the 
                        50 States, the District of Columbia, Puerto 
                        Rico, and such territory or possession.
                    (B) Foreign citizens.--For purposes of applying 
                paragraph (3) to an individual who is not a national of 
                the United States, the term ``abroad'' means outside of 
                the country of which that individual is a citizen.
            (6) United states.--The term ``United States'' means the 50 
        States, the District of Columbia, Puerto Rico, the United 
        States Virgin Islands, the Commonwealth of the Northern Mariana 
        Islands, American Samoa, and Guam.
            (7) Miscellaneous terms.--
                    (A) Group health plan; health insurance coverage; 
                health insurance issuer; plan sponsor.--The terms 
                ``group health plan'', ``health insurance coverage'', 
                ``health insurance issuer'', and ``plan sponsor'' have 
                the meanings given those terms in section 2791 of the 
                Public Health Service Act (42 U.S.C. 300gg-91), except 
                that in applying such terms under this section the term 
                ``health insurance issuer'' includes a foreign 
                corporation which is predominantly engaged in an 
                insurance business and which would be subject to tax 
                under subchapter L of chapter 1 of the Internal Revenue 
                Code of 1986 if it were a domestic corporation.
                    (B) Foreign state; national of the united states; 
                nonimmigrant; reside; lawful permanent resident.--The 
                terms ``national of the United States'', and 
                ``nonimmigrant'' have the meaning given such terms in 
                section 101(a) of the Immigration and Nationality Act 
                (8 U.S.C. 1101(a)), the term ``reside'' means having a 
                residence (within the meaning of such term in such 
                section), and the term ``lawful permanent resident'' 
                means an alien lawfully admitted for permanent 
                residence (as defined in such section).

            Passed the House of Representatives April 29, 2014.

            Attest:

                                                                 Clerk.
113th CONGRESS

  2d Session

                               H. R. 4414

_______________________________________________________________________

                                 AN ACT

 To clarify the treatment under the Patient Protection and Affordable 
     Care Act of health plans in which expatriates are the primary 
                   enrollees, and for other purposes.
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