#aacth ,,congress #b;d ,session ,h4 ,r4 #ddad ,,an ,,act ,to clarify the treatment under the ,patient ,protection and ,affordable ,care ,act of health plans in which expatriates are the primary enrollees1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,expatriate ,health ,coverage ,clarification ,act of #bjad4 #b4 ,treatment of expatriate health plans under ,,aca 7a7 ,in general ,subject to subsection 7b71 the provisions of 7including any amendment made by7 the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and of title ,i and subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb7 shall not apply with respect to-- 7#a7 expatriate health plans2 7#b7 employers with respect to any such plans for which such employers are acting as plan sponsors2 or 7#c7 expatriate health insurance issuers with respect to coverage offered by such issuers under such plans4 7b7 ,minimum essential coverage and eligible employer-,sponsored plan ,for purposes of section #ejjj;,a7f7 of the ,internal ,revenue ,code of #aihf1 and any other section of the ,internal ,revenue ,code of #aihf that incorporates the definition of minimum essential coverage provided under such section #ejjj;,a7f7 by reference1 coverage under an expatriate health plan shall be deemed to be minimum essential coverage under an eligible employer-sponsored plan as defined in paragraph 7#b7 of such section4 7c7 ,qualified expatriates and dependents not ,united ,states health risk 7#a7 ,in general ,for purposes of section #ijaj of the ,patient ,protection and ,affordable ,care ,act 7#bf ,u4,s4,c4 #djja note prec471 for calendar years after #bjad1 a qualified expatriate 7and any dependent of such individual7 enrolled in an expatriate health plan shall not be considered a ,united ,states health risk4 7#b7 ,special rule for #bjad ,the fee under section #ijaj of such ,act for calendar year #bjad 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 7determined without regard to this paragraph7 as-- 7,a7 the amount of premiums taken into account under such section with respect to such issuer for such year1 less the amount of premiums for expatriate health plans taken into account under such section with respect to such issuer for such year1 bears to 7,b7 the amount of premiums taken into account under such section with respect to such issuer for such year4 7d7 ,definitions ,in this section3 7#a7 ,expatriate health insurance issuer ,the term expatriate health insurance issuer means a health insurance issuer that issues expatriate health plans4 7#b7 ,expatriate health plan ,the term expatriate health plan means a group health plan1 health insurance coverage offered in connection with a group health plan1 or health insurance coverage offered to a group of individuals described in paragraph 7#c77;,b7 7which may include dependents of such individuals7 that meets each of the following standards3 7,a7 ,substantially all of the primary enrollees in such plan or coverage are qualified expatriates1 with respect to such plan or coverage4 ,in applying the previous sentence1 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 citizen4 7,b7 ,substantially all of the benefits provided under the plan or coverage are not excepted benefits described in section #ihcb7;c7 of the ,internal ,revenue ,code of #aihf4 7,c7 ,the plan or coverage provides benefits for items and services1 in excess of emergency care1 furnished by health care providers-- 7i7 in the case of individuals described in paragraph 7#c77;,a71 in the country or countries in which the individual is present in connection with the individual's employment1 and such other country or countries as the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of the ,treasury and the ,secretary of ,labor1 may designate2 or 7ii7 in the case of individuals described in paragraph 7#c77;,b71 in the country or countries as the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of the ,treasury and the ,secretary of ,labor1 may designate4 7,d7 ,in the case of an expatriate health plan that is a group health plan offered by a plan sponsor that-- 7i7 also offers a qualifying minimum value domestic group health plan1 the plan sponsor reasonably believes that the benefits provided by the expatriate health plan are actuarially similar to1 or better than1 the benefits provided under a qualifying minimum value domestic group health plan offered by that plan sponsor2 or 7ii7 does not also offer a qualifying minimum value domestic group health plan1 the plan sponsor reasonably believes that the benefits provided by the expatriate health plan are actuarially similar to1 or better than1 the benefits provided under