What does 12 month waiting period mean in insurance?
Asked by: Abby Berge | Last update: October 16, 2025Score: 4.7/5 (52 votes)
What does waiting period mean for insurance?
Oct 18, 2022. A waiting period is the time between when you sign up for insurance coverage and when it goes into effect. It can also refer to the period between starting a new job and gaining access to your employer-sponsored benefits, like health and dental insurance.
What does a 12 month waiting period mean for dental insurance?
A dental insurance waiting period is the time you have to wait to be eligible for the benefit to kick in. For services like fillings and extractions, this can be anywhere from six to 12 months. That means if you need dental care during the waiting period, you'll typically need to pay out of pocket or pay a higher rate.
What is the 12 month waiting period for pre-existing conditions?
The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
How soon after getting insurance can you use it?
As soon as your policy is active, typically 12:01 am on the date of your policy, you technically can make a claim. The chances of the claim being reviewed as suspicious is probably fairly high though. Consider getting an estimate and paying out of pocket if it makes more financial sense.
Health insurance waiting periods, explained
What is the meaning of waiting period?
noun. a specified delay, required by law, between officially stating an intention and acting on it, as between securing a marriage license and getting married. Insurance.
How long after getting full coverage insurance can you file a claim?
As long as the problems began after you started your policy, you can file a claim immediately.
How far back do insurance companies look for pre-existing conditions?
To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.
How soon after getting insurance can you get surgery?
Depending on your provider, insurance companies can take anywhere between 1-30 days to approve the request. Stay in communication with your care team, as timing for approval varies between insurance providers.
What pre-existing conditions are not covered in insurance?
Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.
Can I get dental insurance and use it right away?
Preventive: Most dental insurance plans do not require a waiting period for preventive care. That means you and your family may receive exams, cleanings, x-rays, and fluoride treatments as provided in your plan. Basic: Some basic procedures may have a three- to six-month waiting period.
Can an employer waive a health insurance waiting period?
In most cases, employers will waive the waiting period when a group initially sets up a plan. Not only does this mean that new hires will have one less thing to worry about (especially if they have dependents counting on health coverage, too), but it can also help make employers more attractive to job seekers.
Why do dental plans have waiting periods?
The dental insurance company establishes waiting periods to ensure a person isn't just purchasing the plan to cover oral health issues that have accumulated over the years.
How do waiting periods work?
A waiting period is an initial period of health insurer membership during which no benefit is payable for certain procedures or services. Waiting periods can also apply to any additional benefits when you change (upgrade) your health insurance policy.
What are the three biggest mistakes you should avoid making when applying for an insurance policy?
- Setting your deductible too high or too low. ...
- Not having enough home or auto insurance. ...
- Knowing when to drop your car's comprehensive or gap coverage. ...
- Not knowing about health care networks and referrals. ...
- Not telling your family about your life insurance.
Why would insurance deny a surgery?
Reasons your insurance may not approve a request or deny payment: Services are deemed not medically necessary. Services are no longer appropriate in a specific health care setting or level of care. You are not eligible for the benefit requested under your health plan.
Can you get dental insurance with pre-existing conditions?
Pre-existing conditions: Most dental plans exclude coverage for dental conditions that already existed at the time of enrollment. For example, many policies won't cover missing teeth. But pre-existing conditions don't include dental conditions you weren't aware of, such as cavities.
Can you get surgery and pay later?
There are many lenders available that provide financing for elective medical procedures. You can sign up for monthly payments and schedule your surgery or procedure in advance.
What is the usual minimum waiting period for a pre-existing condition?
The length of time before the start date of coverage during which a condition would be considered pre-existing varies, and can be anywhere from 30 days to 6 months or longer.
Can an insurance company see your medical records?
The answer varies depending on the state. In California, the retention period can be anywhere from two to ten years, depending on the type of procedure or healthcare provider. However, an insurance claim medical report should only look as far back as the injury in question.
How far back does insurance look?
You typically won't be charged for anything that happened beyond three years ago, however, insurance companies will still pull five years of driving history from your Motor Vehicle Report (MVR).
Whose insurance do you call when rear-ended?
Now you know that you should call your own insurance company if someone rear-ends you.
Can I sue my insurance company for taking too long?
The answer to this question is complex, but California health insurance providers are bound by state law to respond to claims within a specific amount of time. If they fail to do so, you may have the basis for a lawsuit against your insurer due to bad faith.
Does Progressive give good settlements?
What Is it Like Negotiating With Progressive For a Car Accident Settlement? Compared to other insurance companies, Progressive is more aggressive in offering lowball settlements, which means their first offer is likely to be significantly low. According to J.D. Power's 2023 U.S.