New-hire enrollment windows and notices: what to get right in the first weeks.

Federal law caps the wait for coverage at 90 days but leaves the enrollment window to your plan. This guide covers the window, missed-window rules and the hire-date notices.

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Who Sets The Window And How Long A Wait Can Be.

When an employee becomes eligible, the first question is how long they have to sign up. Federal law does not answer it. The initial enrollment period is a plan-document and carrier matter. Many plans allow about 30 days from the date of eligibility, but that is a plan choice, not a federal rule, and some plans use other lengths. Read the plan document and carrier contract before you quote a number to a new hire.

What federal law does set is a cap on the wait before coverage starts. Section 2708 of the Public Health Service Act, 42 U.S.C. 300gg-7, says a group health plan or issuer shall not apply a waiting period that exceeds 90 days. The rules are at 29 CFR 2590.715-2708 and 26 CFR 54.9815-2708, apply to plan years beginning on or after January 1, 2015, and reach grandfathered plans too. A waiting period is the time that must pass before coverage for an otherwise eligible person can become effective.

Count every calendar day, weekends and holidays included, starting on the enrollment date. That is why the 91st day is the outside date for coverage to begin. A plan may start coverage earlier, for example when day 91 lands on a weekend.

Eligibility conditions are treated differently from a pure wait. A condition based only on the passage of time is allowed for no more than 90 days. Other conditions, such as being in an eligible job classification, are generally allowed unless designed to avoid the 90-day limit. For full-time or variable-hour status, the regulation allows a reasonable measurement period of up to 12 months, a cumulative hours requirement may not exceed 1,200 hours, and an orientation period may not exceed one month. If your plan uses any of these, have the design reviewed against the regulation itself. Our 90-day limit guide goes deeper.

One practical point from the regulation: a plan may tie coverage to the employee completing enrollment materials, and the time before a late or special enrollment is not a waiting period. The employee’s own delay does not count against the plan.

Four Notices And When Each Is Due.

Marketplace coverage options notice. Section 18B of the Fair Labor Standards Act, 29 U.S.C. 218b, requires covered employers to give each new employee written notice at the time of hiring. DOL Technical Release 2013-02 said it would treat the notice as timely if given within 14 days of the start date. It applies to every employee regardless of plan enrollment or full-time status, even if you offer no plan. The statute text we reviewed has no penalty provision, and we did not find a current DOL statement on enforcement, so confirm that point before relying on it.

Summary of benefits and coverage. Under 29 CFR 2590.715-2715, both the plan and the issuer must provide it. It goes with any written application materials, or if there are none, no later than the first date the person is eligible to enroll. For special enrollees it is due by the date the summary plan description is required, 90 days from enrollment.

HIPAA special enrollment notice. The plan must give it at or before the time an employee is first offered the chance to enroll (29 CFR 2590.701-6).

COBRA general notice. Under 29 CFR 2590.606-1, it goes to the employee and spouse no later than the earlier of 90 days after their coverage begins or the first date the administrator must send a COBRA election notice. It may be included in the summary plan description if that is furnished on the same schedule. See our COBRA notice deadlines page.

The employer mandate overlap. For employers subject to the ACA employer mandate, 26 CFR 54.4980H-3 contains a three-month period for new full-time employees, under which coverage must be offered by the first day of the fourth full calendar month of employment. That test is separate from the 90-day cap, which counts calendar days. Run both tests on your plan design. Our employer shared responsibility page explains the mandate.

We are licensed insurance brokers, and we help employers build an onboarding calendar that keeps the window and the notices in step. General information, not legal advice.