Health Care Reform and Expatriate Health Benefits

“This article is intended to survey the law related to the manner in which the Patient Protection and Affordable Care Act (‘PPCA’ or ‘ACA,’ also referred to as ‘Health Care Reform’ or ‘HCR’) is applied to employees working outside of their home countries and the employer plans that provide health benefits to those employees. These employees are referred to in this article as either:

• expatriate employees – U.S. citizens working in countries outside the United States; or
• inpatriate employees – foreign nationals working in the United States.

As the use of the word ‘expatriate’ and ‘inpatriate’ imply, the focus of this discussion is primarily on employees or are working regularly for extended periods away from their home countries. Business trips and limited short-term assignments (that is, generally less than three months in duration, based on the short coverage gap exception discussed below) should not involve any significant application of PPACA law, and instead the laws of the employee’s home country should prevail in those situations.

To most effectively address the evolving law on this topic, this article is divided into four parts:

• Background – summarizing the various PPACA health coverage mandates;
• Expatriate Compliance – addressing employer and employee under PPACA law for expatriate status;
• Inpatriate Compliance – addressing employer and employee PPACA law for inpatriate status; and
• Expatriate Health Coverage Clarification Act – summarizing the manner in which this law regulates employer plans that qualify as Expatriate Health Plans under the law.”

See Tara Silver-Malyska & Mark Voelpel, Health Care Reform and Expatriate Health Benefits, Probate and Property Magazine, Vol. 32, No. 3, May/June 2018.