; and (C) ways to target low-income Americans as participants in the program. (c) Selected countries initial selection In choosing Selected Countries for the Program, the Secretary shall initially select at least 11 distinct nations or political subdivisions thereof, which shall include Canada, the Federal Republic of Germany, the Republic of India, the State of Israel, the Republic of Korea, the Republic of the Philippines, the Republic of Panama, the United Mexican States, Dominican Republic, and at least one nation or political subdivision thereof in Africa. (d) Applicable beneficiary (1) Voluntary beneficiary participation An Applicable Beneficiary may participate in the Program on a voluntary basis and may terminate participation in the Program at any time. The election to participate in the Program or to terminate participation shall constitute a Special Election Period under section 1852(e)(4) of this title. (2) Services In order to participate in the Program, an Applicable Beneficiary shall agree to receive coverage of health care items and services in a Selected Country during such time as the Applicable Beneficiary is a resident of that country. (3) Beneficiary access to services Nothing in this section shall be construed as limiting an Applicable Beneficiary’s access to items and services covered under this title when furnished in the United States, and Applicable Beneficiaries shall not be required to relinquish access to such benefits as a condition of receiving services from a participant in the Program. (4) Number of applicable beneficiaries The Secretary may cap the number of Applicable Beneficiaries accepted into the Program, but at a number no smaller than 150,000. (e) Physician certification Participating physicians must be in good standing with accreditation institutions or licensing authorities in the Selected Countries. (f) Payments (1) In general The Secretary shall make payments to or on behalf of Applicable Beneficiaries for the costs of health care items and services paid by Applicable