CWA HEALTH CARE REFORM UPDATE: Minimum Waiting Periods

Does the ACA contain rules on minimum waiting periods for employer-based health care?

Under the Affordable Care Act, starting January 1, 2014 otherwise eligible employees cannot be forced to wait more than 90 days before being allowed to enroll in employer-based health care coverage. For the purposes of this requirement, all calendar days (weekend, holidays, or otherwise) are counted.

Other requirements for eligibility not based solely on time are still permissible, unless they are found to be designed solely to avoid complying with the 90-day rule. Eligibility requirements that involve the accumulation of work hours are among those allowed, but they can’t exceed 1,200 accumulated hours before an employee is eligible.

When there’s a full-time status requirement for coverage and it can’t be determined whether a new hire will meet that requirement within the 90-day window, these employees can be classified as a “variable hour employee,” and the employer will be allowed to take an extended period of time to determine eligibility. This determination period may last as long as 12 months, and can begin anytime within the calendar month of the employee’s start date. Coverage for variable hour employees that are found to be qualified must begin no later than the first day of the 13th full calendar month after the employee was hired.

Overview of these provisions: Proposed Rule on the Affordable Care Act’s 90-Day Waiting Period Provides Flexibility for Employers

Guidance with helpful examples: Guidance on 90-day Waiting Period Limitations under Public Health Service Act