How is the 90-day waiting period changing?
For plan years beginning on or after January 1, 2014, employees and dependents who are otherwise eligible for coverage under an employer’s group health plan cannot be required to satisfy a waiting period (the time that must pass before coverage can become effective) longer than 90 days, including weekends and holidays. Employers are not obliged to make employees observe any waiting period at all.
While the law indicates that the probationary period is no longer than 90 days, Premera has made a business decision to implement a waiting period that does not exceed first of the month following 60 days.
Once the employee obtains coverage under the plan there can be no further exclusions to limit coverage for pre-existing conditions.
How will we administer this provision?
The standard waiting periods Premera will administer and include in contracts will be:
What about certificates of creditable coverage?
Effective January 1, 2015, Certificates of Creditable Coverage will no longer need to be provided.
Note: HIPAA certs do still need to be distributed throughout 2014 as groups who are on plan years may still require certificates of credible coverage for pre-existing conditions.
Does this rule apply to my group?
This rule applies to all grandfathered and non-grandfathered group health plans and health insurance issuers, including multi-employer health plans and single-employer group health plans maintained pursuant to collective bargaining agreements.
The proposed regulations permit different eligibility conditions based on a participating employer’s industry or an employee’s occupation as long as they are not designed to avoid compliance with the 90-day rule. The preamble to the proposed regulations specifically notes that eligibility provisions based on compensation or buy-ins to satisfy hours of service requirements, and hour banks are permitted under the proposed regulations. The proposed rules clarified that MSPPs will be subject to the Federal External Review process if not subject to a State’s external review process.
Note: Groups with collectively bargained agreements are NOT exempt from the effective period of the waiting period.
How does the regulation relate to employer shared responsibility (200+ employers)?
The proposed regulations warn that substantive eligibility conditions that are permitted under the 90-day waiting period rule may nonetheless result in a failure by a large employer to offer coverage to a full-time employee and could result in an assessable payment under the employer shared responsibility rules.
What's the administrative process look like for this waiting period?
What if an employee is already in a waiting period when the new rules take affect?
If an employee is within their current plan’s waiting period after the group renews post January 1, 2014, the 90-day rule takes affect.
Programs that help members take a more active role in managing their health.