The Affordable Care Act states the maximum benefit eligibility waiting period is 90 days. It also adds that an “orientation period” could be applied prior to the beginning of the eligibility period.

1. Employers can choose whether an “Orientation Period” is applicable to their employees. The orientation period must be bona fide as employment-based and reasonable. Examples of situations when an “orientation period” may apply include:

  • Individual must meet licensing requirement
  • Apprentices or interns who need to meet job classification requirement

Note: the Orientation Period must have a legitimate purpose and cannot be used to avoid offering coverage.

2. Further clarification stated that an “orientation period” cannot exceed one calendar month. An orientation period can be implemented on plans effective on or after January 1st, 2015.

  • Example: an individual begins employment July 17th. Their orientation period is from July 17th through August 16th. The benefit eligibility period begins on August 17th.
  • Example: an individual begins employment October 1st. Their orientation period is from October 1st through October 31st. The benefit eligibility period begins on September 1st.

3. Orientation Periods must be written into the eligibility criteria in plan documents.

Public Health Service Act section 2708 provides rules governing orientation and eligibility periods for group health plans and health insurers. Employer shared responsibility mandate is a separate requirement for large employers. If you have questions or would like more information, please contact us.