a qualifying minimum value domestic group health plan4 7,e7 ,if the plan or coverage provides dependent coverage of children1 the plan or coverage makes such dependent coverage available for adult children until the adult child turns #bf years of age1 unless such individual is the child of a child receiving dependent coverage4 7,f7 ,the plan or coverage-- 7i7 is issued by an expatriate health plan issuer1 or administered by an administrator1 that maintains1 with respect to such plan or coverage-- 7,i7 network provider agreements with health care providers that are outside of the ,united ,states2 and 7,,ii7 call centers in more than one country and accepts calls from customers in multiple languages2 and 7ii7 offers reimbursements for items or services under such plan or coverage in more than two currencies4 7,g7 ,the plan or coverage1 and the plan sponsor or expatriate health insurance issuer with respect to such plan or coverage1 satisfies the provisions of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 chapter #ajj of the ,internal ,revenue ,code of #aihf1 and part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha et seq471 which would otherwise apply to such a plan or coverage1 and sponsor or issuer1 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 #bjaj4 7#c7 ,qualified expatriate ,the term qualified expatriate means any of the following individuals3 7,a7 ,workers ,an individual who is a participant in a group health plan1 who is an alien residing outside the ,united ,states1 a national of the ,united ,states1 lawful permanent resident1 or nonimmigrant for whom there is a good faith expectation by the plan sponsor of the plan that1 in connection with the individual's employment1 the individual is abroad for a total of not less than #ahj days during any period of #ab consecutive months4 7,b7 ,other individuals abroad ,an individual1 such as a student or religious missionary1 who is abroad1 and who is a member of a group determined appropriate by the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of the ,treasury and the ,secretary of ,labor4 7#d7 ,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 requirements3 7,a7 ,substantially all of the primary enrollees in the plan are not qualified expatriates1 with respect to such plan4 7,b7 ,substantially all of the benefits provided under the plan are not excepted benefits described in section #ihcb7;c7 of the ,internal ,revenue ,code of #aihf4 7,c7 ,the application of section #cf;,b7c77#b77;,c77ii7 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 #cf;,b7c77#b77;,b7 of such ,code4 7#e7 ,abroad 7,a7 ,united ,states ,nationals 7i7 ,in general ,except as provided in clause 7ii71 for purposes of applying paragraph 7#c7 to a national of the ,united ,states1 the term abroad means outside the #ej ,states1 the ,district of ,columbia1 and ,puerto ,rico4 7ii7 ,special rule ,for purposes of applying paragraph 7#c7 to a national of the ,united ,states who resides in the ,united ,states ,virgin ,islands1 the ,commonwealth of the ,northern ,mariana ,islands1 ,american ,samoa1 or ,guam1 the term abroad means outside of the #ej ,states1 the ,district of ,columbia1 ,puerto ,rico1 and such territory or possession4 7,b7 ,foreign citizens ,for purposes of applying paragraph 7#c7 to an individual who is not a national of the ,united ,states1 the term abroad means outside of the country of which that individual is a citizen4 7#f7 ,united ,states ,the term ,united ,states means the #ej ,states1 the ,district of ,columbia1 ,puerto ,rico1 the ,united ,states ,virgin ,islands1 the ,commonwealth of the ,northern ,mariana ,islands1 ,american ,samoa1 and ,guam4 7#g7 ,miscellaneous terms 7,a7 ,group health plan2 health insurance coverage2 health insurance issuer2 plan sponsor ,the terms group health plan1 health insurance coverage1 health insurance issuer1 and plan sponsor have the meanings given those terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia71 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 #a of the ,internal ,revenue ,code of #aihf if it were a domestic corporation4 7,b7 ,foreign state2 national of the ,united ,states2 nonimmigrant2 reside2 lawful permanent resident ,the terms national of the ,united ,states1 and nonimmigrant have the meaning given such terms in section #aja7;a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a771 the term reside means having a residence 7within the meaning of such term in such section71 and the term lawful permanent resident means an alien lawfully admitted for permanent residence 7as defined in such section74 ,passed the ,house of ,representatives ,april #bi1 #bjad4;,clerk4