,,ii  #aac? ,,congress  #b;d ,session   
,h4 ,r4 #ddad  ,,9 ,,! ,,s5ate ,,( ,,!  
,,unit$ ,,/ates  ,april #cj1            
#bjad,receiv$  ,,an ,,act  ,to cl>ify ! 
treatm5t "u ! ,pati5t ,protection &     
,af=dable ,c>e ,act ( heal? plans 9 :i* 
expatriates are ! prim>y enrollees1 & = 
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,expatriate ,heal?     
,cov]age ,cl>ification ,act ( #bjad4    
#b4 ,treatm5t ( expatriate heal? plans  
"u ,,aca  7a7 ,9 g5]al ,subject to      
subsection 7b71 ! provisions ( 7includ+ 
any am5dm5t made by7 ! ,pati5t          
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh7 & ( title ,i &  
subtitle ,b ( title ,,ii ( ! ,heal? ,c>e
 & ,education ,reconciliation ,act (    
#bjaj 7,public ,law #aaa-aeb7 %all n    
apply ) respect to--  7#a7 expatriate   
heal? plans2  7#b7 employ]s ) respect to
 any su* plans = :i* su* employ]s are   
act+ z plan sponsors2 or  7#c7          
expatriate heal? insurance issu]s )     
respect to cov]age (f]$ by su* issu]s "u

 su* plans4  7b7 ,m9imum ess5tial       
cov]age & eligible employ]-,sponsor$    
plan ,= purposes ( section #ejjj;,a7f7 (
 ! ,int]nal ,rev5ue ,code ( #aihf1 & any
 o!r section ( ! ,int]nal ,rev5ue ,code 
( #aihf t incorporates ! def9ition (    
m9imum ess5tial cov]age provid$ "u su*  
section #ejjj;,a7f7 by ref]5ce1 cov]age 
"u an expatriate heal? plan %all be     
deem$ to be m9imum ess5tial cov]age "u  
an eligible employ]-sponsor$ plan z     
def9$ 9 p>agraph 7#b7 ( su* section4    
7c7 ,qualifi$ expatriates & dep5d5ts n  
,unit$ ,/ates heal? risk  7#a7 ,9 g5]al 
,= purposes ( section #ijaj ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act 7#bf  
,u4,s4,c4 #djja note prec471 = cal5d>   
ye>s aft] #bjad1 a qualifi$ expatriate  
7& any dep5d5t ( su* individual7 enroll$
 9 an expatriate heal? plan %all n be   
consid]$ a ,unit$ ,/ates heal? risk4    
7#b7 ,special rule = #bjad ,! fee "u    
section #ijaj ( su* ,act = cal5d> ye>   
#bjad ) respect to any expatriate heal? 
insurance issu] %all be ! am\nt :i* be>s

 ! same ratio to ! fee am\nt det]m9$ by 
! ,secret>y ( ! ,treasury ) respect to  
su* issu] "u su* section = su* ye>      
7det]m9$ )\t reg>d to ?is p>agraph7 z-- 
7,a7 ! am\nt ( premiums tak5 into acc\nt
 "u su* section ) respect to su* issu] =
 su* ye>1 less ! am\nt ( premiums =     
expatriate heal? plans tak5 into acc\nt 
"u su* section ) respect to su* issu] = 
su* ye>1 be>s to  7,b7 ! am\nt (        
premiums tak5 into acc\nt "u su* section
 ) respect to su* issu] = su* ye>4  7d7 
,def9itions ,9 ?is section3  7#a7       
,expatriate heal? insurance issu] ,! t]m
 expatriate heal? insurance issu] means 
a heal? insurance issu] t issues        
expatriate heal? plans4  7#b7           
,expatriate heal? plan ,! t]m expatriate
 heal? plan means a gr\p heal? plan1    
heal? insurance cov]age (f]$ 9          
connection ) a gr\p heal? plan1 or heal?
 insurance cov]age (f]$ to a gr\p (     
individuals describ$ 9 p>agraph         
7#c77;,b7 7:i* may include dep5d5ts (   
su* individuals7 t meets ea* ( ! foll[+ 

