Waiting time

The waiting period is a classic feature of private health insurance: there is a defined period between the start of coverage and the first actual claim, during which the insured person pays premiums but does not yet receive any reimbursements. In modern group private health insurance plans, waiting periods have generally been eliminated entirely—and this is one of the most compelling advantages of this type of insurance compared to individual private supplemental insurance.

What waiting periods apply to individual insurance

For context: In individually purchased private supplemental health insurance policies, there are traditionally three types of waiting periods. The general waiting period is typically three months and covers all benefits. The special waiting period applies to certain categories of benefits, such as dental prosthetics, childbirth, or psychotherapeutic treatments, and lasts eight months. And in individual cases, specific benefit exclusions are agreed upon for existing diagnoses, which effectively amount to an indefinite waiting period.

These waiting periods were historically established to prevent policyholders from taking out a policy just when they need foreseeable treatment—for example, shortly before a scheduled dental implant procedure. In this way, insurers protect themselves against adverse selection.

Why bKV policies have no waiting periods

In a group dental insurance plan, the selection problem is structurally eliminated: the employer enrolls the entire workforce (or a clearly defined group)—regardless of who is currently planning to get dental work done. The pool is thus inherently mixed, and the individual who has already scheduled a dental appointment plays no statistical role. Insurers can therefore eliminate waiting periods without significantly increasing their risk.

In practice, this means that an employee who is enrolled in the supplementary health insurance plan on the 1st of the month can use the full health budget starting that day. Dental cleanings, eyeglasses, alternative practitioners, preventive checkups—all are immediately eligible for reimbursement. With many providers, this even applies to treatments that began before the insurance took effect, as long as the invoice is dated after the insurance start date.

Exceptions and what employers should check

Not all supplementary health insurance plans are completely free of waiting periods. Here are three situations in which waiting periods may still apply:

• Specific high-cost services: Some plans still have waiting periods for expensive individual services such as major dental procedures (implants, full dentures) or laser eye surgery. These often have tiered coverage limits: a maximum of a certain percentage in the first year of the contract, a higher percentage in the second year, and the full coverage amount starting in the third year.
• Late enrollment: If an employee enrolls months after starting work or after the company’s enrollment window has closed, some insurers may still require a medical exam or a short waiting period.
• Family members: When adding spouses, partners, or children to the policy, waiting periods may apply—depending on the insurer and plan—especially if the addition is made outside the enrollment window following the policy’s start date.

Employers should review these details when selecting a plan and, above all, clearly communicate them to employees. Nothing is more frustrating than an employee who submits a claim and has it denied due to a waiting period, even though it was communicated internally that coverage takes effect from day one.

What this means for communication

The absence of waiting periods is one of the strongest selling points in activation communications because it is concrete and creates an immediate incentive to act. “You can schedule a dental cleaning appointment tomorrow and submit the costs through us” is more powerful than any abstract list of plan benefits. Companies that have successfully activated their supplementary health insurance plans therefore often work with specific promotional calendars: In the first month after launch, there’s a dental cleaning campaign; in the second, a promotion on eyeglass frames; and in the third, a series of osteopathy sessions.

FAKTOR MENSCH : We recommend that companies, during their initial briefing with staff, don’t just say, “There are no waiting times”—but instead rephrase it more concretely: “Anyone who books an appointment for a dental cleaning or eye exam by the end of the month can have the costs billed directly through us.” Based on our consulting experience, we see utilization rates triple in the first quarter when the communication includes this specific call to action—rather than just an abstract reference to the absence of waiting times.

Waiting period when changing employers

A common follow-up question: What happens to the waiting period if an employee leaves the company and transfers their supplementary health insurance to an individual policy with the same insurer? As a general rule, the months covered under the group policy are credited toward the waiting period of the individual policy. Anyone who has been enrolled in the supplementary health insurance for two years has long since passed the standard waiting periods for individual insurance and can continue to receive benefits without interruption.

Even if you switch to another employer that has its own group supplementary health insurance plan, there are generally no waiting periods under the new plan—provided that the new employer has also chosen a plan without waiting period clauses.

Conclusion

The absence of waiting periods is not just a cosmetic detail of modern supplemental health insurance plans, but a structural advantage that makes the coverage available from day one. For employers, it’s a selling point that wins them over during sales pitches; for employees, it’s the difference between a nice piece of paper in a drawer and a real benefit in everyday life. Plans with longer waiting periods or tiered benefit levels still exist, but they are now the exception and should be carefully weighed against alternatives with no waiting periods at all when selecting a plan.