The Afford­able Care Act pro­vid­ed a max­i­mum 90 day wait­ing peri­od for cov­er­age of employ­ees (Cal­i­for­nia has updat­ed this and made it 60 days, both as of the anniver­sary date of exist­ing group cov­er­age). What’s in a word, or expres­sion, or name? Some high­lights, which are left open to inter­pre­ta­tion as to how this should all be insti­tut­ed (26 CFR Part 54)

  1. A group health plan or health insur­ance issuer offer­ing group health insur­ance cov­er­age shall not apply any wait­ing peri­od that exceeds 90 (60) days
  2. Applies to both grand­fa­thered and non grand­fa­thered plans
  3. Eli­gi­bil­i­ty con­di­tions that are based sole­ly on the lapse of a time peri­od would be per­mis­si­ble for no more than 90 days
  4. The eli­gi­bil­i­ty con­di­tion is not con­sid­ered to be designed to avoid com­pli­ance with the 90 day wait­ing peri­od lim­i­ta­tion if the cumu­la­tive hours of ser­vice require­ment does not exceed 1,200 hours
  5. Wait­ing peri­od still defined as that which must pass before cov­er­age for an indi­vid­ual who is oth­er­wise eli­gi­ble to enroll under the terms of a group health plan can become effective
  6. Wait­ing peri­od lim­i­ta­tion gen­er­al­ly doesn’t require the plan spon­sor to offer cov­er­age to any par­tic­u­lar indi­vid­ual or class of indi­vid­u­als. Instead the final reg­u­la­tions pro­hib­it requir­ing oth­er­wise eli­gi­ble indi­vid­u­als to wait more than 90 days before cov­er­age becomes effective
  7. Oth­er con­di­tions are gen­er­al­ly per­mis­si­ble under these reg­u­la­tions unless the con­di­tion is designed to avoid com­pli­ance with the 90 day wait­ing peri­od limitation