Final Regs Announced for ACA Waiting Period Limit

A joint announcement from the U.S. Departments of Labor, Treasury, and Health and Human Services says the final regulations will be published in the February 24 edition of the Federal Register.

“This is a common-sense measure that helps workers access employer-sponsored health insurance while providing employers flexibility,” says Phyllis Borzi, Assistant Secretary of Labor for Employee Benefits Security.

In compliance with the Patient Protection and Affordable Care Act (or ACA), the regulations require that no group health plan or group health insurance issuer may impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.

To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the regulations say that such conditions also cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.

Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The regulations also address situations in which it cannot be determined that a new employee will be working full time.

The aforementioned federal agencies are also issuing a companion proposed rule, which would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment. It can be downloaded here.

The text of the companion proposed rule will also be available in the February 24 edition of the Federal Register.