Waiting periods are common in the administration of health insurance plans. In the simplest parlance, a waiting period is a specified period of time that must pass before some or all benefits of a health care policy begin. A customer seeking to acquire new health insurance or change his existing plan should be aware of certain health insurance terms associated with waiting periods. There are three health insurance terms used to describe waiting periods.

Affiliation Period

The United States Department of Labor defines an Affiliation Period for a HMO (Health Maintenance Organization) as a period of time that must pass before health insurance coverage provided becomes effective. For group coverage, an affiliation period cannot be more than two months (three months for late enrollees) from your enrollment date. The plan is not permitted to have a pre-existing condition exclusion. During the affiliation period, you are not required to pay premiums and the HMO is not required to provide benefits. Finally, the affiliation period runs jointly with any waiting periods for coverage.

Pre-existing Condition Exclusion

Per the U.S. Department of Labor, a pre-existing condition exclusion permits the restriction or denial of benefits from a group health plan because a pre-existing condition existed prior to the enrollment date. The rules governing a pre-existing condition exclusion are complicated and require thorough review in order to be fully understood. This condition applies uniquely to pregnancy, genetic information without a diagnoses, and newborn children, children being adopted, and children being placed for adoption.

In the simplest of health insurance terms, a pre-existing condition is one that for which you have received (or had recommended) medical advice, diagnoses, treatment or care within six months of your enrollment date. The pre-existing condition exclusion is not permitted to be longer than twelve months from the enrollment date, and eighteen months for late enrollees. If you do have a pre-existing condition, be sure to obtain a certificate of creditable coverage if you are currently insured and in the process of changing insurance. The exclusion period will be reduced by the prior credible coverage period.

Employer Waiting Period

The Employer Waiting Period is the most common waiting period and applies exclusively to employer group health plans. It is when an employee must wait for a specified period of time before health care services start. These are imposed to protect employers from new hires who file large health care claims immediately after joining and then quickly quit.

As you can see, there are multiple health insurance terms which apply when one is discussing waiting periods. Be sure to study and understand the rules that might affect your ability to obtain health care insurance.