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Health Insurance 101: Waiting Periods

Ger Conalty
Posted by Ger Conalty on Sep 30, 2022 11:40:39 AM

The wording around health insurance can be confusing, but it’s important you fully understand your policy, what you’re entitled to and any exclusions. In our Health Insurance 101 series, we explain the key terms often used in health insurance policies in the Irish market.

Let’s get started with ‘waiting periods’.

 

What is a Waiting Period?

 

Essentially, a waiting period refers to the length of time between you taking out your health insurance policy, and you benefiting from the policy’s full cover.

You can usually still access a number of benefits during your waiting period, depending on your specific policy and any pre-existing conditions. So, if you’ll need to make use of any particular areas of cover shortly after taking out health insurance, be sure to clarify what benefits are subject to waiting periods with your broker or insurance provider before committing to a policy.

Waiting periods can sometimes be confused with ‘waiting times’ or ‘waiting lists’. These terms refer to the length of time you wait to access treatment once referred, which is determined by resource and appointment availability rather than your cover – so these are entirely different to the waiting periods listed on your health insurance policy.

 

Waiting Periods for New Policyholders

 

In Ireland, initial waiting periods usually only apply when you’re taking out health insurance for the first time, or more than 13 weeks have passed between your previous policy ending and your new one beginning. When this is the case, the typical waiting period for hospital cover is 26 weeks, provided you don’t have any pre-existing conditions.

Where possible, you should therefore avoid taking a break from cover for 13 weeks or more to ensure you don’t need to wait longer than necessary for treatment.

 

Pre-Existing Conditions

 

A pre-existing condition is defined as an ailment, illness or condition, based on medical advice, the signs or symptoms of which existed at any time in the previous six months.

If you have a pre-existing condition when you take out a health insurance policy either for the first time or after a break in cover of 13 weeks or more, a longer waiting period is likely to apply for any treatment or benefits relating to that condition.

The waiting period for pre-existing conditions is typically five years, but be sure to clarify this with your broker or insurance provider before signing up to you policy. During this time, you will still be fully covered for any new illnesses that are not related to your pre-existing condition.

Provided you remain covered under a health insurance policy, with no lapses of more than 13 weeks, your time served on your waiting period should be honoured by all providers – the clock does not restart if you change policies or even providers. So if, for example, you had a policy with Irish Life Health for two years before switching to Laya Healthcare, you would still only have three years remaining of your five year waiting period.

Likewise, if you have completed your waiting period before switching, you will immediately have full cover without having to serve the waiting period again – so don’t be afraid to change to a better deal.

 

Upgrading Your Level of Cover

 

If you’re upgrading your level of cover and don’t have any pre-existing conditions, as defined above, you shouldn’t need to serve any waiting periods before being fully covered by your upgraded policy.

However, if you’ve had a condition in the six months prior to the upgrade, a waiting period of up to two years may apply for claims relating to treatment for your pre-existing condition. Regardless of whether you choose to upgrade your cover with your current insurer or a new provider, you will continue to be covered at the level of your previous policy throughout your upgrade waiting period.

For example – if you previously had a low-level plan with cover only for a semi-private hospital room, and choose to upgrade to cover for treatment in a private room or high-tech hospital after already being diagnosed with a condition, you would only be able to access that upgraded treatment relating to the pre-existing condition after serving your waiting period. However, you would still be covered for the semi-private room included in your original policy during this time, and could access the private or high-tech treatment for any new conditions unrelated to the pre-existing illness.

 

Maternity and Fertility

 

While the standard waiting period for new policyholders with no pre-existing conditions is 26 weeks for the majority of your cover, longer waiting periods apply for maternity and fertility treatment.

For maternity care and benefits, the waiting period is 12 months. So, if you want to access any of your policy benefits during your pregnancy – such as for antenatal classes, scans, and other benefits such as maternity yoga – you’ll need to have a policy in place at least a year before you get pregnant.

Likewise, typically fertility treatment is subject to a 12-month waiting period. However, some plans with a higher level of cover and benefits come with a two-year waiting period, so make sure you double check this when you’re comparing plans if you think you may need fertility support in the near future.

 

Summary of Waiting Periods

 

Here’s a quick breakdown of the typical waiting periods described above.

New Policyholder: 26 weeks

Pre-Existing Conditions: 5 years

Upgrade, with Pre-Existing Condition: 2 years

Maternity: 1 year

Fertility: 1-2 years

 

Ultimately, the sooner you get covered under a health insurance policy – whether that’s through your employer or by taking out cover yourself – the less likely you are to face a long wait for treatment. If you wait until you start feeling unwell, it could already be too late, and the chances are you’ll have to join the long waiting lists for hospital treatment currently being faced in the public health service.

But all plans are not created equal. It may not be enough to just take out the lowest cost policy, although this will provide more protection than having no cover at all. With additional waiting periods applying for upgrades once you become unwell, it’s important to make sure you have the cover you need from the start.

Whether you’re looking to cover just yourself, your family, or an entire workforce, at Eppione we can help you find the right policy to meet your needs – while ensuring you don’t overpay for your chosen level of cover. Our health insurance advisors compare all plans on the market to find the best one for you, and will take the time to explain all the terms to you, and your employees, to make sure you understand exactly what you’re entitled to.

For expert support with your health insurance, get in touch using the form below.