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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Five of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 829-4385

315 Montgomery Street

Suite 902

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

March 28, 2013 

 State and Federal Law Alert

 

Regulations Proposed on PPACA's 90-day Waiting Period; HIPAA Certificates

 

DOL, IRS and HHS have issued proposed regulations on the Patient Protection and Affordable Care Act ("PPACA") prohibition against waiting periods in excess of 90 days.  PPACA's 90-day waiting period limit, which is effective for plan years beginning on or after January 1, 2014, applies to grandfathered and non-grandfathered group health plans alike.

 

The proposed regulations define "waiting period" as the period of time that must pass before health coverage becomes effective for an employee or dependent who is "otherwise eligible" under the terms of the plan.  Waiting periods based solely on the passage of time cannot extend beyond 90 days.  However, plan sponsors may continue to impose substantive eligibility requirements for coverage (e.g., the attainment of certain sales goals or full-time employment).

 

The proposed regulations explain how the 90-day waiting period limit will apply to variable hour employees when eligibility is based upon the performance of a specified number of hours of service within a specified time period.  If an employer cannot determine whether a newly-hired employee will work the specified number of hours, the plan can take a "reasonable period of time" to make this determination.  A reasonable period of time is defined as no more than 12 months from any date between the employee's start date and the first day of next full calendar month.  If the variable hour employee is determined to be eligible for health coverage, the plan will comply with PPACA's waiting period limit if coverage is effective within 13 months of the employee's start date.

 

The proposed regulations offer the following additional information about the 90-day waiting period limitation:

 

         Employers may require employees to complete a specified number of hours of service before becoming eligible for health coverage. However, this requirement can only be imposed on a one-time basis and the total hours required cannot exceed 1,200.

         Plans may allow employees to make self-payments, or buy-ins, to satisfy hours of service requirements.

         Because coverage must commence by the 91st day, employers who wish to have coverage commence on the first of a month must have coverage begin no later than the first of the month following 60 days employment.

 

The proposed regulations also amend the Health Insurance Portability and Accountability Act ("HIPAA") regulations to remove provisions superseded by PPACA's prohibition on preexisting condition exclusions.  This includes the obligation of health plans to issue HIPAA certificates of creditable coverage to participants and beneficiaries who lose coverage.  The proposed effective date for eliminating the certificates of creditable coverage requirement is December 31, 2014.

 

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Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.

 

This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.