Ninety Day Waiting Period

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Waiting periods cannot exceed 90 days, but there are other options…

Overview

PHS Act section 2708 provides that, for plan years beginning on or after January 1, 2014, a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. PHS Act section 2704(b)(4), ERISA section 701(b)(4), and Code section 9801(b)(4) define a waiting period to be the period that must pass with respect to an individual before the individual is eligible to be covered for benefits under the terms of the plan. In 2004 regulations, the Departments defined a waiting period to mean 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.

PHS Act section 2708 does not require the employer to offer coverage to any particular employee or class of employees, including part-time employees. PHS Act section 2708 merely prevents an otherwise eligible employee (or dependent) from having to wait more than 90 days before coverage becomes effective.

Source: DOL Technical Release 2012-02

Formatted Rules (work in progress)

There appear to be two sets of final rules related to the 90 day waiting period (one that mentions the 1,200 hour rule and one that does not). There is a separate final rule on the optional orientation period. Semi-formatted versions of two of the final rules are below and the third will be added soon. We’re still working on re-formatting them to make them easier to read.

90 Day Wait Final Rules – version 1

90 Day Wait Final Rules – version 2

Regulations and Guidance

Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act – Proposed Rule
These proposed rules implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act. They also propose amendments to regulations to conform to Affordable Care Act provisions already in effect as well as those that will become effective beginning 2014. (03/21/2013)
DOL Technical Release 2012-02
Guidance on 90-Day Waiting Period Limitation under Public Health Service Act § 2708. This Technical Release, which is being issued in substantially identical form by the other two Departments, provides temporary guidance regarding the 90-day waiting period limitation in Public Health Service Act (PHS Act) section 2708. The guidance will remain in effect at least through the end of 2014. (02/11/2012)

ACA Section 1201

PHS Section 2708Print


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