Student Health and Expatriate Plans FAQ
Last Updated 11/1/2015
- Would these student health plans covered under EHCCA of 2014 be subject to ACA?
In general, no. 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:
- expatriate health plans;
- employers with respect to any such plans for which such employers are acting as plan sponsors; or
- expatriate health insurance issuers with respect to coverage offered by such issuers under such plans.
- Can student health plans be covered under the Expatriate Health Coverage Clarification Act of 2014 (EHCCA)?
Yes, the EHCCA includes a student who is studying abroad as a qualified expatriate.
- Are there any standards that these student health plans covered under the expatriate health plans must meet?
Yes, the standards for expatriate health plans specified in the EHCCA are as follows:
- 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.
- 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.
- the plan or coverage provides benefits for items and services, in excess of emergency care, furnished by health care providers-
- the plan sponsor 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
- the plan sponsor 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.
- 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.
- the plan or coverage is issued by an expatriate health plan issuer, or administered by an administrator, that maintains, with respect to such plan or coverage has licenses to sell insurance in more than two countries
- maintains network provider agreements with health care providers that that provide for direct claims payments, directly or through third party contracts, with health care providers in eight or more countries
- maintain call centers, directly or through third party contracts in three or more countries and accepts calls from customers in eight or more languages
- processes (in the aggregate together with other plans or coverage it issues or administers) at least $1,000,000 in claims in foreign currency equivalents each year
- offers reimbursements for items or services under such plan or coverage in the local currency in eight or more countries
- makes available (directly or through third party contracts) global evacuation/repatriation coverage; and
- maintains legal and compliance resources in three or more countries
- the plan or coverage, and the plan sponsor or expatriate health insurance issuer with respect to such plan or coverage, satisfies the fair health insurance premium 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 ERISA under 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.
The answers provided are not meant to be a substitute for legal advice.