Overview of the 90-day Waiting Period Limit

Overview of the 90-day Waiting Period Limit

by Posted on: August 5, 2014Categories: HR & Compliance   
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.

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