/&>ds3  7,a7 ,sub/antially all ( !      
prim>y enrollees 9 su* plan or cov]age  
are qualifi$ expatriates1 ) respect to  
su* plan or cov]age4 ,9 apply+ ! previ\s
 s5t5ce1 an individual %all n be tak5   
into acc\nt z a prim>y enrollee if !    
individual is n a national ( ! ,unit$   
,/ates & resides 9 ! c\ntry ( :i* !     
individual is a citiz54  7,b7           
,sub/antially all ( ! b5efits provid$ "u
 ! plan or cov]age are n except$ b5efits
 describ$ 9 section #ihcb7;c7 ( !       
,int]nal ,rev5ue ,code ( #aihf4  7,c7 ,!
 plan or cov]age provides b5efits =     
items & s]vices1 9 excess ( em]g5cy c>e1
 furni%$ by heal? c>e provid]s--  7i7 9 
! case ( individuals describ$ 9 p>agraph
 7#c77;,a71 9 ! c\ntry or c\ntries 9 :i*
 ! individual is pres5t 9 connection ) !
 individual's employm5t1 & su* o!r      
c\ntry or c\ntries z ! ,secret>y (      
,heal? & ,human ,s]vices1 9 consultation
 ) ! ,secret>y ( ! ,treasury & !        
,secret>y ( ,labor1 may designate2 or   
7ii7 9 ! case ( individuals describ$ 9  

p>agraph 7#c77;,b71 9 ! c\ntry or       
c\ntries z ! ,secret>y ( ,heal? & ,human
 ,s]vices1 9 consultation ) ! ,secret>y 
( ! ,treasury & ! ,secret>y ( ,labor1   
may designate4  7,d7 ,9 ! case ( an     
expatriate heal? plan t is a gr\p heal? 
plan (f]$ by a plan sponsor t--  7i7    
also (f]s a qualify+ m9imum value       
dome/ic gr\p heal? plan1 ! plan sponsor 
reasonably believes t ! b5efits provid$ 
by ! expatriate heal? plan are          
actu>ially simil> to1 or bett] ?an1 !   
b5efits provid$ "u a qualify+ m9imum    
value dome/ic gr\p heal? plan (f]$ by t 
plan sponsor2 or  7ii7 does n also (f] a
 qualify+ m9imum value dome/ic gr\p     
heal? plan1 ! plan sponsor reasonably   
believes t ! b5efits provid$ by !       
expatriate heal? plan are actu>ially    
simil> to1 or bett] ?an1 ! b5efits      
provid$ "u a qualify+ m9imum value      
dome/ic gr\p heal? plan4  7,e7 ,if !    
plan or cov]age provides dep5d5t cov]age
 ( *ildr51 ! plan or cov]age makes su*  
dep5d5t cov]age available = adult *ildr5

 until ! adult *ild turns #bf ye>s (    
age1 unless su* individual is ! *ild ( a
 *ild receiv+ dep5d5t cov]age4  7,f7 ,! 
plan or cov]age--  7i7 is issu$ by an   
expatriate heal? plan issu]1 or adm9i/]$
 by an adm9i/rator1 t ma9ta9s1 ) respect
 to su* plan or cov]age--  7,i7 network 
provid] agreem5ts ) heal? c>e provid]s t
 are outside ( ! ,unit$ ,/ates2 &       
7,,ii7 call c5t]s 9 m ?an "o c\ntry &   
accepts calls f cu/om]s 9 multiple      
languages2 &  7ii7 (f]s reimbursem5ts = 
items or s]vices "u su* plan or cov]age 
9 m ?an two curr5cies4  7,g7 ,! plan or 
cov]age1 & ! plan sponsor or expatriate 
heal? insurance issu] ) respect to su*  
plan or cov]age1 satisfies ! provisions 
( title ,,xxvii ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et  
seq471 *apt] #ajj ( ! ,int]nal ,rev5ue  
,code ( #aihf1 & "p #g ( subtitle ,b (  
title ,i ( ! ,employee ,retirem5t       
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aaha et seq471 :i* w\ld      
o!rwise apply to su* a plan or cov]age1 

& sponsor or issu]1 if n = ! enactm5t ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act & title ,i & subtitle ,b ( title   
,,ii ( ! ,heal? ,c>e & ,education       
,reconciliation ,act ( #bjaj4  7#c7     
,qualifi$ expatriate ,! t]m qualifi$    
expatriate means any ( ! foll[+         
individuals3  7,a7 ,work]s ,an          
individual :o is a p>ticipant 9 a gr\p  
heal? plan1 :o is an ali5 resid+ outside
 ! ,unit$ ,/ates1 a national ( ! ,unit$ 
,/ates1 lawful p]man5t resid5t1 or      
nonimmigrant = :om !re is a good fai?   
expectation by ! plan sponsor ( ! plan  
t1 9 connection ) ! individual's        
employm5t1 ! individual is abroad = a   
total ( n less ?an #ahj days dur+ any   
p]iod ( #ab consecutive mon?s4  7,b7    
,o!r individuals abroad ,an individual1 
su* z a /ud5t or religi\s mission>y1 :o 
is abroad1 & :o is a memb] ( a gr\p     
det]m9$ appropriate by ! ,secret>y (    
,heal? & ,human ,s]vices1 9 consultation
 ) ! ,secret>y ( ! ,treasury & !        
,secret>y ( ,labor4  7#d7 ,qualify+     

