New Customer Waiting Periods
When you take out health insurance for the first time, or it has been more than 13 weeks since you last held private health insurance, you may have to serve waiting periods before you are fully covered, but accident and injury will be covered immediately. The maximum waiting periods are:
| Accident and Injuries | Illnesses that start after you join | Illnesses that existed in the 6 months before you join | Maternity related claims |
|---|---|---|---|
| None | 26 weeks | 5 years | 52 weeks |
Once you serve these waiting periods you will not have to serve them again if you switch to another insurer, as long as you haven't had a break in cover of more than 13 weeks. If you switch insurers while you are serving new customer waiting periods, the amount of time served with the first insurer will be taken into account and you will finish off your waiting periods with the new insurer. You will only have to serve additional waiting periods if you switch to a plan with higher benefits. See our section on switching for further details.
Infants born to policyholders will not serve a waiting period if they are added to a policy within 13 weeks of their date of birth.
Illnesses that existed in the 6 months before you join are called pre-existing conditions and from 1 May 2015, a pre-existing condition is defined as:
"Pre-existing condition” means an ailment, illness or condition, where, on the basis of medical advice, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the contract.
Current Market Practice
| Age | Outpatient Medical Expenses | Day to day medical expenses | Inpatient New Condition | Inpatient Pre-existing Condition |
|---|---|---|---|---|
| Under 50 | None | None | 26 weeks | 5 years |
| 50+ | None | 26 weeks | 26 weeks | 5 years |
| Age | Outpatient Medical Expenses | Day to day medical expenses | Inpatient New Condition | Inpatient Pre-existing Condition |
|---|---|---|---|---|
| Under 55 | None | None | 26 weeks | 5 years |
| 55+ | None | 26 weeks | 26 weeks | 5 years |
| Age | Outpatient Medical Expenses | Inpatient New Condition | Inpatient Pre-existing Condition |
|---|---|---|---|
| All age groups | None | 26 weeks | 5 years |
| Benefit | Waiting Period |
|---|---|
| Dental and Optical | 3 months except for Laser Eye Surgery which is 6 months |
| Dental Trauma | No waiting period |
| GP and A&E | 3 months. No waiting period following an accident |
| Prescription | 3 months |
| Practitioner | 3 months |
| Wellbeing and Alternative Treatments | 3 months |
| Consultations | 3 months |
| Medical Tests | 3 months |
| Birth and Adoption Grant | 10 months, also applies to maternity claims |
| Hospital-General and Hospice | 3 months |
| Hospital-Accident | No waiting period |
| Hospital-Elderly and Mental Illness | 3 months |
| Recuperation | 3 months |
| Day Case | 3 months |
| Surgical Appliances and Hearing Aids | 3 months |
| Personal Accident | No waiting period |
| HSF Assist | No waiting period |
| Pre-existing conditions and health problems | If anyone has a pre-existing condition, there will be a waiting period for claims under the Practitioners, Wellbeing and Alternative Treatments (excluding chiropody/podiatry), Consultations, Medical Tests, Hospital and Day Case, Recuperation and Surgical Appliances & Hearing Aids categories. The waiting time will be 5 years from date of first registration. |
Switching/Upgrade Waiting Periods
If you are switching plans, the following maximum waiting periods may be applied to any higher benefit on the new plan:
| Any higher benefit | 2 years |
|---|---|
| Maternity benefits | 52 weeks |
Current Market Practice
* All insurers apply a 52 week waiting period for higher maternity benefits.
| Age | Outpatient Medical Expenses | Day to day Medical Expenses | Inpatient Pre-existing conditions |
|---|---|---|---|
| Under 50 | None | None | 2 years |
| 50-54 | None | 26 weeks | 2 years |
| 55-64 | None | 26 weeks | 2 years |
| 65+ | None | 26 weeks | 2 years |
| Age | Outpatient Medical Expenses | Day to day Medical Expenses | Inpatient pre-existing conditions |
|---|---|---|---|
| Under 55 | None | None | 2 years |
| 55+ | None | 26 weeks | 2 years |
Laya Healthcare
No waiting period for higher outpatient benefits. 2 year waiting period for higher inpatient benefits when used for a pre-existing condition.
Cash Plan Waiting Periods
Rules surrounding waiting periods, switching and upgrading of your cash plan are governed by the same legislation that applies to inpatient health insurance plans as described in our pages on "New Customer Waiting Periods" and "Switching/Upgrading waiting periods".
Cash Plan New Customer Waiting Periods
| Accident and Injuries | Illnesses that commence after you join | Illnesses that commence before you join | Maternity related claims |
|---|---|---|---|
| None | 26 weeks | 5 years | 52 weeks |
*Rules concerning pre-existing conditions do not apply to Dental and Optical, General Practitioner and Emergency Department, Prescriptions and Chiropody/Podiatry
Cash Plan Upgrade/Switching Waiting Periods
If you are switching plans, the following maximum waiting periods may be applied to any higher benefit on the new plan:
|
Any higher benefit |
2 years |
|---|---|
|
Maternity benefits |
52 weeks |