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ACA 90 Day Maximum Waiting Period for Small and Large Groups

Effective January 1, 2014, a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 actual days.
Please note the following administrative guidelines per insurer:

AETNA: the waiting period will change to a maximum of 60 days at the first renewal on or after January 1, 2014.

AMERIHEALTH: is not administering; it is the employer’s responsibility to monitor.

HORIZON BCBS OF NJ: the employer must advise of their new hire waiting period election at renewal or potentially be subject to penalties if an employee is made to wait for more than 90 days for coverage.

NIPPON: for groups w/51+ employees, the benefit waiting period will change at renewal.

UNITEDHEALTHCARE/OXFORD: for small groups, the benefit waiting period will automatically change:

  • If the existing waiting period exceeds 90 days, it will change to 90 days.
  • If it exceeds 60 days with the first of the month administration, it will change to 60 days.
  • If it exceeds two months with the first of the following month administration, it will change to two months.

UnitedHealthcare Groups w/51+ employees: the benefit waiting period will change at renewal, and UHC will require the employer to confirm they are in agreement.

We will continue to provide information from the insurers as it becomes available.