What is a waiting period?
A waiting period is the amount of time
before an employee's benefits begin. Waiting periods
are established by the employer based on carrier
approved options.
Small group waiting period options vary by
carrier and range from 0 months to 365 days for
medical benefits, as indicated on the employer group
application.
We specified a zero waiting period. Do benefits
become effective immediately?
Only if the hire date is the first of the month. In
general, benefits become effective the first of the
month following the wait period. For example, an
employee hired on December 2 would have benefits begin
on January 1.
What is an exclusionary period?
An exclusionary period for pre-existing
conditions is the amount of time, up to 6 months,
before a PPO or POS will cover a pre-existing
condition.
Exclusionary periods are set by the carrier and
are eliminated if the employee has had prior private
coverage for 6 months or more and a gap in coverage
of no longer than 180 days.
Many dental plans also have exclusionary periods
for major services and orthodontia.
I have an employee who works 32 hours per week. Can
I provide health benefits?
Yes. For eligibility purposes, carriers consider 30
hours per week to be full-time employment. Some
carriers also permit coverage for part-time employees
who regularly work 15-29 or 20-29 hours per week, if
specified on the group application.
I have a new employee I'd like to provide benefits
for immediately. Can I do it?
Only if you have established a zero wait period for
your entire group. Employees can apply for short- term
individual coverage in the interim period. Call us for
information.
Can I change my company's waiting period?
You can make an across the board change to your
benefits waiting period at renewal/open enrollment.
What are common wait periods?
A third of our clients have benefits that begin on
the first of the month following the hire date. See
the charts below to compare wait period by group size.
Companies with high turnover often have longer wait
periods.
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