Does Your Health Plan Have a Waiting Period?

A health plan waiting period restricts what your plan will cover for a limited amount of time.

There are three common kinds of waiting periods — an exclusion waiting period, an employer waiting period, and an affiliation waiting period.

If you’re looking for your own individual health policy, the exclusion waiting period is the one you’ll most likely run into. But it’s helpful to understand all of them. Let’s take a look at each.


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Exclusion Waiting Period

If you have a pre-existing medical condition when you enroll in a health insurance plan, that plan may exclude coverage of your condition for a pre-set period. Exclusion waiting periods can apply to either an individual plan or a group plan.

For example, let’s say you recently had knee surgery. If you enroll in a health plan today, that plan would likely exclude coverage for further knee surgery and physical therapy for a year. After that year is up, you’d have full coverage for anything related to your knee.

Insurance plans include waiting periods to prevent people from enrolling in a plan and filing an expensive claim the very next day — which would drive the cost of coverage for everyone. These waiting periods often last as long as a year.

Can you avoid the exclusion waiting period? You can if:

  • You’ve been covered by a health insurance plan for at least 18 months,

    and
  • You haven’t been without coverage for more than 63 days

A federal law called the Health Insurance Portability and Accountability Act (HIPAA for short) prevents health plans from excluding coverage for anyone who meets those two criteria.

Employer Waiting Period

When an employer offers group health benefits for newly hired employees, their insurance benefits may not start for a specified amount of time. This is called the employer waiting period.

Employers determine how long the waiting period is before new employees start their coverage. Usually, the wait period lasts around three months.

If your group plan includes an exclusion waiting period, the employer waiting period cannot add to the total amount of time your benefits are restricted.

Affiliation Waiting Period

The affiliation waiting period applies to some group HMO plans. During this waiting period, employees won’t have to pay any premiums but also won’t have insurance coverage.

HIPAA restricts affiliation periods to no longer than two months.

If a group HMO has an affiliation period, they are not allowed to impose an exclusion waiting period for any pre-existing health conditions.

Looking for Coverage… and Avoiding the Wait

If you’re looking for your own health plan and are worried about having your coverage restricted, it’s a good idea to shop around with an independent health insurance agent. Every health insurance company has a different set of rules about which applicants get waiting periods attached to their plans. A professional agent can steer you toward the company most likely to give you a plan with no strings attached.

Use our free service to connect with multiple agents for expert advice and competitive quotes.

You can also view plans online in minutes to see what kinds of plans are available in your state.