Migliaccio & Rathod LLP is investigating whether certain private-sector employers’ health insurance required eligible employees to wait more than 90 days before becoming effective.
Federal law generally prohibits covered employer health plans from imposing an eligibility waiting period longer than 90 days once an employee has otherwise satisfied the plan’s eligibility requirements.
A potential problem can arise where an employer tells new employees that coverage begins on the “first day of the month following 90 days of employment.” Depending on the employee’s start date, that rule can push the actual start of coverage beyond 90 calendar days.
For example, an employee who completes 90 days shortly after the start of a month may be forced to wait several additional weeks before coverage begins.
You May Be Affected If:
- You work or worked for a private-sector employer that offered health insurance;
- You became eligible for the employer health plan based on your employment status;
- Your employer required you to complete 90 days of employment and then wait until the first day of the following month for coverage;
- More than 90 calendar days passed before your health insurance became effective;
- You incurred medical or prescription expenses during the extra waiting period;
- You purchased other insurance because your employer coverage had not started; or
- You delayed medical treatment because you were waiting for your employer-sponsored coverage to begin.
Why This Matters
An extra week or several weeks without insurance can create real financial consequences.
Employees may have to:
- pay medical or prescription expenses out of pocket;
- purchase temporary or marketplace coverage;
- delay treatment;
- go without needed medication; or
- lose employer contributions that should have begun earlier.
The key question is not simply whether the employer used a “90-day” rule. We are particularly interested in policies where the employee had to complete 90 days and then wait longer for the next month to begin.
Does This Apply to Your Health Plan?
This investigation generally concerns ERISA-covered health plans sponsored by private-sector employers.
Government employers and certain church employers generally are not governed by ERISA.
Your offer letter, employee handbook, benefits guide, hire date, and insurance effective date may be enough for us to determine whether the waiting period warrants investigation.
We Are Interested in Hearing From Employees Who:
- were told health coverage begins on the first of the month after 90 days;
- waited more than 90 days for coverage to become effective;
- incurred uncovered medical or prescription expenses during that period;
- purchased substitute insurance;
- delayed care because they were uninsured;
- lost an employer HSA contribution or other health-plan benefit during the extra waiting period; or
- have offer letters, handbooks, benefits guides, or enrollment records showing the waiting-period rule.
If your employer required you to wait more than 90 days for health-insurance coverage to begin, we would like to hear from you. Please complete the contact form on this page, send us an email at [email protected], or call us at (202) 470-3520.