Last week (02/20/2014), the ACA’s “trinity” of compliance and enforcement (i.e., departments of Health/Human Services; Labor; Treasury) jointly issued both FINAL and PROPOSED regulations pertaining to the ACA provision addressing new hire waiting period limitations. This week’s post will focus primarily on the FINAL regulations.
Let me start by defining what it is that we received guidance on – the so called “90 day waiting period limitation”. For readers not familiar with this issue…the waiting period is the period of time allowed to pass before health insurance coverage can become effective for an otherwise eligible employee (and his/her dependents). Per the Affordable Care Act (ACA), this period of time is now restricted, and can be NO LONGER than 90 days. Thus, the latest possible time that coverage can take effect is the 91st day from the initial date of hire. This affects any employer that has a waiting period that is:
IMPORTANT: This provision applies to ALL group health plans renewing on or after January 1, 2014, regardless of grandfather status, size of group, or funding arrangement (i.e., fully or self insured).
There are only two (2) differences between the final regulations issued last week, and the proposed regulations released last August:
The final regulations also provided the following particulars:
· If a person enrolls as a late or special enrollee, any time period before the enrollment date is not counted as part of the 90-day limit.
The final regulations also addressed the issuance of Health Insurance Portability and Accountability (HIPAA) “certificates of creditable coverage”, more commonly referred to in industry parlance as “HIPAA certs”. In light of the ACA’s ban on preexisting condition limitations, HIPAA certs will no longer be necessary. However, since the ban takes effect on each employer plan’s PLAN YEAR, rather than a specific, fixed date in time, HIPAA certs continue to be required until 12/31/2014.
To access a copy of the 85 pages of final regulations, click here – http://www.cignaproducer.com/pdf/90_Day_Waiting_Period_Final_Reg_02-20-14.pdf