WHAT IS 'Waiting Period'

A waiting period refers to the time an insured must wait before some or all of their coverage comes into effect. The insured may not file claims for insurance policy benefits until the waiting period is up.

BREAKING DOWN 'Waiting Period'

The waiting period or elimination period before the insured may make claims varies by insurer, policy and type of insurance. The cost per unit of coverage decreases as the waiting period increases. Insurance premiums and elimination period have an inverse relationship. The shorter the elimination period, the higher the premium will be; the longer the elimination period, the lower the premium will be. Policyholders need to to consider ability to pay for care expenses when choosing length of waiting period.

Waiting period duration

In health insurance, there are several types of waiting periods. An employer waiting period requires an employee to wait a certain period of time, such as three months, before they can receive covered health services. This is to discourage an employee from filing a major claim and leaving the company shortly thereafter. Affiliation waiting periods are imposed by health maintenance organizations or HMO. The Health Insurance Portability and Accountability Act, or HIPAA, regulates this and does not allow it to exceed three months. A pre-existing condition exclusion period varies from one to 18 months and refers to those that had a condition during the six months prior to enrolling in a health insurance plan. Insurance coverage may be limited or excluded for any pre-existing condition. However, if the insured can prove uninterrupted insurance previous to the current plan, that coverage can be credited toward a pre-existing condition exclusion. One year of group health insurance at one job and followed by enrollment in health insurance at a new job without a break of more than 63 days exempts the insured from pre-existing conditions exclusions.

Many health insurance plans come with long mandatory waiting periods for certain types of coverage including cancer treatment, cardiovascular procedures and maternity care. Cancer and cardiovascular care may have waiting periods of up to two years. Maternity care coverage wait may be as long as 10-12 months but commonly is 60 or 90 days and may be available at 30 days with a higher premium cost. The dental care waiting period typically is 6-12 months. Some insurance companies also impose restrictions, or additional waiting periods, that control how often the insured can receive certain dental treatments. For example, denture replacement may be restricted to once every five years or filling replacement to six years. Some treatments are refused coverage, including pre-existing conditions such as missing teeth or dental work already in progress. Cosmetic services, dental implants and orthodontics are rarely covered by traditional dental insurance plans.

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