text: 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:
  
                                                   KAREN L. HAAS,
  
                                                                   Clerk.
target: Expatriate Health Coverage Clarification Act of 2014 - Exempts expatriate health plans, employers acting as sponsors of such plans, and health insurance issuers providing coverage under such plans from the health care coverage requirements of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Deems expatriate health coverage to be minimum essential coverage for purposes of meeting the individual responsibility requirements of the Internal Revenue Code. Declares that a qualified expatriate (and any dependent) enrolled in an expatriate health plan shall not be considered a U.S. health risk for purposes of assessing the annual fee on health insurance providers that provide health coverage to any U.S. health risk for any year after 2014. Establishes a special rule for calculating the amount of this fee for calendar 2014. Defines a "qualified expatriate" as: (1) a participant in a group health plan who is an alien residing outside the United States, a U.S. national, a lawful permanent resident, or a nonimmigrant about whom there is a good faith expectation of being abroad, in connection with his or her employment, for at least 180 days in a 12-month period; or (2) an individual who is abroad as a member of a group determined appropriate by the Secretary of Health and Human Services (HHS). 
feat_title: Expatriate Health Coverage Clarification Act of 2014