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When can you start using your health insurance?

Keep in mind...
  • Health insurance has an effective and end date
  • Insurance is usually effective as soon as the first Premium is paid
  • It’s important to know if Your health insurance comes with any waiting periods before scheduling any apointments

So, you’ve bought health insurance; now when can you use it? In most situations, you can start using your health insurance right away.

Unless your health insurance comes with a waiting period, it’s usually effective as soon as you pay your first premium payment. However, every insurance is different, and your effective date is based on several different factors. Learn more about the situations that could affect your health insurance effective date below.

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Insurance Through Your Employer

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When you work full-time, you may be offered health insurance through your employer. During the hiring process, your employer or the person handling HR on behalf of your company will explain when you are eligible to be covered by the group’s health insurance. In some situations, you may qualify for health insurance as soon as you turn your paperwork into the HR department.

Buying Individual Health Care Insurance

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If you’re buying individual healthcare insurance, your broker or agent should explain to you when the coverage will be effective. Once the initial payment has been received, and the details of when future premiums will be paid have been ironed out, your coverage should be almost immediate.

Most health insurance policies begin and end on the first and last day of a month. If you enroll for coverage during an open enrollment event, the day you apply for coverage may influence your effective date. For instance, if you apply during the 1st or 15th of a month, your coverage will likely start the 1st of the next month. If you enroll after the 15th of a month, your coverage may not start until for six weeks or so.

For example, if you apply for health insurance on February 1st, your coverage should begin on March 1st. But, if you wait until February 18th to apply, your insurance may not be effective until April 1st. The difference of just a few days or weeks can influence your effective date significantly.

If you are in need of health insurance immediately, it’s important you pay attention to effective dates and apply as soon as you know you’ll need coverage.

Being Eligible for Coverage Doesn’t Mean Your Services are Covered

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If you’ve been continually covered by health insurance, you should be able to use new coverage right away. There are exclusions to this rule, but in general, it holds true. When you’ve had a lapse in coverage for any significant amount of time, you may have waiting periods assigned to your new coverage.

The waiting period could include all medical services or only a few. Each insurance company handles waiting periods and exclusions a bit differently, so it’s always a good idea to shop around.

What’s a Waiting Period?

If your insurance company informs you that you have a waiting period before you can use part or all of your health insurance, it means you will have to wait until that period has ended before health insurance will cover services. Waiting times vary greatly and are dependent on a variety of factors.

Average waiting times enforced by health care insurance are three months, six months, or one year. To get a better understanding of health insurance waiting periods consider the following scenario.

Example:

Sam has a waiting period of six months for any medical services regarding heart disease. If Sam finds out he needs a heart bypass three months into his coverage, his health insurance will not pay the bill for his service.

Insurance does not cover the service even though Sam has health care coverage because he is still within the six-month heart disease waiting period.

Waiting Periods are Only Applicable for Specified Conditions

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If you have waiting periods applied to your health care coverage, you don’t have to worry about being covered in case of emergency or accident.

Waiting periods for coverage are usually only applicable to certain conditions. Other conditions or services that are generally always included right away include preventative, routine, and maintenance services.

It’s important to understand when your insurance will cover you for all medical care. Knowing when your insurance is sufficient and whether you have any exclusions or waiting periods applied to your coverage will help you schedule medical appointments, procedures, and treatments appropriately.

When scheduled in accordance with your coverage, you should be able to feel confident that the insurance will be paying your bills and you won’t be stuck paying for it in its entirety.

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