Government Issues Proposed Rules to Clarify 90 Day Waiting Period Requirement

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Since the passage of the Affordable Care Act (ACA) in 2010, there has been quite a few questions proposed concerning the new 90 day waiting period rule. This rule limits waiting periods before coverage is to become effective to 90 days. The Department of Labor and the Internal Revenue Service have issued the following proposed rules concerning the 90 day waiting period requirement:

• If the eligibility period is based solely on time, then the waiting period cannot be longer than 90 days
• If eligibility is based on factors other than time, the waiting period can be longer than 90 days as long as the requirements are not designed to specifically circumvent the 90 day rule
• Variable hour workers: the waiting period can be extended up to 13 months after the date of hire if you are reasonably uncertain that a new employee is not going to be working enough hours to be eligible for health insurance coverage
• If eligibility requirements are based on achieving a cumulative service requirement, it is not considered to be designed to avoid the 90 day rule; after the eligibility requirements have been met in terms of service hours, then the coverage has be effective within 90 days
• When counting days, all days including holidays and weekends are including in the 90 day requirement
• Waiting period is defined per HIPAA rules as the time between when an employee or dependent becomes eligible for coverage and when the coverage becomes effective

 

If you questions about the 90 day rule, please give Travis Sinquefield a call at (616) 735-3088.

Travis Sinquefield
HR Manager
616.735.3088
traviss@hscompanies.com