HIPAA AND WAITING PERIODS

[Guest AllanB]

I am comfused by the definition of a "waiting period" for purposes of the enrollment date. If the Plan contains certain eligility requirements, other than the passage of time, when does the waiting period start? For example:

A welfare benefit plan provides health benefits which requires an employee to work at least 30 hours per week for 4 weeks before the employee is an employee eligible to enroll. After (1) meeting this eligiblity requirement and (2) preparing an enrollment form, the employee becomes a participant in the plan on the first day of the first month following completion of these two requirements. Lets assume that an employee starts employment on June 1, 1998 and works no more than 20 hours per week until January 11, 1999. On January 11, 1999 the employee begins working over thirty hours per week. On February 8, 1999, the employee completes 4 weeks of employment with at least 30 hours per week, and prepares an enrollment form for an effective date of participation of March 1, 1999. When does the enrollment date start under HIPAA? June 1, 1998, January 11, 1999 or February 8, 1999? I would think February 8, 1999 since that is the date he has met eligiblity and now is waiting for his participation to begin on March 1, 1999. June 1, 1998 doesn't seem to make sense. Nor does January 11, 1999 since the employee has not met eligiblity. If it is June 1, 1998, then part time ineligible employees who work more than 12 months would never have a preexisting condition exclusion apply to them, right?

[Guest Mark Restum]

HIPPA says the enrollment date is the date coverage begins, or if earlier, the first day of the waiting period for enrollment in the plan. In the case of a part-time employee who becomes full-time, the enrollment date is the first day of full-time employement. The preexisting condition limitation would then be counted backward from that date.

[Guest HIPAAdrome]

I think Mark's view is certainly one interpretation. But, unfortunately, I think this is one of those "open issues" under HIPAA, and there is no clear answer one way or the other. Consequently, you should analyze the risks and benefits of different interpretations.