The benefits of health insurance are numerous, so it's no surprise that so many people choose to have one. However, when signing the contract, it's common to come across the terms “waiting period” and “exclusion” and not know exactly what they mean.
We'll answer all your questions in this article.
What is a waiting period?
The waiting period is the period of time that must elapse from the effective date of the insurance policy for it to take effect. During the waiting period, the insurance will not provide its benefits. The length of time of the waiting period will depend on the type of insurance you purchase, as well as the care you require.
Why is the waiting period necessary?
When you purchase health insurance, insurers don't know your complete medical history. The waiting period gives them enough time to verify that the information you provide is accurate and to prevent possible irregularities, omissions, or inadvertent errors in any information provided.
What happens if an emergency occurs during the waiting period?
In most health insurance or hospital cover policies, emergencies such as heart attacks, strokes, or life-threatening accidents are typically covered even during the waiting period. However, coverage for pre-existing or non-emergency treatments may still be subject to the waiting period. Always check the specific terms of your policy to understand what is included from day one.
Can the waiting period be eliminated?
The possibility of eliminating the waiting period depends on several factors:
- Type of insurance: Not all insurance policies allow for the elimination of the waiting period. Generally, sick leave insurance policies without waiting periods are designed to provide immediate coverage.
- Negotiation: In some cases, insurance companies are willing to negotiate this aspect, especially if the insured has a claim-free history or if the policy purchased is of high value.
- Special conditions: Occasionally, policies that include a reduced or zero waiting period may be offered as part of specific promotions.
Although waiting periods are common in many coverages, some essential services, such as basic medical consultations, may be exempt from this period, allowing the insured to access them from the first day the policy is effective. Again, always check the specific terms of your policy to understand what is included from day one.
This brings us to exclusions. What are they?
What are exclusions?
When purchasing insurance, it's very important to know the details of the coverage it offers, i.e., all the situations in which your insurance applies. Exclusions in health insurance are all the situations that your insurance doesn't cover. It’s a way for the insurer to limit the risk they are willing to cover.
Why is it important to know your insurance exclusions?
Purchasing insurance without knowing its exclusions can be a mistake. You may have false expectations about what you're insuring, resulting in dissatisfaction with your policy. It's important to know that exclusions vary for each type of insurance.
For example, for a supplementary health insurance, an exclusion may be not covering expenses related to aesthetic treatments, while for a sports health insurance, its exclusions may relate to not covering accidents in certain high-risk sports.
What you should keep in mind when choosing a policy
Before signing an insurance contract, it's very important that you carefully review the policy's terms and conditions, especially regarding waiting periods. Here are some key things to keep in mind:
- Waiting period length: Waiting periods can vary considerably, from a few days to several months, depending on the type of coverage.
- Affected Services: Not all coverages are subject to a waiting period. Find out which services you can use immediately and which ones will not be available until after the waiting period.
- Specific conditions: If you have any pre-existing conditions or plan to use services such as assisted reproduction, check the specific deadlines that will apply to you.
Finally, read the contract carefully before signing and ask any questions you may have. Ensure the information is clear and as agreed. Keep a copy of the contract and any documents proving your subscription.
By following these steps, you can choose a health plan that meets your needs and won't let you down when you need it most.
With M-KOPA’s health cover, you can have confidence that the coverage is transparent and reliable. Our partnership with Turaco Insurance ensures that you get the care you need when it matters most.
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