ACA: No More Waiting Periods Over 90 Days

The Affordable Care Act prohibits group health plans or group health insurers from imposing any waiting period that exceeds 90 days. (Neither plans nor insurers must impose any waiting period.) In March,the Internal Revenue Service, the Employee Benefits Security Administration, and the Health and Human Services Department proposed regulations that would clarify how waiting periods would apply to employees with variable hours.

A group health plan that conditions eligibility on an employee regularly working a specified number of hours per period (or working full-time) would be able to take “a reasonable period of time” to determine whether a variable-hour employee meets this condition. This “measurement period” can last no more than 12 months, beginning on any date between the employee’s start date and the first day of the first calendar month following the employee’s start date.

The measurement period will not be considered out of compliance with the 90-day waiting period limitation if coverage is made effective no later than 13 months from the employee’s start date, plus the time remaining until the first day of the next calendar month. Plans cannot impose awaiting period in addition to the measurement period. For more information on implementing the Affordable Care Act in your Iowa or Illinois organization, please contact Group Services online or by calling 800.925.8846.

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