Blue Cross and Blue Shield of Illinois

 

October 11, 2013

Legislative Update
Updated 90-day Waiting Period FAQ Now Available for Employer Groups

A newly updated and expanded FAQ for the 90-day waiting period provision is now available (see below).

This FAQ has been updated with new regulatory information that was included in the FAQ released by the federal government in March. The FAQ also includes additional details of Blue Cross and Blue Shield of Illinois’ business decisions and implementation plans for group accounts impacted by the 90-day waiting period requirements.

Updated 90-Day Waiting Period FAQ
This provision of the Affordable Care Act applies to all fully insured and self-insured group health plans ― both grandfathered and non-grandfathered. It does not apply to plans in the individual market.

The federal government issued a proposed rule on the 90-day waiting period in March 2013. The government issued an FAQ in September 2013 that clarifies the following, among other things:

  • Plans and issuers can rely on the agencies’ guidance from the March 2013 proposed rules at least through 2014.
  • To the extent final regulations are more restrictive on plans or issuers than the proposed regulations, they will not be effective prior to Jan. 1, 2015.

The following examples and FAQs show how we are administering the 90-day waiting period and answers some frequently asked questions. Our cross-functional workgroup will review and address any operational issues that may arise. Please note that our current interpretation of the requirements and our business approach could change based on final rules when they are issued.

Examples:

  • An employee is hired Sept. 15, 2013, and the group’s effective date is Jan. 1, 2014. Since the individual’s waiting period has exceeded 90 days at the start of their plan year, coverage must be made available as of Jan. 1, 2014.
  • An employee is hired March 1, 2014, and the employer has a June 1, 2014, plan year. That employee’s coverage must be available as of the start of the plan year on June 1, 2014, so the waiting period does not exceed 90 days.

Frequently Ask Questions (FAQs)

Q: Can benefits start on the 91st day or the first of the month following 90 days? 
A:  The 91st day or the first of the month following 90 days of the date of hire will no longer be options that we administer. 

Q: Are there any plans that are excluded from the 90-day waiting period?
A: The provision applies to both grandfathered and non-grandfathered group health plans, and fully insured and self-insured business. It also applies to government accounts. It does not apply to plans in the individual market.

Q: Does this need to be applied on Jan. 1, 2014?
A: It needs to be applied on the first plan year on or after Jan. 1, 2014.

Q: What if an employee elects coverage late? Do they still have to be insured within 90 days?
A: Under the proposed rule, coverage needs to be made available to employees and their dependents within 90 days, but there is no penalty to the employer or plan sponsor if an employee or dependent is late in electing coverage, which causes the 90-day period to be exceeded.

Q: How does the proposed rule work for employees who are already in a waiting period prior to Jan. 1, 2014?
A: For employees who are already in a waiting period prior to Jan. 1, the days served prior to the plan year will count towards the 90-day waiting period limitation. 

Q: Does the new 90-day waiting period limitation have a significant impact on our existing business? 
A: Most large group and ASO groups have a 30-day waiting period. We anticipate that this will mostly impact small group accounts.

Q: What operational changes will Blue Cross and Blue Shield of Illinois (BCBSIL) have to make to meet the new requirements?
A: We have formed an implementation workgroup that is continuing to develop strategies, update documentation, implement procedures, and communicate new information.

Q: How will BCBSIL communicate the changes to groups?
A: We have developed a communications plan that details our outreach to producers and employers about the provision. All impacted accounts will be notified in October, November and December of actions required in order to comply with the waiting period requirements. Communications are being created for different market segments, for plans with an effective date of Jan. 1, 2014, and after.

This communication is intended for informational purposes only. It is not intended to provide, does not constitute, and cannot be relied upon as legal, tax or compliance advice. The information contained in this communication is subject to change based on future regulation and guidance.

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.