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Understanding ACA's 90-Day Waiting Period

Oct 31, 2016

HR360, Inc.

October 27, 2016​

​Understanding the ACA's 90-Day Waiting Period Limitation 

Limits Also Placed on Cumulative Service Requirements, Orientation Periods 

The Affordable Care Act (ACA) limits waiting periods applied by group health plans to 90 days after an employee is otherwise eligible for coverage. The discussion below is intended to help employers understand this limitation—however, please keep in mind that compliance with the waiting period rules is not determinative of compliance with other ACA provisions (such as pay or play). 

'Waiting Period' Defined 

A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective. Being "otherwise eligible" for coverage means having met the plan's substantive eligibility requirements (such as, for example, being in an eligible job classification or satisfying a reasonable and bona fide employment-based orientation period). 

90-Day Waiting Period Limit 

After an individual is determined to be otherwise eligible for coverage, he or she cannot wait more than 90 days before coverage is effective. All calendar days are counted for purposes of the 90-day limit, including weekends and holidays, beginning on the individual's enrollment date. For example, if a group health plan provides that full-time employees are eligible for coverage and Employee A begins employment as a full-time employee on January 19, Employee A's coverage must become effective no later than April 19 (assuming February lasts 28 days). 

Eligibility Conditions 

Conditions for eligibility under the terms of a group health plan are generally permissible, unless the condition is designed to avoid compliance with the 90-day waiting period limitation. Federal regulations provide the following guidelines regarding two specific conditions for eligibility: 

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