Life just got a lot easier under the federal health reform law, for expatriate coverage. Expat coverage has been subject to a confusing patchwork of special rules and exceptions under several key portions of the law, such as certain benefit and administrative mandates, including the duties to supply preventive care at no out-of-pocket costs (for non-grandfathered plans) and summaries of benefits and coverage.
Recognizing this, federal authorities recently gave expatriate coverage a free pass under the health reform law, for all plan years ending prior to 2016, with respect to the reform law’s rules concerning:
- Prohibition on annual and lifetime dollar limits on essential health benefits, and limits on pre-existing condition restrictions
- Coverage of adult children to age 26
- Coverage of preventive care recommended by a variety of federal or quasi-federal agencies
- Obligation to furnish summaries of benefits and coverage
- Limitation on waiting periods (maximum 90 days)
- Healthcare claims and appeals (including independent review of final appeals)
- Nondiscrimination, and
- Prohibition on retroactive coverage rescissions.
To obtain this relief, expat plans must comply with pre-health reform versions of such requirements, to the extent they existed. In short, the relief largely returns expat plans to their pre-health reform status quo. They must continue to comply, for example, with HIPAA and mental health parity rules, and pre-health reform claims and appeals rules.
The federal agencies also noted that expat coverage is considered adequate to satisfy the individual mandate under the health reform law.