A Full Guide To Group Health Insurance Waiting Periods

A waiting period is a period during which you cannot claim your group health insurance benefits. Read to know about various group health insurance waiting periods.
Team Loop Health
June 1, 2021

Providing, or even expanding, employee benefits like comprehensive health insurance will positively influence your employees’ overall health and wellbeing. And healthier employees make a more productive workforce. 

With health issues arising anytime, anywhere, it’s important to secure health insurance as early as possible. But before you purchase a group health insurance plan, be aware of its waiting period.

What Is Waiting Period In Group Health Insurance?

A waiting period is the time period during which you cannot claim your group health insurance benefits.

Once you pay your premium and receive your policy documents, your group health insurance comes into effect. However, the coverage doesn’t begin. Before you can make claims for a condition or disease, you must wait.

Think of it as booking a cab; it takes a while to arrive. Similarly, with group health insurance, once you buy a health insurance policy from any health insurance company, you need to wait for a while before the coverage kicks in. This is known as a waiting period. The extent of the waiting period in health insurance, as well as its terms and conditions, differ from one insurer to the next.

Typically, with individual health insurance cover, the waiting period can be as little as a few months for some procedures or extend to four years if you’re diagnosed with a pre-existing condition.

Types Of Waiting Periods In Group Health Insurance:

Broadly speaking, these are the different group health insurance waiting periods. These vary from policy to policy and insurer to insurer.

1. Initial

Also known as the cooling period, it’s the amount of time you need to wait from the date of purchase until you can make any claim. Although the time varies from insurer to insurer, the typical period is a minimum of 30 days to 90 days. 

The one exception to the initial waiting period in group health insurance is accidental claims. Claims are approved if the insured meets with an accident and requires immediate hospitalization.

2. Pre-existing diseases waiting period

A pre-existing disease is any disease, injury, ailment, or condition that’s been in existence for about 48 months before you purchase the policy. Usually, it’s diseases like thyroid, high blood pressure, diabetes, etc.

So, if you have any pre-existing disease that falls under this umbrella, you will have to wait for a specific period before you make any claims related to medical expenses or hospitalization for that ailment. The standard waiting period for pre-existing diseases is four years. Again, this varies from insurer to insurer and the type of health insurance policy you purchased.

3. For a specific disease

Different diseases like osteoporosis, hernia, ENT disorder, tumor, etc. come with a specific waiting period for claiming for treatment and hospitalization, which ranges from one to two years, depending on the ailment. The waiting period and the ailments vary from insurer to insurer, so it’s important to discuss with the insurer or read the details of the policy carefully.

4. Maternity and newborn

The maternity and newborn baby benefit assists with the expenses that arise during and post-labor. However, the group health insurance waiting period for the maternity cover ranges from nine months to four years.

Can You Reduce Your Group Health Insurance Waiting Period?

It’s nearly impossible to get group health insurance without a waiting period. You can get short-term insurance that kicks in until your coverage starts, or a few insurers may cut wait time by charging more premiums. But group health insurance is one of the greatest options for your company.

However some health insurance firms have created plans for senior citizens that eliminate the need for group health insurance waiting periods by including a co-pay provision.

Reducing Waiting Period With Group Health Insurance:

As you’re aware, individual health insurance comes with different waiting period clauses about maternity benefits, pre-existing diseases, etc. So, even if you have insurance, you cannot make a claim until the completion of the waiting period for those diseases.

Here’s where group insurance mitigates such limitations and offers one of the greatest advantages - waiving the waiting period. So, albeit any pre-existing conditions, maternity benefits, specific diseases, by paying a nominal amount as extra premium, you can waive off the waiting period. This will ensure coverage kicks in for the insured, their parents, children, and spouse from day one of the policy.  

This is extremely advantageous especially if the group insurance plan covers families. So, the insured knows their loved ones are safe and protected. Additionally, group health insurance policies don’t necessitate any medical tests. Irrespective of the employee, everyone gets comprehensive coverage.

Are You Ready To Get Group Health Insurance?

We hope you understand the concept of waiting period in group health insurance. Now you know how to choose the best group health insurance plan. The key to a successful business is focusing on both the customers' needs as well as making sure your employees are well taken care of. And health insurance is an important piece of your organization’s puzzle.

Spending a few minutes now to set up the right coverage for your employees will enable them to focus on what matters while contributing to your company’s end goal.    

Loop is here to help you take care of your people. It only takes a few minutes to set up and you will be surprised at how affordable it can be. Once you determine how much coverage you need, you can apply in just a few minutes.

In case you need extra protection, you can sign up for bundled coverage. Plus, with free primary care and round-the-clock support from specialized doctors, you’re in good hands! Our goal is to make sure that managing your employee's insurance is as easy as can be.

Interested in learning more about Group Health Insurance? Click here

Get HR Insights delivered to your inbox every week

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.