Health Insurance Waiting Periods: What You Need to Know

You’ve just taken out a health insurance policy only to discover that it won’t cover certain treatments immediately? This waiting period, known as a délai de carence, can come as an unpleasant surprise. Yet, it’s often overlooked by policyholders. How does it work? Can you avoid it? And what are your rights as a member? This article explains everything clearly and without jargon, to help you plan ahead and make the right choices.

What is a health insurance waiting period?

A waiting period, also referred to as a période de stage or délai d’attente, is a period during which your health insurance policy does not reimburse (or only partially reimburses) certain treatments, even though you’ve already started paying your premiums. It typically applies from the moment you sign the contract and may vary depending on the cover and the provider.

Why does it exist?

Health insurers justify this waiting period for two main reasons:

• To prevent abuse: avoiding situations where a policyholder takes out insurance solely to benefit from immediate reimbursement (for example, for a planned operation).
• To balance risks: insurers aim to protect themselves against high expenses in the first few months, which could disrupt their budget.

Practical examples

• Dental care: a waiting period of 6 to 12 months is common for prosthetics or implants.
• Optical care: some policies impose a waiting period of 3 to 6 months before reimbursing glasses or contact lenses.
• Hospitalisation: waiting periods can range from 1 to 9 months, depending on the cover.
• Maternity: some insurers apply a waiting period of 9 to 12 months for pregnancy and childbirth-related expenses.

Note: These durations are indicative and vary from one policy to another. It is therefore essential to read the general terms and conditions carefully before signing.

How can you find out about your health insurance waiting period?

The waiting period must be clearly stated in your contract or in the general terms and conditions of your health insurance policy. Here’s where to look:

In the contractual documents

• The general terms and conditions: this document details the cover, exclusions, and applicable waiting periods. It is often sent by email or available online after signing up.
• The cover table: some policies present waiting periods in a table format, making them easier to read.
• The information notice: this document summarises the main features of the policy, including waiting periods.

If in doubt

If you can’t find this information, don’t hesitate to:

• Contact your advisor: they are obliged to provide these details.
• Check your insurer’s website: waiting periods are often explained in an FAQ or dedicated section.
• Request a paper copy: if you prefer to consult the documents physically.

Tip: Before signing up, compare waiting periods across different insurers. A shorter waiting period may justify a slightly higher premium.

Can you avoid or reduce the waiting period?

In some cases, it is possible to waive or reduce the waiting period. Here are the most common situations:

1. Waiving the waiting period

Some insurers offer policies without a waiting period to attract new members. These offers are often time-limited or reserved for specific profiles (young professionals, employees of partner companies, etc.).

2. Switching insurers

If you switch insurers without a break in cover, you may sometimes benefit from portability of rights. This means your new insurer may take into account your previous membership to reduce or waive waiting periods. To benefit from this:

• Do not cancel your old policy before signing the new contract.
• Provide proof of prior membership (a certificate from your previous insurer).

3. Group policies (employer-sponsored)

If you have health insurance through your employer, waiting periods are often reduced or waived. Group policies are negotiated for a large number of members, allowing insurers to relax their conditions.

4. Emergency situations

In the event of unexpected hospitalisation or an accident, some insurers waive the waiting period. This depends on the clauses in your policy: check whether this exception is included.

5. Negotiation

Some brokers or insurance advisors may negotiate shorter waiting periods for you, especially if you have a low-risk profile (young, healthy, etc.).

What can you do if the waiting period disadvantages you?

If you discover a waiting period after signing up and it causes you problems, here are some possible solutions:

1. Check the legality of the waiting period

Waiting periods are permitted by law, but they must be reasonable and proportionate. An excessively long waiting period (for example, 24 months for routine care) could be challenged. If in doubt, consult a social protection advisor or a consumer association (such as UFC-Que Choisir).

2. Cancel your policy

If you believe the waiting period was not clearly stated when you signed up, you can cancel your policy within 14 days of signing (cooling-off period). After this period, cancellation depends on the terms of your policy (notice period, potential fees, etc.).

3. Request an exemption

Some insurers may waive the waiting period upon a justified request, for example, in the event of a change in circumstances (job loss, divorce, etc.). Contact your advisor to explain your situation.

4. Take out temporary cover

If you need urgent treatment during the waiting period, you can take out temporary cover (such as hospitalisation insurance) to cover this period. These policies are often cheaper and have no waiting period.

How to choose the right health insurance to minimise waiting periods?

To avoid unpleasant surprises, here are some tips for choosing a policy that suits your needs:

1. Compare offers

Use an online comparison tool to evaluate the waiting periods of different insurers. Prioritise those offering short or no waiting periods for the cover you need.

2. Read the small print

Before signing, carefully read:

• The general terms and conditions (for waiting periods).
• The cover table (for reimbursement amounts).
• The exclusions (to find out which treatments are never covered).

3. Opt for policies without waiting periods

Some insurers offer policies without waiting periods for new members. These are ideal if you need immediate cover.

4. Check essential cover

If you have specific needs (dental care, optical care, maternity), ensure these are without a waiting period or with a very short one.

5. Seek advice

An insurance broker or social protection advisor can help you find the most suitable policy for your situation, with reduced waiting periods.

Frequently Asked Questions

What is the difference between a waiting period and an excess?

A waiting period is a period during which you cannot benefit from reimbursements, even though you are paying your premiums. An excess, on the other hand, is an amount that remains your responsibility for each treatment (for example, €20 per doctor’s visit). Both can coexist in the same policy.

Can you combine multiple health insurance policies to cover a waiting period?

No, it is not possible to combine reimbursements from multiple health insurance policies for the same treatment. However, you can take out temporary cover (such as hospitalisation insurance) to cover the waiting period.

Do waiting periods apply to children?

Yes, waiting periods generally apply to all beneficiaries of the policy, including children. However, some insurers offer exceptions for children’s routine care (vaccinations, paediatric consultations, etc.). Check the terms of your policy.

What can you do if your insurer refuses to reimburse a treatment due to the waiting period?

If your insurer refuses reimbursement due to the waiting period, first check that this clause is clearly stated in your policy. If it is, you can:

• Request an exemption by explaining your situation.
• Challenge the decision with your insurer’s complaints service.
• Refer the matter to the insurance mediator if the dispute persists.

Are waiting periods the same for all insurers?

No, waiting periods vary from one insurer to another and even from one policy to another within the same insurer. They depend on the cover chosen, your profile, and the negotiated terms. This is why it is important to compare offers before signing up.