Published: Thursday, December 26, 2013

ACA 90 Day Waiting Period Limitation

Effective January 1, 2014, a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days.

Please note the following administrative guidelines per carrier:

Aetna

Groups in the Small Group Market (applicable in all states – NY, NJ, PA, DE, CT): The carrier will change to a maximum of 60 days at the first renewal on or after January 1, 2014 unless the employer advises the carrier differently.

Groups in the Large Group (51+ Employees) Market: The benefit waiting period will change at the first renewal in 2014.

AmeriHealth & Independence Blue Cross

Small and Large Group Markets (NJ): The carrier is not administering. They feel it is the employer’s responsibility to monitor.

Horizon BCBSNJ

Groups in the Small Group and 51-99 Group Markets (NJ): Effective January 1, 2014, the benefit waiting period will change unless advised otherwise by the employer.

Small Group:

  • The carrier will advise employers who have a greater than 90 day maximum waiting period per the system.
  • ESAT will not accept days and is still on the monthly increment only rule. Therefore, this change will be the employer’s responsibility. The employer must comply or potentially be subject to penalties if an employee is made to wait for more than 90 days for coverage.

Groups in the 100+ Employees Market (NJ): The benefit waiting period will be changed to 90 days at renewal.

Nippon Life Benefits

Groups in the 51+ Employees Market (NY, NJ): The benefit waiting period will change at renewal.

UnitedHealthcare/Oxford

Groups in the Small Group Market (NY, NJ), the benefit waiting period will automatically change:

  • If the existing waiting period exceeds 90 days, it will change to 90 days.
  • If it exceeds 60 days with the first of the month administration, it will change to 60 days.
  • If it exceeds two months with the first of the following month administration, it will change to two months.

UnitedHealthcare Groups in the 51+ Employees Market (NY, NJ, PA, DE, CT): The benefit waiting period will change at renewal. UnitedHealthcare will require confirmation from the employer to confirm that the employer is in agreement.

We will continue to provide information as it becomes available.