Federal regulators are trying to keep employers from using long coverage waiting periods to thwart Patient Protection and Affordable Care Act (PPACA) group coverage access expansion goals.
Regulators also are trying to keep employers from coming up with clever ways to disguise coverage limits created to violate PPACA antidiscrimination rules by.
The regulators have included efforts to achieve those goals in a new batch of draft regulations, “Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act” (CMS-9952-P, RIN 1210-AB56).
The agencies that developed the regulations are Internal Revenue Service (IRS), an arm of the U.S. Treasury Department; the Employee Benefits Security Administration (EBSA), an arm of the U.S. Labor Department; and the U.S. Department of Health and Human Services (HHS).
Employers will not have to offer coverage to any employees, but a coverage access section that’s separate from the play-or-play provision will require employers that do offer major medical coverage to limit any waiting periods that occur before coverage begins to 90 or fewer days.
The PPACA waiting period limit rules are now expressed in Public Health Service Act (PHS Act) Section 2708; Employee Retirement Income Security Act (ERISA) Section 7010(b)(4); and Internal Revenue Code (IRC) Section 9801(b)(4).
In the proposed regulations, officials have tried to answer questions employers have asked about treatment of employees with unusual work schedules.
Officials said in the preamble to the regulations that the proposed regulations should help employers that use unusual but “substantive” indicators when determining whether workers are eligible for benefits.