§18014 Treatment of Expatriate Health Plans Under Aca

Summary

The rule says the main parts of the Affordable Care Act do not apply to expatriate health plans, the employers that sponsor them, or the insurers that sell them, with some limits. For tax rules that use the phrase "minimum essential coverage" (section 5000A(f) of the tax code), an expatriate plan counts as an employer plan for primary enrollees in categories (d)(3)(A) and (B), and counts as an individual-market plan for enrollees in category (d)(3)(C) only for sections 36B, 5000A, and 6055. The rule does not stop reporting under section 6055 or employer shared-responsibility rules under sections 4980H and 6056 for large employers; those reports can be given electronically and the main insured is treated as agreeing to electronic delivery unless they refuse. Section 4980I still applies for a qualified expatriate who is assigned (not transferred) to work in the United States. People who are "qualified expatriates" and their covered family members are not counted as U.S. health risks for the health-insurer fee under section 9010 for calendar years after 2015. For 2014 and 2015, the fee for an expatriate insurer is reduced by the ratio: (premiums counted minus expatriate-plan premiums) divided by total premiums counted. Key terms: an expatriate health insurance issuer is an insurer that issues expatriate plans; an expatriate health plan is a group plan or group coverage that mostly covers qualified expatriates, is not mainly made of excluded benefits, offers inpatient, outpatient, physician, and emergency care in the required countries, meets an actuarial standard, covers adult children to age 26, and meets operational tests (licenses in more than two countries; provider networks in at least eight countries; call centers in at least three countries with service in eight or more languages; processes at least $1,000,000 in foreign-currency claims yearly; offers global evacuation/repatriation; legal and compliance resources in at least three countries; and can reimburse in local currency in eight or more countries). A qualified expatriate is someone transferred or assigned to the U.S. temporarily with multinational needs, someone working outside the U.S. at least 180 days in a 12‑month period, or a member of a similar international group (not formed to sell insurance) that requires multinational coverage. "United States" means the 50 states, DC, and Puerto Rico. The departments of Treasury, HHS, and Labor may make rules to carry this out. The rule took effect December 16, 2014, and applies to plans issued or renewed on or after July 1, 2015.