What is the Waiting Period in Health Insurance?

July 5, 2018 Health A-Z

The waiting period in health insurance refers to the time period that needs to be passed before you can start availing of the benefits. The benefit of waiting period is given to providers as a safeguard of sorts from fraudulent claims. It’s important for you to be familiar with the waiting period concept, in order to be better informed while picking your health insurance plan.

Types of Waiting Periods

There are different types of waiting periods in health insurance, depending on specific plans.

Employer waiting period

This type of waiting period in health insurance exists in employee group plans. It applies to new employees who need to wait for a specific period of time before they can claim health insurance benefits. The employer imposes this kind of waiting period and it can be up to three months. The reason for this type of waiting period is to lessen the risk of new employees taking undue advantage of insurance benefits. Otherwise, new employees would be able to seek benefits and leave the employment immediately.

Exclusion waiting period

This type of waiting period in health insurance relates to pre-existing conditions and diseases. If you have had a condition for at least six months, the provider can exclude it from the list of benefits offered to you. This type of health insurance waiting period can last for up to 18 months.The solution to remove this waiting period from your health insurance is to prove that you have had insurance benefits without interruptions before your existing plan. Once you provide the proof, the provider can include any pre-existing condition.

Recommended Read: Health Insurance Coverage for Pre-existing Conditions

Another thing to note here is that if you have been a part of any group health plan for at least a year and then immediately received insurance from another group plan at your new place of employment; you are eligible to receive the benefits without any exclusion waiting period. The only restriction is that the gap between the two insurance plans mustn’t exceed 63 days.

Affiliation waiting period

This type of waiting period is put up by the HMO (Health Maintenance Organization) plans. It cannot be longer than three months and is applicable to only group HMO schemes. If HMO plans have affiliation periods then the same schemes cannot use exclusion waiting period at the same time. HMO plans can also have very specific conditions that are applicable for different policies in terms of waiting period. So, check all the available plans to see if any of these work for you.

Considering Waiting Period before Buying Health Insurance

It is not possible to find health insurance with no waiting period. Almost every plan has some sort of waiting period to ensure there are no fraudulent claims by policyholders. But you may be able to avoid waiting period in health insurance by talking directly with your provider. Such an option may not be possible with group employment plans. As mentioned above, pre-existing condition waiting periods can be waived if you are able to meet certain criteria mentioned in the specific plans.

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Dental checkups and maternity insurance are often included in pre-existing conditions. For the latter, the waiting period can be for up to a year. For the former, the waiting period can be between 6-12 months. So, if you think you may require maternal insurance within a year of buying a new plan; make sure to discuss the same with your provider. You may need to plan buying health insurance accordingly.

It is important to talk to different providers and know about their waiting period policies before buying health insurance.