I 

113TH CONGRESS 

2D SESSION H. R. 4414 

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. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 7, 2014 

Mr. CARNEY (for himself, Mr. NUNES, Mr. MEEHAN, Mr. RENACCI, Mr. 

DENT, Mr. LARSON of Connecticut, Mr. FATTAH, Mr. COSTA, Mr. GERLACH, Mr. TIBERI, Mr. KIND, Mr. FITZPATRICK, Ms. ESTY, Mr. MATHESON, Mrs. KIRKPATRICK, Mr. MURPHY of Florida, Mr. VALADAO, Mr. 

MCCARTHY of California, Mr. BARROW of Georgia, Mr. BARBER, and Ms. 

HANABUSA) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce, Education and the Workforce, the Judiciary, Natural Resources, and House Administration, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Expatriate Health Cov5 erage Clarification Act of 2014’’. 


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1 SEC. 2. TREATMENT OF EXPATRIATE HEALTH PLANS 

2 UNDER ACA. 

3 (a) IN GENERAL.—Subject to subsection (b), the pro4 visions of (including any amendment made by) the Patient 

5 Protection and Affordable Care Act (Public Law 111– 

6 148) and of title I and subtitle B of title II of the Health 

7 Care and Education Reconciliation Act of 2011 (Public 

8 Law 111–152) shall not apply with respect to— 

9 (1) expatriate health plans; 

10 (2) employers with respect to any such plans 

11 for which such employers are acting as plan spon12 sors; or 

13 (3) expatriate health insurance issuers with re14 spect to coverage offered by such issuers under such 

15 plans. 

16 (b) MINIMUM ESSENTIAL COVERAGE AND ELIGIBLE

17 EMPLOYER-SPONSORED PLAN.—For purposes of section 

18 5000A(f) of the Internal Revenue Code of 1986, and any 

19 other section of the Internal Revenue Code of 1986 that 

20 incorporates the definition of minimum essential coverage 

21 provided under such section 5000A(f) by reference, cov22 erage under an expatriate health plan shall be deemed to 

23 be minimum essential coverage under an eligible employer24 sponsored plan as defined in paragraph (2) of such sec25 tion. 


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1 (c) QUALIFIED EXPATRIATES AND DEPENDENTS

2 NOT UNITED STATES HEALTH RISK.— 

3 (1) IN GENERAL.—For purposes of section 

4 9010 of the Patient Protection and Affordable Care 

5 Act (26 U.S.C. 4001 note prec.), for calendar years 

6 after 2014, a qualified expatriate (and any depend7 ent of such individual) enrolled in an expatriate 

8 health plan shall not be considered a United States 

9 health risk. 

10 (2) SPECIAL RULE FOR 2014.—The fee under 

11 section 9010 of such Act for calendar year 2014 

12 with respect to any expatriate health insurance 

13 issuer shall be the amount which bears the same 

14 ratio to the fee amount determined by the Secretary 

15 of the Treasury with respect to such issuer under 

16 such section for such year (determined without re17 gard to this paragraph) as— 

18 (A) the amount of premiums taken into ac19 count under such section with respect to such 

20 issuer for such year, less the amount of pre21 miums for expatriate health plans taken into 

22 account under such section with respect to such 

23 issuer for such year, bears to 


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1 (B) the amount of premiums taken into ac2 count under such section with respect to such 

3 issuer for such year. 

4 (d) DEFINITIONS.—In this section: 

5 (1) EXPATRIATE HEALTH INSURANCE

6 ISSUER.—The term ‘‘expatriate health insurance 

7 issuer’’ means a health insurance issuer that issues 

8 expatriate health plans. 

9 (2) EXPATRIATE HEALTH PLAN.—The term 

10 ‘‘expatriate health plan’’ means a group health plan, 

11 health insurance coverage offered in connection with 

12 a group health plan, or health insurance coverage of13 fered to a group of individuals described in para14 graph (3)(B) (which may include dependents of such 

15 individuals) that meets each of the following stand16 ards: 

17 (A) Substantially all of the primary enroll18 ees in such plan or coverage are qualified expa19 triates, with respect to such plan or coverage. 

20 In applying the previous sentence, an individual 

21 shall not be taken into account as a primary en22 rollee if the individual is not a national of the 

23 United States and resides in the country of 

24 which the individual is a citizen. 


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1 (B) Substantially all of the benefits pro2 vided under the plan or coverage are not ex3 cepted benefits described in section 9832(c) of 

4 the Internal Revenue Code of 1986. 

5 (C) The plan or coverage provides benefits 

6 for items and services, in excess of emergency 

7 care, furnished by health care providers— 

8 (i) in the case of individuals described 

9 in paragraph (3)(A), in the country or 

10 countries in which the individual is present 

11 in connection with the individual’s employ12 ment, and such other country or countries 

13 as the Secretary of Health and Human 

14 Services, in consultation with the Secretary 

15 of the Treasury and the Secretary of 

16 Labor, may designate; or 

17 (ii) in the case of individuals described 

18 in paragraph (3)(B), in the country or 

19 countries as the Secretary of Health and 

20 Human Services, in consultation with the 

21 Secretary of the Treasury and the Sec22 retary of Labor, may designate. 

23 (D) In the case of an expatriate health 

24 plan that is a group health plan offered by a 

25 plan sponsor that also offers a domestic group 


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1 health plan, the plan sponsor reasonably be2 lieves that the benefits provided by the expa3 triate health plan are actuarially similar to, or 

4 better than, the benefits provided under a do5 mestic group health plan offered by that plan 

6 sponsor. 

