What are waiting periods and how do they work in international health insurance?

What is a waiting period in international health insurance?

A waiting period is a defined period after an international health insurance policy starts during which the insured person cannot yet claim for certain benefits.

The policy is active and premiums are payable, but medical expenses relating to the affected benefits are not covered until the waiting period has ended.

Waiting periods usually begin on the policy start date shown on the insurance certificate. This may be different from the date on which the application was submitted, the policy was signed or the first premium was paid.

For example, if a policy includes a 12-month maternity waiting period, maternity-related expenses will only become eligible for cover once the conditions set out in the policy have been met and the waiting period has expired.

Why do international health insurers apply waiting periods?

Waiting periods help insurers manage predictable and planned medical costs while maintaining a sustainable balance between all policyholders.

They are designed in particular to prevent someone from taking out insurance shortly before a known medical expense, claiming for the treatment and then cancelling the policy soon afterwards.

Waiting periods are therefore more commonly associated with treatment that can be anticipated or scheduled, rather than unexpected illnesses or accidents.

They also enable insurers to offer different levels of cover and pricing according to the benefits selected.

Which benefits may be subject to a waiting period?

The benefits affected vary between international health insurance policies. A single policy may also include different waiting periods for different types of care.

Maternity cover

Maternity is one of the benefits most commonly subject to a waiting period.

Depending on the policy, the waiting period may apply to:

• antenatal consultations;

• pregnancy scans;

• routine pregnancy monitoring;

• childbirth;

• pregnancy complications;

• postnatal care;

• certain newborn benefits.

Anyone planning to start a family while living abroad should therefore arrange cover well in advance.

It is also important to check exactly how the waiting period is applied. Some policies assess eligibility based on the date of conception, while others refer to the date of treatment or childbirth.

Dental treatment

Some policies may cover emergency dental treatment from the policy start date but apply a waiting period to routine, planned or more expensive dental care.

This may include:

• crowns;

• bridges;

• implants;

• dentures;

• orthodontics;

• periodontal treatment.

Dental treatment required as a direct result of an accident may be treated differently, depending on the terms and conditions of the policy.

Optical care

Waiting periods may also apply to glasses, contact lenses and certain ophthalmic procedures.

Optical benefits may additionally be subject to:

• annual reimbursement limits;

• limits on how often glasses can be replaced;

• co-payments;

• specific conditions relating to prescriptions.

Planned hospital treatment

Emergency hospital treatment and treatment following an accident may be covered from the policy start date, provided the policy conditions are met.

However, planned hospital admissions, elective procedures and non-urgent treatment may be subject to a waiting period or require prior authorisation from the insurer.

Preventive care and health checks

Health screening, vaccinations, routine check-ups and preventive treatment may be available immediately or only after a specified period.

These benefits may also have their own annual limits or eligibility conditions.

How long do international health insurance waiting periods last?

There is no standard waiting period that applies to all international health insurance policies.

Depending on the policy and the benefit concerned, a waiting period may last:

• a few weeks;

• several months;

• one year or longer for certain benefits, such as maternity or orthodontic treatment.

The exact duration should always be checked in the:

• table of benefits;

• policy terms and conditions;

• policy schedule;

• insurance certificate.

A waiting period should not be confused with a permanent exclusion.

Once a waiting period has ended, the relevant benefit can normally become available within the policy limits. An exclusion, by contrast, means that a particular condition, treatment or circumstance is not covered.

When does a waiting period begin?

A waiting period usually begins on the effective date of the insurance policy.

For example, if a policy starts on 1 January and includes a six-month waiting period for planned dental treatment, the relevant benefit may become available from 1 July, subject to the policy wording.

The application date and the policy start date are not always the same. Applying for insurance in November for cover beginning in January does not necessarily mean that the waiting period starts in November.

Are medical emergencies subject to a waiting period?

Accidents and certain medical emergencies are often covered from the policy start date, subject to the terms, limits and exclusions of the policy.

An emergency is generally understood to mean a sudden and unexpected medical condition requiring urgent treatment.

However, treatment that was already planned before the policy began, or treatment linked to a known pre-existing condition, may not be considered an eligible emergency.

For hospital treatment, the insured person may also need to contact the insurer or assistance provider to obtain prior approval or arrange direct billing.

Can a waiting period be waived?

In some circumstances, an insurer may agree to reduce or waive certain waiting periods.

This may be possible when the applicant had equivalent health insurance immediately before the new policy began, with no break in cover.

The insurer may ask for:

• proof of previous insurance;

• confirmation of the previous policy dates;

• details of the benefits previously covered;

• a cancellation or termination certificate;

• additional medical information.

A waiver is not automatic. It will depend on the insurer’s rules, the level of previous cover and whether there has been any interruption between the two policies.

Some waiting periods, particularly those relating to maternity, may remain mandatory even where continuous cover can be demonstrated.

Are pre-existing conditions covered after the waiting period?

Waiting periods and pre-existing conditions are separate concepts.

A pre-existing condition generally refers to an illness, symptom, treatment or medical history that existed or was known before the policy start date.

Following medical underwriting, a pre-existing condition may be:

• covered on standard terms;

• covered with an additional premium;

• covered with specific limitations;

• excluded from cover;

• declined altogether.

Waiting until the end of a waiting period does not automatically make a pre-existing condition eligible for cover.

The underwriting decision and the policy wording will determine whether treatment relating to that condition can be reimbursed.

What is the difference between a waiting period, a deductible and a benefit limit?

These terms affect cover in different ways.

A waiting period is a time-based restriction. The benefit is not available during a defined period after the policy begins.

A deductible is an amount that the insured person must pay before the insurer starts reimbursing eligible medical expenses.

A benefit limit is the maximum amount the insurer will reimburse for a particular type of treatment or over a specified period.

The same treatment may be subject to a waiting period, a deductible and a reimbursement limit.

How can you avoid a gap in cover?

It is advisable to arrange international health insurance before moving abroad or before an existing policy ends.

Before choosing a policy, you should:

1. check the end date of your current insurance;

2. arrange the new policy start date to avoid a break in cover;

3. compare waiting periods for each benefit;

4. provide evidence of previous cover as early as possible;

5. anticipate maternity, dental, optical or other planned healthcare needs;

6. read the policy terms before arranging costly treatment.

Where a waiting period has been waived or amended, it is advisable to obtain written confirmation from the insurer.

How do waiting periods work with APRIL International?

With APRIL International, waiting periods and eligibility conditions depend on the international health insurance solution selected, the chosen level of cover and any optional benefits included in the policy.

Depending on the plan, cover may include hospital treatment, outpatient care, emergency treatment, assistance services, maternity care, dental treatment and optical care.

Before taking out a policy, applicants should review the table of benefits and policy terms to identify any waiting periods that may apply.

APRIL International’s teams can help customers understand the cover available according to their destination, family circumstances, healthcare needs and budget.

Once the policy is active, APRIL International’s digital services and 24/7 assistance teams help members manage their cover and access support while living or travelling abroad.