Signing up for an annual health contract is a smart step in protecting yourself and your family’s health. The contract covers various medical expenses such as visits to doctors, lab work, prescription medications, and surgeries.

However, it’s important to understand the waiting periods and exceptions outlined in the contract.

What is a Waiting Period?

A waiting period is a specified duration that needs to have passed before certain benefits within your health plan become available.

During this waiting period, you won’t be able to access certain medical care, or you may need to pay for the services out of pocket until the waiting period has passed.

Waiting periods typically vary from one health plan to another, and they may apply to certain services only. For instance, behavioral health services, routine medical checkups, and prescription drug coverage may have different waiting periods.

It’s important to read your contract carefully to identify the services that have a waiting period and the specific duration of that waiting period.

What are Exceptions?

An exception is a clause in your health contract that allows certain medical services or treatments to be covered even if they don’t fall within the standard list of benefits.

Exceptions are usually included to provide coverage for some critical and costly medical procedures.

Exceptions typically require preapproval from the insurance company before the service is performed. This is because they often require specialized medical equipment, additional healthcare professionals, or hospitalization.

Types of Waiting Periods

Initial Waiting Period

The initial waiting period is the period between when your coverage starts and when you are eligible to start receiving benefits. Some insurance companies require an initial waiting period of up to three months before benefits kick in.

During this period, you’ll be responsible for the full cost of any medical services you receive.

Service Waiting Period

A service waiting period applies to specific healthcare services such as dental care, vision care, or mental health.

The waiting period could range between a few weeks and several months, and you won’t be able to access the designated service or be reimbursed for its cost during that time.

Pre-existing Condition Waiting Period

A pre-existing condition waiting period applies to health problems that existed before you applied for the coverage. The condition could be anything from hypertension to diabetes.

If you have a pre-existing condition, your insurance may require a waiting period of up to a year before it will start covering the condition’s treatment.

Types of Exceptions

Emergency Services

One of the most common exceptions is for emergency medical services.

If you find yourself in an emergency situation and require immediate care, your insurance provider will cover the cost of the service, even if it is not included in your standard insurance benefits.

Out-of-Network Providers

Another common exception is when you require care from a healthcare provider who is outside of your insurance provider’s network.

In such a case, your insurance provider may cover the cost of the service, even if the provider is not within your network coverage.

Specialized Care

Some medical procedures require specialized care and equipment that may not be available in your local area. In such cases, your insurance provider may agree to cover the cost of travel to another location to access the required medical treatment.

Preventing Problems with Waiting Periods and Exceptions

It’s vital to know the details of your health contract before you need to use it. Be sure to go over the contract thoroughly and consult your insurance provider if you have any questions or need further clarity.

It’s also essential to keep an up to date copy of your health contract and reference it whenever you receive medical care.

Knowing waiting periods and exceptions ahead of time can also help you plan accordingly, so you’re not caught off guard by an unexpected cost.

In Conclusion

Understanding your annual health contract is an essential part of protecting your health and financial wellbeing. Knowing about waiting periods and exceptions ensures that you understand what medical services are covered and when they become available.

By being aware of these details, you can make informed medical decisions and avoid unexpected expenses.