7 (E) If the plan or coverage provides de8 pendent coverage of children, the plan or cov9 erage makes such dependent coverage available 

10 for adult children until the adult child turns 26 

11 years of age, unless such individual is the child 

12 of a child receiving dependent coverage. 

13 (F) The plan or coverage is issued by an 

14 expatriate health plan issuer, or administered 

15 by an administrator, that maintains, with re16 spect to such plan or coverage— 

17 (i) network provider agreements with 

18 health care providers that are outside of 

19 the United States; and 

20 (ii) call centers in more than one 

21 country and accepts calls from customers 

22 in multiple languages. 

23 (3) QUALIFIED EXPATRIATE.—The term ‘‘quali24 fied expatriate’’ means any of the following individ25 uals: 


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1 (A) WORKERS.—An individual who is a 

2 participant in a group health plan, who is a na3 tional of the United States, lawful permanent 

4 resident, or nonimmigrant for whom there is a 

5 good faith expectation by the plan sponsor of 

6 the plan that, in connection with the individ7 ual’s employment, the individual is abroad for a 

8 total of not less than 90 days during any period 

9 of 12 consecutive months of enrollment in the 

10 group health plan, or travels abroad on not less 

11 than 15 occasions during such a 12-month pe12 riod. 

13 (B) OTHER INDIVIDUALS ABROAD.—An in14 dividual, such as a student or religious mis15 sionary, who is abroad, and who is a member 

16 of a group determined appropriate by the Sec17 retary of Health and Human Services, in con18 sultation with the Secretary of the Treasury 

19 and the Secretary of Labor. 

20 (4) DOMESTIC GROUP HEALTH PLAN.—The 

21 term ‘‘domestic group health plan’’ means a group 

22 health plan that is offered in the United States and 

23 in which substantially all of the primary enrollees 

24 are not qualified expatriates, with respect to such 

25 plan, and substantially all of the benefits provided 


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1 under the plan are not excepted benefits described in 

2 section 9832(c) of the Internal Revenue Code of 

3 1986. 

4 (5) ABROAD.— 

5 (A) UNITED STATES NATIONALS.— 

6 (i) IN GENERAL.—Except as provided 

7 in clause (ii), for purposes of applying 

8 paragraph (3) to a national of the United 

9 States, the term ‘‘abroad’’ means outside 

10 the 50 States, the District of Columbia, 

11 and Puerto Rico. 

12 (ii) SPECIAL RULE.—For purposes of 

13 applying paragraph (3) to a national of the 

14 United States who resides in the United 

15 States Virgin Islands, the Commonwealth 

16 of the Northern Mariana Islands, Amer17 ican Samoa, or Guam, the term ‘‘abroad’’ 

18 means outside of the 50 States, the Dis19 trict of Columbia, Puerto Rico, and such 

20 territory or possession. 

21 (B) FOREIGN CITIZENS.—For purposes of 

22 applying paragraph (3) to an individual who is 

23 not a national of the United States, the term 

24 ‘‘abroad’’ means outside of the country of which 

25 that individual is a citizen. 


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1 (6) UNITED STATES.—The term ‘‘United 

2 States’’ means the 50 States, the District of Colum3 bia, Puerto Rico, the United States Virgin Islands, 

4 the Commonwealth of the Northern Mariana Is5 lands, American Samoa, and Guam. 

6 (7) MISCELLANEOUS TERMS.— 

7 (A) GROUP HEALTH PLAN; HEALTH IN8 SURANCE COVERAGE; HEALTH INSURANCE

9 ISSUER; PLAN SPONSOR.—The terms ‘‘group 

10 health plan’’, ‘‘health insurance coverage’’, 

11 ‘‘health insurance issuer’’, and ‘‘plan sponsor’’ 

12 have the meanings given those terms in section 

13 2791 of the Public Health Service Act (42 

14 U.S.C. 300gg–91), except that in applying such 

15 terms under this section the term ‘‘health in16 surance issuer’’ includes a foreign corporation 

17 which is predominantly engaged in an insurance 

18 business and which would be subject to tax 

19 under subchapter L of chapter 1 of the Internal 

20 Revenue Code of 1986 if it were a domestic cor21 poration. 

22 (B) FOREIGN STATE; NATIONAL OF THE

23 UNITED STATES; NONIMMIGRANT; RESIDE; LAW24 FUL PERMANENT RESIDENT.—The terms ‘‘na25 tional of the United States’’, and ‘‘nonVerDate Mar 15 2010 04:03 Apr 08, 2014 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4414.IH H4414

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1 immigrant’’ have the meaning given such terms 

2 in section 101(a) of the Immigration and Na3 tionality Act (8 U.S.C. 1101(a)), the term ‘‘re4 side’’ means having a residence (within the 

5 meaning of such term in such section), and the 

6 term ‘‘lawful permanent resident’’ means an 

7 alien lawfully admitted for permanent residence 

8 (as defined in such section). 

Æ 


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