We use cookies to improve security, personalize the user experience,
enhance our marketing activities (including cooperating with our marketing partners) and for other
business use.
Click "here" to read our Cookie Policy.
By clicking "Accept" you agree to the use of cookies. Read less
What is the Waiting Period (Health Care) and Why Does It Matter?
Definition & Meaning
The waiting period in health care refers to a specified duration during which an individual must wait before they can access certain benefits under a health insurance policy. This period is crucial as it determines when coverage begins for various health care services. Generally, there are three main types of waiting periods:
Employer waiting periods: Timeframes set by employers before new employees are eligible for health benefits.
Affiliation periods: The time an individual must be associated with a group plan before coverage starts.
Pre-existing condition exclusion periods: Timeframes during which coverage for pre-existing conditions is not provided.
According to federal law, specifically 26 USCS § 9801(b)(4), a waiting period is defined as the time that must elapse before an individual can receive benefits from a group health plan.
Table of content
Legal Use & context
The term "waiting period" is commonly used in the context of health insurance and employee benefits law. It is relevant for:
Understanding eligibility for health benefits under group health plans.
Determining compliance with the Affordable Care Act (ACA) regulations.
Managing employee onboarding processes regarding health insurance coverage.
Individuals can often navigate their rights and responsibilities regarding waiting periods using legal templates available through resources like US Legal Forms.
Key legal elements
Real-world examples
Here are a couple of examples of abatement:
Here are a couple of examples of waiting periods in health insurance:
Example 1: An employee starts a new job and must wait 30 days before their employer-sponsored health insurance becomes active.
Example 2: A person joins a health plan that has a six-month waiting period for coverage of pre-existing conditions (hypothetical example).
Relevant laws & statutes
Key laws related to waiting periods include:
Affordable Care Act (ACA): Establishes rules regarding waiting periods for health insurance coverage.
Employee Retirement Income Security Act (ERISA): Governs employer-sponsored health plans and their waiting periods.
State-by-state differences
State
Waiting Period Rules
California
Waiting periods cannot exceed 90 days for group health plans.
Texas
Waiting periods can be up to 12 months for pre-existing conditions.
New York
No waiting periods for essential health benefits are allowed.
This is not a complete list. State laws vary, and users should consult local rules for specific guidance.
Comparison with related terms
Term
Definition
Affiliation Period
The time a person must be part of a group before coverage starts.
Pre-existing Condition Exclusion
A period during which coverage for pre-existing health issues is not available.
Common misunderstandings
What to do if this term applies to you
If you are facing a waiting period for health coverage:
Review your health insurance policy to understand the specific waiting periods that apply.
Consider alternative coverage options during the waiting period, such as short-term health insurance.
Explore ready-to-use legal form templates on US Legal Forms to manage your health insurance needs effectively.
If you have questions or concerns, consulting a legal professional may be beneficial.
Find the legal form that fits your case
Browse our library of 85,000+ state-specific legal templates.