What is a health insurance waiting period?
When it comes to health insurance waiting periods, the Spanish Insurance Association (UNESPA), through its Estamos Seguros initiative, explains the concept in a simple and easy-to-understand way:
- A waiting period is the length of time during which you cannot yet access certain healthcare services or benefits included in your policy.
- Waiting periods do not apply to every healthcare service or benefit, only to those specifically stated in the insurance policy.
In short, a waiting period in private health insurance is the amount of time an insured person must wait before being able to access certain healthcare services or benefits. The duration of the waiting period may vary depending on the insurance provider.
By the way, the terms "waiting period" and "co-payment" are sometimes confused. A co-payment allows you to reduce your insurance premium by paying part of the cost each time you use certain healthcare services included in your policy. At Adeslas, we adapt to your needs by offering both health insurance with co-payments and health insurance without co-payments. The choice is yours!
How does the waiting period work in private health insurance?
The easiest way to understand how a waiting period works is through a practical example:
- On 1 June 2024, a man takes out a private health insurance policy that includes a 6-month waiting period for vasectomy procedures.
- If, at a later date, he and his family decide on permanent contraception and he wishes to undergo a vasectomy, he will not be able to use his health insurance for this procedure until the 6-month waiting period has ended.
- From 1 December 2024, once the waiting period has expired, he will be able to discuss with his Adeslas doctor whether undergoing a vasectomy is appropriate.
As with many other insurance providers, Adeslas health insurance policies include waiting periods for certain specialist treatments. These are grouped into waiting periods of 3, 6 and 8 months.
3-month waiting periods
- High-tech diagnostic tests.
- Outpatient surgical procedures (Group 0 to II procedures according to the Spanish Medical Association classification).
- Laser therapy for ophthalmic photocoagulation treatments, as well as laser therapy for musculoskeletal rehabilitation.
- Percutaneous nucleotomy.
6-month waiting periods
- Interventional diagnostic procedures.
- Tubal ligation and vasectomy.
8-month waiting periods
- Hospitalisation for any reason, whether as an inpatient or in a day hospital, as well as any surgical procedures carried out under these arrangements.
- Surgical implants and prostheses (the waiting period does not apply to surgical procedures performed in life-threatening emergencies).
- Childbirth or caesarean section (the waiting period does not apply to surgical procedures or complicated deliveries carried out in life-threatening emergencies, nor to premature births occurring before the 28th week of pregnancy).
- Laser therapy for colorectal surgery; surgical procedures in gynaecology, otorhinolaryngology and dermatology; procedures for benign prostatic hyperplasia; urinary tract lithotripsy; and endoluminal treatment of varicose veins and tracheobronchial lesions.
- Pain management treatment.
- Dialysis.
- Shock wave therapy for musculoskeletal calcifications.
- Kidney lithotripsy.
- Chemotherapy and radiation oncology.
Waiting periods by Adeslas health insurance plan
It is important to bear in mind that all Adeslas private health insurance plans are different and vary in terms of price, cover and waiting periods.
- With Adeslas GO, all the benefits included in the policy are available immediately, except for high-tech diagnostic tests, which, as explained above, are subject to a 3-month waiting period.
- Adeslas PLENA VITAL, Adeslas PLENA, Adeslas PLENA PLUS, Adeslas PLENA TOTAL, Adeslas PLENA EXTRA 150 MIL, Adeslas PLENA EXTRA 240 MIL and Adeslas PREMIER offer more comprehensive cover and include a wider range of waiting periods, with services subject to 3-, 6- and 8-month waiting periods.
- Adeslas SENIORS and Adeslas PLENA TOTAL SENIORS are health insurance plans specifically designed to meet the needs of people aged 55 and over. As with the Adeslas PLENA range, waiting periods range from 3 to 8 months.
- All our health insurance policies give you access to an extensive medical network with more than 51,000 healthcare professionals, over 200 private hospitals and more than 1,400 medical centres. They also include a range of additional benefits, such as digital healthcare services and medical assistance.
- If you would like more information about our different private health insurance plans, their cover, healthcare services and waiting periods, you can contact us through our contact channels, visit one of our sales offices, or speak to one of the insurance agents in the Adeslas network.
Why do health insurance policies have waiting periods?
If you're wondering why waiting periods exist, it's important to know that they are introduced for several reasons, including the following:
- Without waiting periods, people could take out private health insurance only when they develop a medical condition or need an expensive treatment.
- Once they have undergone the diagnostic test, surgery or treatment, they could then cancel their policy.
Waiting periods help Adeslas ensure that policyholders make responsible use of the healthcare services and benefits included in their health insurance.
Frequently asked questions
How can I find out if my health insurance has waiting periods?
Waiting periods are set out in your policy's General Terms and Conditions. In addition, Adeslas provides specific documentation so that policyholders can easily check the waiting periods that apply to their plan.
What is the difference between a waiting period and an exclusion period?
Waiting periods and exclusion periods are often confused, but they refer to different concepts:
- Waiting period: the length of time that must pass before a policyholder can access a specific healthcare service or benefit.
- Exclusion period: a period during which certain healthcare services or benefits are not covered by the policy, regardless of how much time has passed since the policy was taken out.
Do waiting periods apply in an emergency?
No. Emergency medical care is not subject to waiting periods.
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