Under the Patient Protection and Affordable Care Act (ACA), a “waiting period” is defined as the period that must pass before coverage for an individual who is otherwise eligible to enroll under the terms of a group health plan can become effective. The ACA prohibits group health plans and group health insurance issuers from imposing a waiting period that exceeds 90 days after an employee is otherwise eligible for health coverage. Generally, an individual is “eligible” to enroll in a health plan if he or she has met the plan’s substantive eligibility conditions, such as being in an eligible job classification, earning a certain level of commission, or satisfying a reasonable and bona fide employment-based orientation period. Once an individual is determined to be eligible for coverage under the terms of the health plan, the ACA’s final rule provides that a waiting period cannot exceed 90 days, including the enrollment date, weekends and holidays.
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