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Life Health > Health Insurance > Health Insurance

Feds complete PPACA waiting period regs

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Federal agencies are giving employers up to 12 months to decide whether some workers with irregular hours put in enough hours to be eligible for group health benefits.

Agencies give the rules for the 12-month “measurement period” in a batch of final rules implementing the Patient Protection and Affordable Care Act (PPACA) 90-day waiting period limitation.

The U.S. Department of Health and Human Services (HHS) developed the regulations together with the Internal Revenue Service and the Employee Benefits Security Administration.

The regulations are set to appear in the Federal Register Monday.

Under PPACA, employers that want to get credit for providing group health coverage most start coverage for most full-time workers within 90 days after the workers go to work.

Agencies created the measurement period system to help employers of workers with schedules that can change from week to week. 

To use a 12-month measurement period, an employer must start coverage for an affected employee who turns out to be eligible for coverage within 13 months from the employee’s start date.

Federal agencies also are giving employers some flexibility when it comes to offering group health coverage to rehired workers.

An employer cannot normally make the same worker go through a coverage waiting period more than once. But an employer that rehires a worker who has left can make the rehired worker go through another waiting period, as long as the employer did not fire and rehire  the worker to get around PPACA coverage requirements. 

Agencies also have weighed in on when group plans and other coverage providers can stop providing “certificates of creditable coverage.”

The Health Insurance Portability and Accountability Act (HIPAA) tried to help consumers who got sick move from one insurance plan to another by providing that any consumer who maintained creditable coverage could get some kind of coverage on a guaranteed-issue basis.

Some commenters told federal agencies that consumers no longer need creditable coverage certificates, because PPACA requires individual plans to sell coverage on a guaranteed-issue basis during open-enrollment periods.

Draft regulations issued in March 2013 required plans to continue to provide the certificates until the end of 2014, and regulators have decided to keep that requirement in place, to help consumers deal with any preexisting condition exclusions in pre-PPACA policies written in 2014.

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