Compliance Alert: Final and Proposed Waiting Period Regulations Issued

For plan years beginning on or after January 1, 2014, a group health plan and a health insurance issuer (the carrier) offering group health insurance coverage may not apply any waiting period that exceeds 90 days.[1] This rule applies to both grandfathered and non-grandfathered plans.

On February 20, 2014, final and additional proposed rules were issued. The following are a few notable changes from previously-issued proposed regulations:

  • Effective Date. The final regulations apply to plan years beginning on or after January 1, 2015. For plan years beginning in 2014, employers may comply with either the previously-issued proposed regulations or the final regulations.
  • Bona fide Employment-based Orientation Period.* A waiting period is the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective. To be otherwise eligible to enroll in a plan means that an individual has met the plan’s substantive eligibility conditions (such as being in an eligible job classification or achieving job-related licensure requirements specified in the plan’s terms). So, the maximum 90-day waiting period does not have to begin until the first day after the substantive eligibility conditions are met.

For the full outline of changes, contact your USI Service Team.

You can also read the full regulations at:Health Care Reform stethescope image

  • Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act; Final Rule

¬    http://www.gpo.gov/fdsys/pkg/FR-2014-02-24/pdf/2014-03809.pdf

  • Ninety-Day Waiting Period Limitation; Proposed Rule

¬    http://www.gpo.gov/fdsys/pkg/FR-2014-02-24/pdf/2014-03811.pdf


[1] Nothing in the Affordable Care Act requires a group health plan, or carrier, to have a waiting period. In addition, state insurance law may be more restrictive than what the federal law requires. For example, California insurance law prohibits waiting periods that exceed 60 days. State insurance requirements are generally not applicable to ERISA self-insured plans.

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