H.R. 4414, Expatriate Health Care Coverage Clarification Act of 2014

H.R. 4414

Expatriate Health Care Coverage Clarification Act of 2014

Rep. John Carney
Ways and Means

April 29, 2014 (113th Congress, 2nd Session)

Staff Contact

Floor Situation

On Tuesday, April 29, 2014, the House will consider H.R. 4414, the Expatriate Health Care Coverage Clarification Act of 2014, under a closed rule. H.R. 4414 was introduced on April 7, 2014 by Rep. John Carney (D-DE).

Bill Summary

H.R. 4414 clarifies the Patient Protection and Affordable Care Act (PPACA) to exempt expatriate health plans, employers providing expatriate health plans, and expatriate health insurance issuers from any provision under the PPACA. This legislation also clarifies that coverage under an expatriate health plan is considered “minimum essential coverage” for the purpose of the individual and employer mandates. H.R. 4414 also clarifies section 9010 of the PPACA (26 U.S.C. 4001 note prec.) to clarify that any qualified expatriate and dependent of an expatriate enrolled in an expatriate health plan will not be considered a U.S. health risk, for purposes of the Health Insurance Tax.

In order for a health plan to qualify as an “expatriate health plan,” it must: 1) be a group health plan; 2) contain “qualified expatriates”[1] as “substantially all” of the enrollees in the plan; 3) not provide excepted benefits under IRC 9832(c); 4) provide coverage in the country or countries where the individual is present in connection with their employment; 5) offer actuarially similar or better benefits if the plan sponsor offers a domestic group health plan; and 6) cover dependent children until age 26 (if the plan offers dependent coverage).[2]


[1] A “qualified expatriate” is defined in the original bill text as: 1) a U.S. national or legal permanent resident (LPR) or nonimmigrant for whom there is a is a good faith expectation that such individual will be abroad in connection with his her employment for at least 90 days during any 12 month period or travels abroad not less than 15 days during any 12 month period; or 2) 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.
[2] An Amendment made in order in the Rules Committee proposed to be considered as adopted clarifies that an expatriate health plan offered by an employer must be actuarially similar or better than a  domestic plan offered by the employer that meets the minimum value test defined in the Internal revenue code section 36B or in the case where the employer does not offer a domestic plan, the expatriate plan must at least meet minimum value.  The amendment also clarifies that an expatriate health plan must make payments in two or more currencies, and the plans must comply with laws that existed prior to the passage of the Affordable Care Act. Finally, the amendment clarifies that an individual must be abroad for at least 180 days in any 12 consecutive months to be qualified to enroll in an expatriate plan.


Expatriate plans can cover individuals of multiple citizenships based in multiple countries within the same plan. Expatriate coverage is robust and usually contains other benefits, which are necessary considering the unique circumstances they face. Under the ACA, plans that are sold to expatriates must meet the law’s requirements. As a result, insurers can no longer write expatriate health plans as U.S. carriers. Insurers have been left with the choice of following clients abroad by moving their expatriate insurance operations to offshore licenses, or losing their business. In the United States, over 1,000 jobs—including individuals who write, administer, and service expatriate plans—could be lost to overseas providers if these requirements are not changed. H.R. 4414 will save American jobs by allowing insurers to continue offering these plans in the U.S.


A CBO cost estimate is currently unavailable.

Additional Information

For questions or further information contact the GOP Conference at 5-5107.