Health Care Reform – Excessive Wait Periods

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Read how Aetna is working with you and our customers to comply

Starting January 1, 2014, the Affordable Care Act (ACA) prohibits health plans from including “excessive waiting periods.” A waiting period is the amount of time an eligible enrollee has to wait before coverage is effective. “Excessive” is considered a waiting period longer than 90 days. This provision applies to all plans, including grandfathered plans.

We will comply with any state law that limits waiting periods to less than 90 days.

What this means for your clients

 We are updating our systems internally to ensure that all plans are in compliance. Any existing Small Group plan with a waiting period longer than 90 days will be changed to a compliant waiting period upon renewal in 2014, as shown in the table below. A plan sponsor may also choose a different compliant waiting period at renewal by notifying us in writing.

The table below explains how we will make updates.

The mandate also includes a special rule related to individuals in a waiting period prior to applicability date. If the member is subject to a waiting period that exceeds 90 days it will no longer be valid. The mandate also includes a special rule for employees who work variable hours where employers can use a measuremet period to determine eligibility.

Plan Sponsor notification

Throughout the next few months, we will be including an insert to bills provided to all Small Group Plan Sponsors detailing the upcoming change. We are also placing a message on the eBilling application for all plan sponsors. 

Thank you for your continued partnership. We ask that you relay this information on to your clients to ensure everyone is informed. If you have any questions, please contact your local Aetna Sales Executive.