Affordable Care Act 90-day Waiting Period for Coverage


Beginning 1/1/2015, the Affordable Care Act prohibits group health plans and group health insurance issuers from applying waiting periods exceeding 90 days. Under newly issued final regulations), (1) the phrase "waiting period" means the period that must pass before coverage can begin for an individual who is otherwise eligible to enroll under the terms of a group; (2) eligibility conditions based solely on the lapse of time are permissible for no more than 90 days, while other conditions for eligibility (not based solely on the lapse of time) are generally permissible unless designed to avoid compliance with the 90-day rule; (3) a plan's waiting period can begin on the first day after the employee satisfies a cumulative hours-of-service requirement, if the requirement does not exceed 1,200 hours; and (4) a requirement to successfully complete a reasonable and bona fide employment-based orientation period may be imposed as a condition for eligibility for coverage under a plan. According to the preamble, nothing in the regulations "requires a plan or issuer to have any waiting period, or prevents a plan or issuer from having a waiting period that is shorter than 90 days."

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