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Arizona Health Insurance Waiting Periods, Exlusions, Conditions & More

Waiting Periods, Preexisting Conditions, Exclusions and Limitations

These provisions limit or exclude the insurance company's obligation to pay benefits. Policies have a list of exclusions and limitations. Policies with fewer exclusions may be more expensive than policies with more exclusions. Make sure you understand what will and will not be covered.

Waiting Periods

A waiting period is the amount of time that must pass after the policy takes effect and before coverage begins. If a policy has a waiting period, benefits will not be paid or they might be limited for expenses that arise during a specific number of days after the policy is in effect. Waiting periods are not applicable if an individual had certain types of prior coverage, and may only apply to certain conditions or services.

Preexisting Conditions

Individual policies usually will not pay benefits until a certain time period has elapsed for a health condition you had when you bought the policy. This type of health condition is known as a "preexisting" condition. Exclusions for preexisting conditions are intended to preclude individuals with an illness or injury from waiting to buy a policy until they need treatment that would otherwise be paid for under the policy.

You should know the meaning of any provisions excluding benefits for preexisting conditions. Also, you should know how long the provision will exclude benefits for preexisting conditions. Many claims are denied because of these provisions.

Do not think that because the application asks no questions about your health or medical history or the policy requires no physical examination, the policy will cover conditions that you already have. It probably will not. If the company asks questions about your health history it is important to answer them truthfully.

Under some definitions a condition would be considered "preexisting" even if you did not know that you had the condition before you bought your policy. Also, you need to know how many previous years will be considered for determining a preexisting condition.

Policies vary regarding how long they exclude or limit benefits for preexisting conditions. Shop for a policy with the shortest exclusion for preexisting conditions.

Other Exclusions

In addition to excluding preexisting conditions, health insurance policies usually exclude illness or injury resulting from war or military service or those covered under workers' compensation.