m9imum value dome/ic gr\p heal? plan ,! 
t]m qualify+ m9imum value dome/ic gr\p  
heal? plan means a gr\p heal? plan t is 
(f]$ 9 ! ,unit$ ,/ates t meets ! foll[+ 
requirem5ts3  7,a7 ,sub/antially all ( !
 prim>y enrollees 9 ! plan are n        
qualifi$ expatriates1 ) respect to su*  
plan4  7,b7 ,sub/antially all ( !       
b5efits provid$ "u ! plan are n except$ 
b5efits describ$ 9 section #ihcb7;c7 ( !
 ,int]nal ,rev5ue ,code ( #aihf4  7,c7  
,! application ( section                
#cf;,b7c77#b77;,c77ii7 ( su* ,code to   
su* plan w\ld n prev5t an employee      
eligible = cov]age "u su* plan f be+    
treat$ z eligible = m9imum ess5tial     
cov]age = purposes ( section            
#cf;,b7c77#b77;,b7 ( su* ,code4  7#e7   
,abroad  7,a7 ,unit$ ,/ates ,nationals  
7i7 ,9 g5]al ,except z provid$ 9 clause 
7ii71 = purposes ( apply+ p>agraph 7#c7 
to a national ( ! ,unit$ ,/ates1 ! t]m  
abroad means outside ! #ej ,/ates1 !    
,di/rict ( ,columbia1 & ,pu]to ,rico4   
7ii7 ,special rule ,= purposes ( apply+ 

p>agraph 7#c7 to a national ( ! ,unit$  
,/ates :o resides 9 ! ,unit$ ,/ates     
,virg9 ,isl&s1 ! ,commonweal? ( !       
,nor!rn ,m>iana ,isl&s1 ,am]ican ,samoa1
 or ,guam1 ! t]m abroad means outside ( 
! #ej ,/ates1 ! ,di/rict ( ,columbia1   
,pu]to ,rico1 & su* t]ritory or         
possession4  7,b7 ,=eign citiz5s ,=     
purposes ( apply+ p>agraph 7#c7 to an   
individual :o is n a national ( ! ,unit$
 ,/ates1 ! t]m abroad means outside ( ! 
c\ntry ( :i* t individual is a citiz54  
7#f7 ,unit$ ,/ates ,! t]m ,unit$ ,/ates 
means ! #ej ,/ates1 ! ,di/rict (        
,columbia1 ,pu]to ,rico1 ! ,unit$ ,/ates
 ,virg9 ,isl&s1 ! ,commonweal? ( !      
,nor!rn ,m>iana ,isl&s1 ,am]ican ,samoa1
 & ,guam4  7#g7 ,miscellane\s t]ms  7,a7
 ,gr\p heal? plan2 heal? insurance      
cov]age2 heal? insurance issu]2 plan    
sponsor ,! t]ms gr\p heal? plan1 heal?  
insurance cov]age1 heal? insurance      
issu]1 & plan sponsor h ! mean+s giv5 ^?
 t]ms 9 section #bgia ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4            

#cjj;gg-#ia71 except t 9 apply+ su* t]ms
 "u ?is section ! t]m heal? insurance   
issu] includes a =eign corporation :i*  
is pr$om9antly engag$ 9 an insurance    
bus9ess & :i* w\ld be subject to tax "u 
sub*apt] ,l ( *apt] #a ( ! ,int]nal     
,rev5ue ,code ( #aihf if x 7 a dome/ic  
corporation4  7,b7 ,=eign /ate2 national
 ( ! ,unit$ ,/ates2 nonimmigrant2       
reside2 lawful p]man5t resid5t ,! t]ms  
national ( ! ,unit$ ,/ates1 &           
nonimmigrant h ! mean+ giv5 su* t]ms 9  
section #aja7;a7 ( ! ,immigration &     
,nationality ,act 7#h ,u4,s4,c4         
#aaja7;a771 ! t]m reside means hav+ a   
resid5ce 7)9 ! mean+ ( su* t]m 9 su*    
section71 & ! t]m lawful p]man5t resid5t
 means an ali5 lawfully admitt$ =       
p]man5t resid5ce 7z def9$ 9 su*         
section74  ,pass$ ! ,h\se (             
,repres5tatives ,april #bi1 #bjad4,k>5  
,l4 ,haas1,cl]k