Benefit Waiting Periods

Pre-Existing Condition Exclusion Period

Some insurance plans will offer credible coverage to those patients with a pre-existing condition.
Some insurance plans will offer credible coverage to those patients with a pre-existing condition.
Photographer: Jsnover I Agency:

A pre-existing condition is defined by health insurance companies as a health condition or illness that you've had at least six months before your first day of coverage on a new plan. If you or a family member suffers from such a condition, your insurance plan may require you to wait a certain amount of time before you can get full coverage of that condition. These exclusion periods are generally found only in group health insurance plans because they're the only type of insurance plans that are required to provide insurance to those with pre-existing conditions. If you applied for an individual health care plan with a pre-existing condition, they're allowed to turn you down completely. Many individual plans make offers with exclusions.

While the idea of a pre-existing condition exclusion period can be daunting to those in need of health care, thanks to HIPAA there are rules and regulations that can work in your favor. In the case of pre-existing condition exclusion periods, HIPAA helps govern the maximum length of time an exclusion can be applied as well as the ways which you can reduce or eliminate this exclusion time period all together. Under the HIPAA guidelines, the maximum amount of time that you have to wait in order to get coverage for your pre-existing condition can't exceed 12 months, or 18 months for late enrollees.

Before you freak out about having to wait a year to get medical coverage for your condition, there are ways to reduce or even eliminate the exclusion period through credible coverage. This term refers to any health care insurance you had prior to your new insurance plan, as long as it wasn't interrupted by a period of time, usually 63 or more days. This time period can be longer depending on your state laws and the type of insurance plan you were on before. Once you have proven that you've had uninterrupted insurance prior to your current plan, this insurance coverage can be added up and credited toward any pre-existing condition exclusion you may have.

For more information on benefit waiting periods, health insurance and related topics, check out the links below.

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More Great Links


  • Department of Labor, elaws: Waiting Period
  • Lehrman Group: Health Insurance FAQs
  • U.S. Department of Labor: Affiliation Period vs. Pre-Existing Condition Period