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.
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 30, 60, 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 30, 60, 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 .