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What is the maximum new hire employee probationary
period  for Health Insurance?

California  now follows the Federal Law Health Care Reform §2708 and allows a MAXIMUM 90 DAYS waiting period for new employees to be enrolled on Group Health Coverage  8.15.2014  SB 1034  Health & Safety Code 1357.51 (c)   

Click here to view a simplified chart of your options that comply with the law.  Generally, 1st of the month after date of hire, 1st of month after 30 days, 60 days.

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The interpretations and implementation can be quite confusing.

There are also  Orientation periods Federal Register in addition to waiting periods and probation.   All carriers,  unless you have the question on the employer app,  which Anthem does not will consider the hire date the permanent hire date unless they can prove with an employee manual that they have a 30 days admin period and the person was hired for the 30 days orientation period on 9/12 etc.  If employer does not ask about orientation period it is stated that whatever hire date the employer put on the employee app is the permanent hire date.

 

Most Insurance companies only start coverage on the 1st of the month, thus 90 days probation may not actually work and be in-compliance with the law, thus the waiting period has to be shorter.  Be sure to read the most recent rulings & graphs from YOUR Insurance Company!

Call 310.519.1335 or email us for more information.

Insurance Company Bulletins:

Kaiser 12.15.2014 Explanation

Blue Cross 2016 Sales Brochure – 3 options

Health Net Orientation Period 2.24.2015

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Sales brochures and enrollment forms for each Insurance company.

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Blue Shield FAQ’s and pro-rated billing.♦  HN Bulletin ♦ HN Sept Bulletin

shrm.org 90 day waiting period 9.2012 Federal

Federal Register – Final Rules  – Orientation Period – with our annotations and highlights

2708 Public Health Service Act – HR 3590 PPACA Page 43

Background…

There has been a lot of confusion regarding waiting periods due to the difference between the federal Affordable Care Act (ACA) requirement of 90 days and the California state requirement of 60 days (AB 1083).  Recently the Department of Managed Healthcare (DMHC) notified health plans regarding their  regulatory position on this issue.  The DMHC indicated (their website)  AB 1083 addresses the maximum waiting period permitted for California health plans.  ACA amended ERISA law so their 90 day maximum applies to employers. Therefore, an employer could select a waiting period of up to 90 days.    First of the month following 60 days is not compliant with AB 1083.

This recent DMHC guidance resulted in changes to the waiting period options offered by some California health plans.  With all of the other health reform changes you have to remember we want to provide this quick reference chart.

Personally, I wish people would stop using the bill # and refer to the actual code.

So, what is it, under CA Law & Health Care Reform, 60 or 90 day maximum waiting – probationary period for new employees?

PPACA and CA regulations and law change DAILY!!!  

Waiting periods required by California health plans can be no longer than 60 days. Buck Consultants    So, it can’t be 1st of month after 2 month probation period..  

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 Excerpt of Actual Law – HISTORICAL

 

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Obsolete Rules AB 1083?

ARTICLE 3.16. Nongrandfathered Small Employer Plans [1357.500 – 1357.516]  Definitions 1357.500

  Health & Safety Code §1357.506

(a) A small employer health care service plan contract shall not impose a preexisting condition provision upon any individual.

(b) A plan contract may apply a waiting period of up to 60 days as a condition of employment if applied equally to all eligible employees and dependents and if consistent with PPACA. A plan contract through a health maintenance organization, as defined in Section 2791 of the federal Public Health Service Act, may impose an affiliation period not to exceed 60 days. A waiting or affiliation period shall not be based on a preexisting condition of an employee or dependent, the health status of an employee or dependent, or any other factor listed in subdivision (h) of Section 1357.503. An affiliation period shall run concurrently with a waiting period. During the waiting or affiliation period, the plan is not required to provide health care services and no premium shall be charged to the subscriber or enrollees.

(c) In determining whether a waiting or affiliation period applies to any person, a plan shall credit the time the person was covered under creditable coverage, provided the person becomes eligible for coverage under the succeeding plan contract within 62 days of termination of prior coverage, exclusive of any waiting or affiliation period, and applies for coverage with the succeeding plan contract within the applicable enrollment period. A plan shall also credit any time an eligible employee must wait before enrolling in the plan, including any affiliation or employer-imposed waiting or affiliation period. However, if a person’s employment has ended, the availability of health coverage offered through employment or sponsored by an employer has terminated, or an employer’s contribution toward health coverage has terminated, a plan shall credit the time the person was covered under creditable coverage if the person becomes eligible for health coverage offered through employment or sponsored by an employer within 180 days, exclusive of any waiting or affiliation period, and applies for coverage under the succeeding plan contract within the applicable enrollment period.

(d) An individual’s period of creditable coverage shall be certified pursuant to subsection (e) of Section 2704 of Title XXVII of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-3(e)).

(Added by Stats. 2012, Ch. 852, Sec. 3.   Effective January 1, 2013.)

42 U.S.C. § 300gg-7, Section 10198.7(c) of the California Insurance Code, as amended by Statutes 2013-2014, 1st Ex. Sess., ch. 1, § 7 and Section 13575.1(c) of the California Health and Safety Code, as amended by Statutes 2013-2014, 1st Ex. Sess., ch. 2, § 2, and all of my qualified employees have complied with the waiting period

For specifics – Please check the rules for each Insurance Company.   Here’s a Summary Chart for all CA Small Employer Insurance Companies ♦ Later Version? ♦

 

 

 (n) “Affiliation period” means a period that, under the terms of the health care service plan contract, must expire before health care services under the contract become effective

 

 

Health Reform §2708 42 US §300gg requires that Employees be eligible within 90 days.  DOL Guidance 2012-02 national underwriter.com Health Reform Facts Q & A 249   Final Federal Ruling 2.2014

However, in CA it will be 60 days.

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