What is a Qualifying period in an insurance policy?
Many insurance policies have a qualifying period, sometimes referred to as an Eligibility Period.
An Eligibility period is a period beginning at the date of purchase of an insurance policy, during which the insured pays an insurance premium (premium) but is not entitled to exercise the insurance for an event that occurred during that period, or the scope of insurance coverage is smaller. The Eligibility period varies between the types of policies and the types of coverage, and usually ranges from a few weeks to a few years. The insured will not be entitled to any insurance benefits in respect of an “insurance event” that occurred during the qualifying period, but only in respect of an “insurance event” that occurred after the eligibility period has ended.
In pension funds, insurance coverage in the event of an aggravation of an existing illness begins only after a qualifying period of 5 years, ie only after the insured has accumulated at least 5 years of contributions to the pension fund.
Sometimes the insured may be entitled to insurance benefits even during the qualifying period, if the insured event occurred due to an accident, and the terms of the policy should be carefully checked.There are also policies that entitle to reduced insurance benefits for insurance cases that occurred during the qualifying period, depending on the terms of the policies. When updating an existing insurance policy, an additional qualifying period may apply and for an “insured event” that occurred during which the insured will not be entitled to compensation. Therefore, when updating a policy it is important to carefully check the terms of the new policy and it is even advisable to consult a professional.It is important to note that during the qualifying period the insured pays an insurance premium (premium).
Examples
Example #1
A person purchased a health insurance policy to cover surgeries.The policy states that the qualifying period of the policy is 90 days.This means that if a person needs surgery during the first 90 days from the date of purchase of the policy, he will not be entitled to his rights under the policy and will not be able to exercise it.
Example #2
In pension insurance (as part of a pension fund), there is a qualifying period of 5 years for existing illnesses. If an insured in a pension fund loses his ability to work during the first 5 years as a result of an illness that already existed when he joined the fund, he will not be entitled to a disability pension from the fund.Please note how the insurance case is defined in the policy.
Example #3
In Serious illness insurance, the “insured case” that entitles the insured to compensation is the date of discovery of the illness and not the date of onset of the illness.In this case the insured will be entitled to compensation for illness if it was discovered after the end of the qualifying period, even if the date of its outbreak was during the period.
| Qualifying period | Waiting period |
|---|---|
| A qualifying period is the period in which the insured pays an insurance premium (premium) but is not entitled to benefits if an “insurance event” occurs or the scope of insurance coverage is smaller. | The waiting period is the period of time between the occurrence of an insurance event that entitles the insured to benefits from the insurance company and the date on which he insurance company must transfer the actual benefits to him.. |
| The qualifying period begins on the date of purchase of the insurance policy and ends within a period of time defined in the policy.. | The waiting period begins with the occurrence of the insured event and ends after the time specified in the policy. |
| The insured will not be entitled at all to insurance benefits due to an insurance event that occurred during the qualifying period, and which is stated in the policy that the qualifying period applies to him. | The insured is entitled to insurance benefits due to an insurance event that occurred during the waiting period, but will have to wait until the end of the waiting period to receive them (provided, of course, that the qualifying period has elapsed). |
Example #4
A person purchased health insurance to cover personal accidents.The policy states that the qualifying period of the policy is 90 days and the waiting period is 14 days.In this case, if the person has an accident during the first 90 days from the date of purchase of the policy, he will not be entitled at all to the insurance benefits.However, if the person has an accident after the end of the qualifying period (end of the first 90 days), he will have to wait 14 days from the date of the accident until the date he receives the insurance benefits.
Based on a translation of content from https://www.kolzchut.org.il/
