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Waiting Period

A waiting period is the amount of time you must be covered under a plan before certain benefits become available. Insurers use waiting periods to prevent individuals from joining a plan solely to claim an expensive procedure immediately. Waiting periods vary by benefit type and plan.

How It Works

A waiting period is a period of time beginning when your policy first comes into force, during which certain expenses you incur are not eligible to be claimed. It is sometimes also called a qualifying period. More precisely, it is the continuous period of time during which a participant must be covered by the policy before becoming eligible for coverage, and once that period is completed it is not applied again as long as the coverage stays in force. Waiting periods exist to protect against anti-selection and to maintain the stability of premiums.

What matters for a waiting period is when the service is actually performed, not when the claim is submitted, so a covered procedure done after the waiting period ends is eligible even if you applied during the waiting period. In Canadian health and benefits usage, the term commonly refers to either a plan-entry delay before coverage itself becomes available, or a benefit-start delay before payment begins after a qualifying loss, and the meaning depends on the contract context. In Canadian group benefits, the waiting period is the time between an employee's first day of work and the date they become eligible to enrol, and it is set by the employer in the master insurance contract rather than by government regulation, with many plans using 30 days, 60 days, 3 months or 6 months depending on the benefit line.

Example:

Suppose a Canadian personal dental plan has a 30-day waiting period for routine dental coverage. If you go to the dentist on day 5 of your policy and have a cavity filling done, that claim would be denied; if you have the same filling done after the 30 days are up, the claim would be eligible. If you had other dental coverage within the prior 60 days, the insurer might waive the routine-dental waiting period so you can use the benefit right away.

What to Watch For:

If a person has had other health and/or dental coverage within the last 90 days, with proof, an insurer may waive the waiting periods so those benefits are accessible immediately. Also note that many provinces impose a waiting period of up to 3 months before public health insurance begins, during which newcomers are personally responsible for healthcare costs, so temporary private health insurance is recommended to cover the gap.

Related Terms

Plan Member

A plan member is an individual who is enrolled in and eligible to receive benefits under a group insurance plan. Typically, the plan member is an employee of a company or a member of an organization that sponsors the group policy. The plan member is covered for the benefits outlined in the plan - such as health, dental, life, and disability insurance - and may also extend coverage to eligible dependents, including a spouse or children.

Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Effective Date

The effective date is the day your insurance coverage officially begins. From this date forward, you are eligible to receive benefits for covered health, dental, life, or disability expenses under the terms of your policy. The effective date is established once your application has been approved, all requirements are met, and the first premium payment has been received, unless otherwise specified in the policy.

Healthcare Spending Account (HCSA)

A Healthcare Spending Account (HCSA) is a flexible, employer-funded benefit that reimburses employees for a wide range of eligible healthcare expenses not fully covered by their group insurance plan or a government health plan. It allows employees to use allocated funds toward medical, dental, and vision expenses based on their personal needs. The Canada Revenue Agency (CRA) regulates which expenses qualify under the Income Tax Act, and reimbursements from an HCSA are received tax-free.

Member

A member is an individual who is enrolled and covered under a group insurance plan, typically through their employer, association, or organization. The member is often referred to as the insured employee or plan participant and receives coverage for benefits such as health, dental, life, and disability insurance. The member may also extend coverage to eligible dependents, such as a spouse or children, under the same plan.

Relevant Plans

Plans that relate to Waiting Period

Alberta Blue Cross - Blue Assured - Basic

Alberta Blue Cross - Blue Assured - Basic

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced

Alberta Blue Cross - Blue Assured - Enhanced

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced+

Alberta Blue Cross - Blue Assured - Enhanced+

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Premium

Alberta Blue Cross - Blue Assured - Premium

Can apply at anytime, at any age.

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