For plan years beginning in 2015, employers may require an employee to satisfy a one-month orientation/evaluation period in addition to a 90 day waiting period before he or she becomes eligible for benefits. The orientation period must be a reasonable and bonafide employment-based condition of eligibility in a position that is otherwise eligible for coverage and not a deliberate attempt to avoid the 90-day maximum waiting period. This period must be used for the employee and the employer to evaluate each other and to engage in orientation and training. This applies to grandfathered and non-grandfathered plans alike, as well as to self-insured and insured plans.
The orientation period starts on the employee’s start date, and all calendar days count, including weekends and holidays. One month is determined by adding one calendar month to the employee’s start date and subtracting one day. For example, if an employee starts working on May 3, the last permitted day of the orientation period is June 2. Special rules apply if there is not a corresponding date in the next calendar month.
While an employee could conceivably be on the payroll for 120 days before becoming eligible for benefits, the maximum waiting period is still considered to be 90 days, because it does not begin until the day following completion of the orientation period.
Large employers should be aware that utilizing a one-month orientation period and a 90-day waiting period could cause them to be in violation of the employer play-or-pay mandate. The play-or pay mandate requires an employee to be covered by the first day of the fourth full calendar month of employment. For example, an employee who starts work on January 6 must be covered by May 1. If the employer starts coverage on May 6–one month plus 90 days after the date of hire–it would be in compliance with the 90 day requirement, but in violation of the play-or-pay mandate.
Information provided by ErisaPros.
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