Question: Next year, based on the new Health Care Reform regulations, may our company still require a 90-day waiting period (60 days in California) before new employees become eligible to enroll in the health plan?

Answer: Yes, your company may still impose a waiting period of up to 90 days for new employees entering your group health plan. However, it is important to note that beginning with an employer’s first plan year starting on or after January 1, 2014, an organization may not use a waiting period that exceeds 90 days (60 days in California). This restriction applies to all employers, regardless of size, that sponsor a group health plan, as well as to both grandfathered and non-grandfathered plans. The proposed guidance does not permit the employer to wait to offer benefits until the first of the month following 90 days of employment. (However, many employer advocacy groups have submitted comments asking for the allowance of a “first of the month following 90 days” waiting period, so it is still possible that the federal government may institute a safe harbor to allow this calculation method in its final guidance.) As the proposed regulations currently read, the employer must count all calendar days when calculating the 90-day waiting period (60 days in California), including weekends and holidays. If the 91st day (61st day in California) is a weekend or holiday, the organization may set a policy permitting coverage to be effective earlier than the 91st day of employment, but it may not make the effective date of coverage later than the 91st day (61st day in California). If your current health insurance plan utilizes a longer waiting period, it may need to be adjusted in 2014 in order to comply with the new regulations. These adjustments may include the authorization of mid-month enrollments if your organization opts to use a 90-day waiting period (60 days in California). There are some exceptions to this rule when the employer is unable to determine if a new employee’s average hours will be sufficient to qualify for health plan participation. When this occurs, the plan may take a reasonable period of time to determine whether the employee meets the plan's eligibility requirements, which may include a measurement look-back period of up to 12 months.