Ed MacConnell

Horizon BCBSNJ Group Administration – 90 Day Maximum Waiting Period

Horizon BCBSNJ has issued This Letter to Group Administrators about the waiting period changes. We would like to provide you with additional clarification regarding this ACA change.

• Groups with one to 99 employees who have a waiting period that exceeds 90 days per Horizon BCBSNJ’s system have been changed to a 90 day waiting period as of January 1, 2014.

For example: A March 1 renewing group that has a six month waiting period will have a 90 day waiting period as of January 1, 2014.

• Additionally, if a new employee is in the waiting period, as of January 1, 2014, they cannot be made to wait more than 90 days for coverage to become effective.

For example: A group has a six month waiting period. A new employee is hired November 1, 2013. As of January 1, 2014, the remaining waiting period is 29 days for an effective date of January 30, 2014. (November = 30 days, December = 31 days, for a total of 61 days satisfied)

• Until Horizon BCBSNJ’s system has been updated to change waiting periods to days, we will need to monitor the member maintenance submissions.

• Groups may only make changes to waiting periods at renewal with a written request signed by the employer.

• Groups in the 100+ market will change to a 90 day maximum waiting period at the first renewal on or after January 1, 2014.

Reminders:

  • Horizon BCBSNJ eliminated all pre-existing exclusions as of January 1, 2014.
  • Small Group continuous open enrollment ends for groups on their first renewal on or after January 1, 2014.

As we receive more information, we will keep you informed of the changes and policy decisions.