Everything you need to know about Insurance waiting periods in Kenya

What is an insurance waiting period?

Waiting period” is the period of time set by the insurer that the member will not get services upon approval of the membership.


How long is it? It depends on the type of benefit. The waiting period applies to specific illnesses, procedures, and medical treatment.


What does it entail? This means the member cannot access services using the medical cover hence the insurer is not liable for any claims incurred within the waiting period.


Imagine being unwell and unable to receive funds to seek medical care ASAP! It’s distressing. You probably have been told by your insurance provider to wait for your claim to be processed, how did it feel? were they right or wrong? In this article, we unpack Insurance waiting periods.

To begin with, a waiting period is a period you must wait for a specified amount of time before you make a claim. Mostly this occurs with medical covers. During this period, you cannot claim the benefits of your medical insurance from your provider.

Kinds of waiting periods

The duration of how long you will wait varies from one insurer to another. Besides, it also varies depending on the type of illness. For instance, in most cases, there is a waiting period of;

·      0 Days -accidents and emergencies.

·      14 days -30 days – also known as the initial waiting period. This is the period before medical insurance can be used for general illnesses.

·      60 days – for medical procedures and surgeries.

·      10-12 months – for maternity and related conditions. For instance, it may not be possible to access maternity cover if the health insurance cover was purchased a week before the expected baby delivery date.

·      6 – 12  months – for chronic and pre-existing conditions

Unethical behavior

While Insurance is good, some people leverage it for all the wrong reasons. For instance, one may buy a cover without disclosing that they have pre-existing conditions. They will then go ahead to get their condition covered which will be a loss to the insurer. Waiting periods allow for such wrong moves to be flagged. To avoid surprises during your relationship with your insurer, most providers recommend that a medical test be done before accepting your request. 

Therefore, having a waiting period clause is important because it protects insured persons and the insurer from unethical practices and claims. It also allows you to better prepare yourself adequately in case any of the above scenarios happen to you.