Expatriate Plan Exemptions from the ACA





Consolidated and Further Continuing Appropriations Act, 2015 clarifies the application of the ACA to “expatriate health plans”. 

The legislation – which applies to both insured and self-insured plans – exempts expatriate plans from most of the health care market reform requirements of the ACA.  While employer shared responsibility requirements continue to apply, such plans will be deemed to be minimum essential coverage for purposes of the individual mandate and employer shared responsibility although the reporting requirements related to those requirements (Section 6055 and 6056) continue to apply. Employers must provide a notice of coverage options to each employee, regardless of plan enrollment status, part-time, or full-time status. It does not have to be provided to retirees or COBRA beneficiaries. In addition, employers are not required to provide a separate notice to dependents or other individuals who are (or may become) eligible for coverage under the plan, but who are not employees.


To satisfy the content requirements, the DOL has provided two model notices, which  include an optional section for employee specific information. In order to complete the notice, employers that offer coverage will need to know whether their plan is “affordable” and provides “minimum value” as those terms are defined under the ACA and its regulations.  There is also a model notice for employers that do not offer coverage.

In addition, the various fees applicable to insurers and health plans under the ACA do not apply.

Special Rule for the PCORI fee:  Until the issuance of further guidance, plan sponsors are permitted to determine the PCORI fee by excluding the lives covered under a specified health insurance policy or self-insured health plan that is issued or renewed on or after July 1, 2015, if the policy or plan:

  1. was designed and issued specifically to cover primarily employees; or
    • who are working and residing outside the United states, or
    • who are not citizens or residents of the United States but who are assigned to work in the United States for a specific and temporary purpose or who wor in the United States for no more than six months of the policy or plan year; or
  2. was designed to cover individuals who are members of a group of similarly situated individuals1.

The legislation applies to plans:

Qualified expatriates are employees:

It also includes members of groups formed to travel internationally to do nonprofit work.


1This provision is primarily relevant to tax-exempt charitable organization and is not discussed here.