An explanation of the qualifying period in long-term care insurance policies: what it is, how it differs from the waiting period, how it affects someone who joined the insurance at an older age, and what to check before filing a claim.
What a qualifying period is
A qualifying period is an interval that begins on the date the insurance starts, during which the cover is limited or does not apply to certain conditions. Its purpose is to prevent someone joining an insurance policy when the event is already foreseeable.
In long-term care policies the period is usually measured in months from the start of the insurance. The exact length varies between products and between periods, so the specific wording has to be checked.
The practical meaning: a long-term care condition that existed within the qualifying period may not be covered, even if the policy is in force.
Qualifying versus waiting — the distinction that causes confusion
These are two terms that sound similar and refer to entirely different things, and almost every family confuses them.
A qualifying period is measured from the start of the insurance. It asks: how long has passed since you joined.
A waiting period is measured from the moment the long-term care condition existed. It asks: how long does the condition have to continue before payment begins.
Both exist in parallel in most policies, and both have to be satisfied before a benefit is paid.
Who this is particularly relevant to
For most insured people the qualifying period is not relevant at all, because they have been insured for many years and it passed long ago.
It becomes substantive in two situations. The first: an insured person who joined the insurance at a relatively advanced age, shortly before their condition deteriorated. The second: a move between covers — for example changing health fund or joining a new group arrangement.
In the second situation there is a point worth clarifying: sometimes continuity of insurance is recognised, so that the qualifying period does not start afresh. This depends on the terms of the arrangement and on the circumstances, and it is worth asking about explicitly.
What to check before filing
If the insured person joined the insurance in recent years, it is worth carrying out a short check before you file.
- The exact date the insurance started
- What the qualifying period in the policy is and what it covers
- Exactly when the long-term care condition began, according to the documentation
- Whether there was earlier cover that might give continuity of insurance
- Whether there was a move between health funds or between arrangements
- Whether the qualifying period applies to all conditions or only to some
When a claim is refused on qualifying-period grounds
A refusal based on the qualifying period rests on two pieces of information: the date the insurance started and the date the long-term care condition began. If either is wrong, the decision is wrong.
So the first thing to check is the dates. Is the recorded date of the start of the insurance correct? Was earlier cover taken into account? And does the date fixed for the start of the condition match the documentation?
If a dispute arises about dates or about continuity of insurance, this is a situation that may call for a legal review.
Frequently asked questions
What is a qualifying period in long-term care insurance?
An interval from the start of the insurance during which the cover is limited or does not apply. A long-term care condition that existed within it may not be covered, even if the policy is in force.
What is the difference between qualifying and waiting?
A qualifying period is measured from the start of the insurance and asks how long has passed since joining. A waiting period is measured from the moment the long-term care condition arose and asks how long it has to continue before payment begins.
We changed health fund — does the qualifying period start again?
Not necessarily. Sometimes continuity of insurance is recognised so that the period does not start afresh, but this depends on the terms of the arrangement and on the circumstances. It is worth clarifying explicitly with the insuring body.
We were refused on qualifying-period grounds — what do we check?
The two dates on which the decision rests: the date the insurance started and the date the long-term care condition began. If either is wrong, or if earlier cover was not taken into account, the decision may change.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
