Navigating the intricacies of the insurance industry and understanding its jargon can be challenging, but it is essential for individuals to understand the fine print of their insurance plan.
Waiting periods, for instance, are commonplace in most individual health insurance policies, yet many people remain unaware of the challenges they pose for those with pre-existing conditions or in need of immediate care. These periods of limited coverage force individuals to postpone accessing necessary medical services and treatments, or face substantial out-of-pocket expenses.
Through their "zero" waiting period policy, group health insurance schemes provide a significant advantage over individual insurance plans in this regard. However, to comprehend the true extent of this advantage, it is essential to delve deeper into the fine print regarding waiting periods.
What is a health insurance waiting period?
In health insurance, the ‘waiting period’ refers to the period of time after the policy takes effect, but before the policyholder can make a claim on their group health insurance benefits. In other words, even after receiving your insurance documents, you may need to wait to access some, or all, of the benefits included in your policy, or to receive reimbursement. Depending on the insurer, the type of insurance, the claimant, and the type of claim, this can take days, weeks, months, or even years.
How long do waiting periods last?
As mentioned above, this depends on the nature of the claim, your insurer, and your specific policy. However, in general, pre-existing health conditions are not covered during the first six months when expats are applying for health insurance for the first time in the UAE.
Waiting periods can be broadly categorized into five different types, and the majority of claimants will fall into at least one:
Initial waiting period:
The initial period after signing up for a health insurance policy, also known as the "cooling period," typically lasts one to three months, depending on the policy. During this time, no claims are accepted. This means that, if a policyholder requires medical attention during this period, they will not be eligible for reimbursement. However, there is an exception to this rule. Some health insurance plans cover accidental claims, when the policyholder has an accident and requires immediate hospitalization, even during the initial waiting period.
Waiting period for maternity coverage:
Maternity insurance covers any medical expenses that may occur in pre- and post-partum care, as well as delivery. However, to access maternity benefits, policyholders are subjected to waiting periods ranging from nine months to four years, depending on the provider.
Waiting period for pre-existing health conditions:
Pre-existing health coverage allows policyholders to claim on any illnesses or diseases that were declared at the time of the application. This often includes chronic health conditions, such as diabetes or Crohn’s, but it can also cover a prior injury, or even symptoms that you have yet to receive a diagnosis for.
The waiting period for this type of claim can vary greatly depending on the insurer and the policy, but on average, a policy holder can expect to wait anywhere between one and four years before being able to make a claim for expenses and treatment related to a pre-existing condition.
Waiting period for specific diseases
Claims for treatments related to specific diseases - such as a tumor - are also subject to waiting periods with most insurance providers. These waiting periods can last anywhere between one and two years.
Waiting period for annual health check-ups
Some insurance providers provide complimentary annual check-ups as part of their policy. However, there may be a waiting period of approximately one year before a policy holder can access this benefit.
Why do waiting periods exist?
Waiting periods prevent individuals from exploiting the insurance system by making immediate claims for conditions that they were aware of at the time of obtaining the insurance policy. This practice helps to maintain the viability of the insurance system, so that insurance firms can avoid substantial increases in the cost of premiums for other policyholders.
Without these waiting periods, the risk of claims being made for undisclosed pre-existing conditions, as well as fraudulent claims for the sake of reimbursement, could place a significant strain on health insurance costs for individuals, businesses, and the healthcare system as a whole.
Why are waiting periods excluded in group health plans?
Group health insurance operates on the principle of risk pooling, where the healthcare costs of all members are combined. This pooling spreads the risk across a larger group, which helps stabilize the insurance risk for the insurer. As a result, group health plans can afford to offer immediate coverage without waiting periods because the risk is distributed among a larger pool of individuals.
The principle of risk pooling extends to the cost of health insurance as well. At GulfCare, we practice medical history disregarded underwriting, which means that we do not consider an individual's medical history when determining eligibility or calculating premiums. Our belief is that individuals should not be penalized based on pre-existing conditions or medical history, and we strive to ensure equal access to healthcare for all employees within your business.
Get in touch today to learn more about GulfCare’s fully customizable corporate health insurance solutions.
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