The 90-day rule is finally final: Any employee eligible for coverage by a company's health plan may not be kept waiting longer than 90 days.
That's the word from the U.S. Departments of Labor, Treasury, and Health and Human Services. The agencies handed down their final regulations implementing a 90-day limit with qualifiers to address various situations, such as employees who have been asked to meet certain sales goals, put in a certain number of hours on the job and so on. But any condition that looks like it was created simply to avoid having to offer coverage after 90 days won't be allowed by the government under the new, amended law.
"Eligibility conditions that are based solely on the lapse of a time period would be permissible for no more than 90 days," the rule's guiding principle reads. "Other conditions for eligibility under the terms of a group health plan (that is, those that are not based solely on the lapse of a time period) are generally permissible under PHS Act section 2708 and the proposed regulations unless the condition is designed to avoid compliance with the 90-day waiting period limitation."
Recommended For You
One example of an exception: "… if a group health plan conditions eligibility on an employee regularly having a specified number of hours of service per period (or working full-time), and it cannot be determined that a newly-hired employee is reasonably expected to regularly work that number of hours per period (or work full-time), the plan may take a reasonable period of time to determine whether the employee meets the plan's eligibility condition, which may include a measurement period of no more than 12 months …"
For most employees who are required to meet a certain number of cumulative hours before they are deemed eligible, those hours cannot exceed 1,200 under the new rules. In addition, such employees do not have to re-qualify for coverage each subsequent year, but are considered eligible for coverage after accumulating those hours in the first year.
The rule makers made clear that their new rules didn't dictate what classification of workers had to be offered coverage within 90 days, just that employees who would normally qualify for coverage had to get it within that time.
"The 90-day waiting period limitation generally does not require the plan sponsor to offer coverage to any particular individual or class of individuals (including, for example, part-time employees). Instead, these final regulations prohibit requiring otherwise eligible individuals to wait more than 90 days before coverage becomes effective," the rules state.
Orientation periods have yet to be dealt with in a final manner, the issuers said. "The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment."
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
