Types of Waiting Periods

Depending on your insurance plan, there can be several waiting periods, with different rules and regulations about how each is to be applied during the submission of a claim.

Typically there are three types of waiting periods that you encounter when filing a health insurance claim.

1. Employer Waiting Period

• often takes place when you are trying to claim benefits from a provided group plan by your employer.
• In most cases, an employee must pass a probation period determined by their employer (~1- 3 months), before they are eligible for health care benefits and services.
• the waiting period is enforced in order to avoid new employees from abusing their benefits plan and quickly leaving the employment position once all benefits have been garnered.

2. Affiliation Period

• a waiting period imposed by an HMO, with an expiration of three months.
• specific rules and regulations are bound to this period and if an HMO plan has an affiliation period, they cannot deny coverage based on any pre-existing conditions.

3. Pre-Existing Condition Exclusion Period*

• a waiting period that includes those who have a condition during six months prior to signing up for health insurance.
• this waiting period can limit or fully exclude coverage and support for any pre-existing conditions.
• The maximum amount of time you can wait for the Pre-Existing Condition Exclusion period is 12 months.
• This period cannot exceed 12 months. Late enrollees may be penalized with an extra 6-month exclusion, making it 18-months.

If you received a pre-existing condition exclusion period from your health insurance provider, then your employer waiting period cannot be added to this period. These two separate waiting periods are served concurrently, having both your employer waiting period and pre-existing exclusion periods beginning on the same day.

What is HIPPA?

The HIPPA (Health Insurance Portability and Accountability Act of 1996) helps govern the maximum amount of time of an exclusion period can take place. Employers must abide by HIPPA standards: click here for more info.

A waiting period is the qualifying period the insurance company takes to clarify your policy. This period can range from four months to 52 weeks. However, in some claims, an employee can qualify for early intervention.

An early intervention is when the insurance company gets involved in your claim within a few days of incurring your injury.