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Health insurance waiting periods: your questions answered

Health insurance waiting periods, the amount of time a policyholder is required to wait to access their health insurance benefits, are often mired in confusion. There are several myths surrounding waiting periods, which can cause anxiety for new customers and those thinking about switching their policy to another that suits them better.

Our health insurance specialists are regularly asked about health insurance waiting periods. In this blog post, we’ll explore the most asked questions and dispel the myths around health insurance waiting periods.

What is the waiting period for first-time health insurance customers?
If you are taking out health insurance for the first time, or if it has been 13 weeks since you last held private health insurance with an Irish health insurer, you can access emergency care for accidents and injuries immediately. However, a waiting period of five years will apply to pre-existing illnesses, 26 weeks for illnesses that begin after you join, and 52 weeks for maternity cover.

Does a waiting period apply if I switch my health insurance provider?
A common misconception among health insurance policyholders is that if they switch their health insurance provider, they will need to reserve their entire waiting period. Once you have served your initial waiting period, you will have continued access to health insurance benefits, regardless of which provider you choose.

If I upgrade my health cover, does a waiting period apply?
If you opt to increase your health insurance cover, you will have immediate access to your plan’s benefits, unless you have a pre-existing condition.
If you have a pre-existing condition, you will have to serve a two-year upgrade waiting period to access a) the enhanced benefits on your new plan that b) you intend to use for your pre-existing illness.

For example, a customer with a heart condition currently pays an excess of € 300 for a semi-private room in a private hospital. The customer decides to upgrade their plan, which has a lower excess of €150. The customer is still covered for their heart condition, but for the first two years, they will continue to pay the €300 excess if admitted for the pre-existing illness. If they are admitted for a new condition, the excess will be charged at the upgraded plan rate of €150.

Does a waiting period apply if I upgrade my plan with the same health insurance provider?
The same upgrade rule applies as above if you increase your cover with the same provider. If you have a pre-existing condition, you will have to serve a two-year upgrade waiting period to access a) the enhanced benefits on your new plan that b) you intend to use for your pre-existing illness.

I have moved from another country where I had health insurance; do I have to serve the waiting period again?
Irish health providers do not recognise cover from outside Ireland. When you take out a policy for the first time in Ireland, you will have to serve the same waiting periods as a first-time customer.

Can I access enhanced outpatient benefits straight away if I upgrade my cover?
You can access the enhanced benefits on your upgraded health insurance plan immediately. In most cases, there is no waiting period for outpatient benefits, such as GP visits, consultant visits, dental appointments, diagnostic tests and physiotherapy. Some providers have a six-month upgrade waiting period for outpatient benefits if you are 55 or over. Check your cover to find out what benefits your plan offers.

Does my age affect my waiting period?
Age can affect the waiting period you need to serve. For instance, some customers over 55 may be required to serve a six-month waiting period on outpatient benefits if they upgrade their plan from a plan that did not previously provide outpatient benefits. Each health insurance provider is different, and age limits and waiting periods can change. It is important you speak with a health insurance specialist to determine what waiting periods apply.

Is there a waiting period for my newborn child?
Newborns that are added to a policy, if they are included from their birth date are exempt from waiting periods.

What if I get pregnant after I join or switch my health insurance cover?
Typically, there is a 52-week waiting period for maternity cover after joining health insurance for the first time. Once you serve this waiting period, you will not have to re-serve if you change provider. However, if you upgrade your maternity cover you will have to serve another 52-week waiting period to avail of the enhanced benefits. If you take out cover in January, became pregnant in April, and were due to have your baby in January the following year, you would have served the 52-week waiting period and be eligible to make a maternity claim by the time the baby is born. It is important to understand your plan terms and benefits because some plans have specific requirements; speak with our health insurance specialists to find out more.

Talk to a health insurance specialist for tailored advice about your cover.
Everyone is different and so are their health insurance needs. That’s why it is essential to discuss your situation with a health insurance specialist to determine whether waiting periods affect your cover and what options are available. With no waiting period for emergency treatment for accidents and injuries or access to enhanced benefits on upgraded cover*, waiting periods may sound more daunting than they are. To find out more about waiting periods and discover a plan that suits your needs, call our team on (091) 586 500 today.

*Restrictions on age and pre-existing conditions may apply, talk to our health insurance specialists to find out more.

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