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Long Term Disability: Waiting Period

Health Insurance waiting periods are specified durations of time which must pass before some or all of your health care benefits can begin.

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If you are dealing with a Disability Claim, call the experts at PW Lawyers.

Long Term Disability: Waiting Period

Health Insurance waiting periods are specified durations of time which must pass before some or all of your health care benefits can begin.

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.

Types of Disability Claims

There are many types of Disability Claims based on your insurance package, or lack of insurance package as a result of your employment terms. Here are a few.

Long Term Disability: Overview

One would consider filing a disability claim if they have endured a sudden injury or illness that has prohibited them from working. These instances often lead to a downfall in the maintenance of the social, economic and health standards that an individual once had secured.

After my injury, I had no hope left. When Dana and Paul took on my case, they told me they would help me reach my goal to get money for the settlement. They took the time and had the patience to help me achieve my personal goals.

Dana had great suggestions for me. It was comforting to know what I should be prepared for, and how I should prepare. If I didn’t achieve goal 1, what would my second goal would be?

Plan A doesn’t always work. The team helped me to prepare myself to put 100% hope in the settlement, and for Plan B to be the best fallback.

I’m very satisfied with the money I got for the settlement – which was more than I expected with Paul’s support and hard work. The organization has great teamwork.

There are people that I have referred to Paul who are interested in legal matters, or accident disability, and some of them have already gotten their case going. In the future, for somebody that needs help, I would suggest them to go with PW Lawyers.

I was hoping that I could pay them back somehow. Perhaps this review is the best way.

Jane PW Lawyers - Long Term Disability Lawyers