Waiting Periods for Insurance

A waiting period is the length of time that employees must work at a company before their coverage is effective.

Employers decide what the waiting period will be, but it cannot exceed 90  days according to the Affordable Care Act.

  • Waiting periods begin when an employee officially becomes "benefits-eligible," so a new hire or an employee moving from  part-time  to  full-time  will need to satisfy their waiting period from their first day as a  full-time  employee .

  • Waiting periods can be changed mid year per the carrier's discretion. 

  • Waiting periods cannot be changed for only one employee

    The available waiting period choices for an admin will depend on carrier restrictions and state laws. For example, some states do not allow  90-day  waiting periods. In Zenefits, waiting periods can be defined as:

    One, Two, or Three, Month(s) from Hire Date
    Example: Two months from Hire Date.

    • Mortimer  Lightwood's  hire date is January  15th.
    • Two months from January  15th  is March  15th.
    • Mortimer will be eligible for benefits on March  15th.

    Hire Date
    Example: Hire Date.

    • Mortimer  Lightwood's  hire date is January  15th.
    • Mortimer will be eligible for benefits on January  15th.

    First of the Month Prior Hire Date
    Example: First of the month prior Hire Date.

    • Mortimer  Lightwood's  hire date is January  15th.
    • The first of month prior to his hire date is January  1st.
    • Mortimer will be retroactively eligible for benefits on January  1st.

    First of the Month Following Hire Date
    Example: First of the month following Hire Date.

    • Mortimer  Lightwood's  hire date is January  15th.
    • Mortimer is eligible for benefits on February  1st.
    First of the Month Following Hire Date, coinciding
    Example: First of the month following Hire Date, coinciding with the current month
    • Mortimer  Lightwood's  hire date is January  1st.
    • If the carrier or policy rule indicates that first of the month hires are effective on their hire date (coinciding = true), Mortimer is eligible for benefits on January 1st.
    • If the carrier or policy rule indicates that first of the month hires are not effective on their hire date (coinciding = false), Mortimer is eligible for benefits on February   1st.

    First of the Month after  3060, or  90  Days
    Example: First of the month after  30  days .

    • Mortimer  Lightwood's  hire date is January  15th.
    • 30  days after January  15th  is February  14th.
    • The first of the month following February  14th  is March  1st.
    • He will be eligible for benefits on March  1st.

    First of the Month after  3060, or  90  Days, coinciding
    Example: First of the month after  30  days, coinciding with the current month

    • Mortimer  Lightwood's  hire date is May  2nd.
    • 30  days after May 2nd is June 1st.
    • The first of the month following 30 days is June 1st
    • When the carrier or policy rule indicates that the 30th calendar day coinciding with a first of the month results in the new hire becoming effective on that day (coinciding = true), Mortimer is eligible for benefits on June   1st.
    • When the carrier or policy rule indicates that the  30th  calendar day coinciding with a first of the month results in the new hire becoming effective on the following first of the month day (coinciding = false), Mortimer is eligible for benefits on July   1st.

    There can be different waiting periods for each line of coverage offered, but not for different plans under the same coverage type.

    • A company can set a "First of the Month Following Hire Date" waiting period for medical and a  60-day  waiting period for dental and vision, if desired.

    • The company cannot set a  30  day waiting period for their medical HMO, a  60  day waiting period for their medical  PPO, and "First of the Month Following Hire Date" for their medical  HDHP  option .

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