Benefits Manager Services
Click the Login button to View Group Information, View and Manage Member Eligibility, Access Online Bill Pay and Perform Group Enrollment Tasks

Register Now

Login
Find a Doctor
Search our provider directory when you need a doctor, hospital, pharmacy or other health care provider.

Health & Wellness
A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.

Learn More

Waiting Periods

PW_034745
There are two types of waiting periods that may affect new members. The first is determined by the employer group and applies to enrollment eligibility; the second type is imposed by us (for insured plans) or by the provisions of a self-funded health care plan, and applies to coverage for pre-existing conditions. 
Eligibility Waiting Period (employer-imposed)
This type of waiting period, determined by the employer, is the length of time that all employees must work before becoming eligible for the group’s health care plan.
Pre-existing Condition Waiting Period (health care plan-imposed)
This waiting period is the length of time a new member must wait before coverage will be provided for a pre-existing condition (defined as a condition, other than pregnancy, for which medical advice, diagnosis, care or treatment was recommended or received during the six-month period prior to the covered person’s effective date or the beginning of the group’s eligibility waiting period).
Coverage for the pre-existing condition is usually provided after a 12-month waiting period. However, this 12-month period will be reduced by any period during which the member was covered under “creditable coverage” unless there has been a break in coverage of at least 63 days. Creditable coverage includes group health plan coverage, individual health insurance, Medicare, and certain other types of coverage. Please refer to the information in the Exceptions to Waiting Periods section of this Administrative Guide.
Members may begin seeking treatment for illness or injuries that are not related to pre-existing conditions when their membership becomes effective.
 
 
Waiting Periods by Group Size
The information in the “Waiting Periods by Group Size” section applies to Anthem HealthKeepers plans only.  
Groups with 2-9 employees
New groups with 2-9 employees enrolling in an Anthem HealthKeepers plan will receive credit toward the waiting period for pre-existing conditions if transferring from another plan. Credit will be given for any amount of time spent enrolled under an individual or group health program as long as the previous coverage was continuous to a date not more than 63 days prior to the date of enrollment. Prior carrier information must be completed in the Proof of Prior Coverage Section on the employee’s enrollment application. The same credit will be given to any new employee enrolling in an already existing group plan. If the employee has not enrolled because he or she has not met the employer-imposed eligibility waiting period, that waiting period is not considered a break in coverage.  
Groups with 10-50 employees
New groups enrolling with 10-50 employees will have the pre-existing condition waiting period waived for all members who are enrolled as of the group’s initial enrollment if we are replacing another carrier and if the employee was covered under the previous carrier’s plan.  
Employees who were not covered under the previous carrier’s plan or new employees to the group will receive credit toward the waiting period for pre-existing conditions if transferring from another group or individual plan as long as the previous coverage was continuous to a date not more than 63 days prior to the date of enrollment. Prior carrier information must be completed in the Proof of Prior Coverage Section on the employee's enrollment application. If the employee has not enrolled because he or she has not met the employer-imposed eligibility waiting period, that waiting period is not considered a break in coverage.  
Groups with 51+ employees
Groups enrolling with 51 or more employees do not have waiting periods for pre-existing conditions if we are replacing another carrier and if the employee was covered under the previous carrier’s plan.  
Employees who were not covered under the previous carrier’s plan or new employees to the group will receive credit toward the waiting period for pre-existing conditions if transferring from another group or individual plan as long as the previous coverage was continuous to a date not more than 63 days prior to the date of enrollment. Prior carrier information must be completed in the Proof of Prior Coverage Section on the employee's enrollment application. If the employee has not enrolled because he or she has not met the employer-imposed eligibility waiting period, that waiting period is not considered a break in coverage.  
 
 
Exceptions to Waiting Periods
Exemptions
Pre-existing conditions waiting periods do not apply to: 
an employee transferring from your employer-sponsored federally-qualified HMO (transfer may be effective only on the group’s annual renewal date),
a newborn child or child placed in the employee’s home for adoption , if enrolled within 31 days of birth or placement
breast cancer for persons who have had breast cancer but have been free of the disease for at least five years or who only have a high risk of breast cancer,
pregnancy or maternity services, or
initial enrollment of groups with 10 or more employees, if covered by your group’s prior carrier (Anthem KeyCare and Anthem BlueCare only)
 
Reduced waiting periods: creditable coverage
An individual’s waiting period for pre-existing conditions is reduced when he or she has “creditable coverage.” Creditable coverage is previous coverage under another group or individual health plan (or certain other types of coverage, listed below), when there has not been a break in coverage of 63 days. The 63-day period begins when the individual’s previous coverage ended. It ends when coverage under your plan begins, or, if earlier, when your group’s waiting period for eligibility begins.  
Types of creditable coverage include coverage under: 
group health plans
most types of health insurance policies, HMO plans, and health service plans
Medicare and Medicaid,
TriCare,
the Peace Corps plan,
a public health plan established or maintained by a state, the U.S. government, a foreign country, or any political subdivision of one of these,
a medical care program of the Indian Health Service, and
the Federal Employees Health Benefit Plan,
 
Employees have the right to prove prior creditable coverage to obtain credit for any time already earned toward meeting the waiting period. To do this, the member must secure a certificate of previous coverage from the former employer, the publicly-sponsored program or the group insurance carrier or health plan that provided the previous coverage, or provide prior coverage information on the application. We will assist the member in obtaining proof of previous coverage if needed. 
 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use