What waiting periods or eligibility rules make sense for our business model?

Your waiting period and eligibility rules determine when employees can enroll in benefits and who qualifies. These factors directly impact compliance, cost, and employee satisfaction. The right approach depends on your workforce composition, turnover rate, and overall benefits strategy.

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Stay within federal compliance limits
Under the Affordable Care Act (ACA) and ERISA, large employers (those with 50 or more full-time employees) must:

• Offer Minimum Essential Coverage (MEC) to at least 95 percent of full-time employees (those working 30 or more hours per week) and their dependents.
• Ensure the waiting period before coverage begins does not exceed 90 calendar days from the date of hire.

Best practice: Keep waiting periods between 30 and 60 days to balance compliance, cost, and onboarding efficiency.

Tailor eligibility rules by employment class, fairly and consistently
Employers may vary eligibility based on legitimate employment categories (bona fide classes), such as:

• Full-time versus part-time
• Hourly versus salaried
• Seasonal, temporary, or variable-hour roles
• Geographic location or worksite

Example:

• Full-time: Eligible after 30 days.
• Part-time: Eligible for MEC plus primary care access after 60 days.
• Seasonal: Eligible after 90 days if expected to work fewer than six months.
  
  

Key rule: Apply eligibility definitions consistently within each class and document them in your Summary Plan Description (SPD).

Match waiting periods to your business model

• High-turnover industries (retail, hospitality, logistics):
  A 60- or 90-day waiting period helps manage costs while offering coverage for longer-tenured employees. Consider providing early access to MEC plus $0 primary care for compliance and engagement.
• Stable, full-time workforces (manufacturing, professional services):
  A 30-day waiting period or “first of the month following hire” supports retention and competitiveness. Employees value early access to coverage as part of a strong onboarding experience.
• Seasonal or variable-hour employees:
  Use a look-back measurement period (typically 12 months) to determine full-time status under ACA rules. Offer MEC or limited coverage for employees who do not qualify for full-time benefits.
  
  

Why it matters: Tailoring eligibility helps control costs while staying compliant and fair across all employee types.

Use waiting periods strategically during onboarding
A well-structured waiting period can:

• Ensure coverage applies only to active, retained employees.
• Give HR teams time to process enrollments accurately.
• Align with payroll cycles for administrative simplicity.

Tip: Communicate waiting periods clearly during hiring to set expectations early.

Offer early access to care, even before full coverage begins
Many employers now bridge the waiting period by providing immediate access to primary or virtual care.
Example: Offer new hires day-one access to Vitable’s $0 primary care, with full insurance coverage beginning after 60 or 90 days. This builds trust, supports early engagement, and promotes employee health from the start.

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Vitable helps employers provide affordable, immediate access to care (even before full coverage begins). Every member receives $0 primary care, mental health, and prescription access through virtual or in-home visits. Employers can pair Vitable with MEC, HDHP, or ICHRA plans to maintain compliance while delivering real value from day one.

The right waiting period and eligibility rules should be compliant, consistent, and employee-friendly.

• Stay within the ACA’s 90-day limit.
• Align eligibility with your workforce model and onboarding timeline.
• Offer immediate access to care through solutions like Vitable to improve engagement and protect employee health from day one.

When compliance, affordability, and access align, your benefits program becomes both sustainable and competitive.

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