For plan years beginning on or after January 1, 2014, the Affordable Care Act (ACA) prohibits group health plans and group health insurance issuers from applying any health care coverage waiting period that exceeds 90 days. However, other eligibility conditions that are not based solely on the lapse of time are generally allowed, unless the condition is designed to avoid compliance with the 90-day waiting period limit.
On February 20, 2014, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) released final regulations on the 90-day waiting period limit. These regulations generally finalize provisions in proposed rules that were issued in March 2013, with minimal changes. At the same time, the Departments released a separate proposed rule regarding a new provision permitting reasonable and bona fide orientation periods under the 90-day waiting period limit.
The final regulations apply for plan years beginning on or after January 1, 2015. However, the 2013 proposed rules provided that the 90-day waiting period limit would apply for plan years beginning on or after January 1, 2014. For plan years beginning in 2014, the Departments will consider compliance with either the 2013 proposed rules or the final regulations to constitute compliance with the 90-day waiting period limit requirement.
Overview of the 90-Day Health Care Coverage Waiting Period Limit
A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in the plan becomes effective. An employee or dependent is otherwise eligible for coverage when he or she has met the plan’s substantive eligibility conditions.
Under the ACA, group health plans and health insurance issuers offering group health insurance coverage may not apply a waiting period that exceeds 90 days. Thus, after an individual is determined to be otherwise eligible for coverage under the terms of the plan, any waiting period may not extend beyond 90 days.
All calendar days are counted beginning on the enrollment date, including weekends and holidays. However, if an individual enrolls as a late enrollee or special enrollee, any period before the individual’s late or special enrollment is not a waiting period. For purposes of the 90-day waiting period, “enrollment date” means:
- The first day of coverage; or
- If there is a waiting period, the first day of the waiting period.
If an individual receiving benefits under a group health plan changes benefit packages, or if the plan changes group health insurance issuers, the individual’s enrollment date does not change.
The waiting period limit does not require an employer to offer coverage to any particular employee or class of employees, including part-time employees. The waiting period limit only prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage under a group health plan becomes effective.
To read more about the 90-Day Waiting Period Limit and permitted orientation periods, click here.
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