banner

What is Waiting Period in Health Insurance?

Know about various types of waiting period in health insurance.

100 Views 83 Shares
banner
Rated by users

Buying health insurance is a necessity for modern living. Still, many people make this purchase without knowing various intricate features of health insurance plans. One such feature is the waiting period in health insurance.

You might have heard people saying they cannot get health insurance benefits because waiting period is not over. Like many others, you might know about waiting period in health insurance and its importance. Let’s dig deeper.

Waiting Period Definition 

In simple words, waiting period in health insurance plans is the period for which you need to wait before getting the insurance benefits, hence the name. It begins from the date of policy commencement, and the insured cannot claim health insurance benefits during this time. The duration of waiting period in health insurance plans may vary from one insurance company to another. 

Consider this example to understand the waiting period in mediclaim policy better –

Mr. Dubey, a resident of Mumbai, recently purchased a health insurance plan having a sum insured of Rs. 4 Lakhs. Given the kind of lifestyle he followed and family history, he was glad to make this decision. However, little did he know there is a waiting period in health insurance.

Just ten days after buying the policy, he suffered from a heart stroke and got admitted to a hospital. He was shocked when informed that the waiting period for health insurance he bought was 30 days. Hence, his claim wasn’t accepted, making him pay for the medical expenses from his pocket.

Just like Mr. Dubey, many of us buy health insurance without knowing such crucial terms. You must know that health insurance purchase does not imply you can get health coverage from the very first date. Rather, you need to pass the waiting period in health insurance before making any claims. Make sure you read the inclusion and exclusion terms of a policy to know about the waiting period in health insurance. 

Types of Waiting Period in Health Insurance 

There are various types of waiting period in health insurance policies, each implying a different condition related to the insured.

1. Initial Waiting Period 

Also known as ‘cooling period,’ this type of waiting period in health insurance refers to the initial period after the health plan's purchase date to start using it. During this period, you are not entitled to receive a claim from the insurer for hospitalization - planned or in an emergency.

The initial waiting period in health insurance may be different for different insurers. Also, there can be some exceptions related to this waiting period in health insurance, like accidental claims for immediate hospitalization. In general, the minimum initial waiting period[1] is at least thirty days.

2. Waiting Period for Pre-Existing Diseases 

On buying a health plan, you are asked about the pre-existing diseases or ailments followed by certain medical tests to confirm the same. This also determines the corresponding waiting period in health insurance. As per IRDAI, any condition, disease, or ailment diagnosed forty-eight months before buying the health insurance policy is considered a pre-existing one. These diseases include hypertension, diabetes, thyroid, to name a few.

This waiting period in health insurance is meant for those diagnosed with a specific pre-existing disease, as listed in the policy document. It implies if you are suffering from a pre-existing disease, you need to wait for the prescribed waiting period in health insurance to end before you can claim any benefits. For some diseases, this waiting period in health insurance plans can be up to four years.

The initial waiting period in health insurance may be different for different insurers. Also, there can be some exceptions related to this waiting period in health insurance, like accidental claims for immediate hospitalization. In general, the minimum initial waiting period[1] is at least thirty days.

2. Waiting Period for Pre-Existing Diseases 

On buying a health plan, you are asked about the pre-existing diseases or ailments followed by certain medical tests to confirm the same. This also determines the corresponding waiting period in health insurance. As per IRDAI, any condition, disease, or ailment diagnosed forty-eight months before buying the health insurance policy is considered a pre-existing one. These diseases include hypertension, diabetes, thyroid, to name a few.

This waiting period in health insurance is meant for those diagnosed with a specific pre-existing disease, as listed in the policy document. It implies if you are suffering from a pre-existing disease, you need to wait for the prescribed waiting period in health insurance to end before you can claim any benefits. For some diseases, this waiting period in health insurance plans can be up to four years.

 

3. Waiting Period Related to Specific Diseases 

The disease-specific waiting period in health insurance is different from the initial waiting period. Various diseases like tumor, hernia, osteoporosis, require long-term care, the cost of which is borne by the health insurance company if a policy is purchased. That is why most insurers include a distinct waiting period in health insurance plans for different diseases.

This waiting period in health insurance can range from one to two years. The exact details of diseases and the corresponding waiting period in health insurance is clearly mentioned in the plan document. Different insurers may also have different rules related to the disease-specific waiting period in health insurance. 

4. Maternity Waiting Period 

Several health insurance policies offer maternity benefits either as a part of the plan or through an add-on. It is meant for those planning to grow their family and keep the financial aspect in mind. The maternity waiting period in health insurance is the duration within which you cannot claim maturity benefits. Any claim application will get rejected during this waiting period in health insurance.

Typically, this waiting period in mediclaim policy varies from 1 to 4 years. It clearly implies that if you have plans to start a family in the recent future and get maternity benefits, it is crucial to consider this waiting period in health insurance. In other words, buy a plan now so that you can get the expenses covered two years from now.

4. Maternity Waiting Period 

Several health insurance policies offer maternity benefits either as a part of the plan or through an add-on. It is meant for those planning to grow their family and keep the financial aspect in mind. The maternity waiting period in health insurance is the duration within which you cannot claim maturity benefits. Any claim application will get rejected during this waiting period in health insurance.

Typically, this waiting period in mediclaim policy varies from 1 to 4 years. It clearly implies that if you have plans to start a family in the recent future and get maternity benefits, it is crucial to consider this waiting period in health insurance. In other words, buy a plan now so that you can get the expenses covered two years from now.

 

5. Waiting Period for Accidental Hospitalization 

Severe accidents in life often cause injuries that require immediate hospitalization and treatment. Given the nature of accidents, considering any waiting period in health insurance may result in loss of life. In general, there is no waiting period in health insurance for immediate hospitalization resulting from an unfortunate accident. Neither the initial waiting period in health insurance applies in such situations.

One can raise claims for accidental hospitalization even during the waiting period in health insurance. However, it would be helpful if you ask the chosen health insurance company about these details explicitly.

6. Waiting Period for Health Checkups 

While researching various health plans, you might have noticed that many of them offer complimentary health check-ups to the insured. This is a facility that everyone would like to benefit from. However, there is a waiting period in health insurance associated with such benefits. The insurers who offer these benefits keep the waiting period to be at least one year. It means you can avail of this benefit only after completing the one-year waiting period in health insurance, i.e., in the second year of your policy.

7. Waiting Period for COVID-19 Coverage 

The Coronavirus infection has shaken the whole world with fear, with India's cases rising every day even after all these months of its origin. Many people are buying COVID health insurance policies to ensure the disease will not cause any financial burden if they contract the virus. Still, there is a risk of losing the benefits by not knowing about the waiting period in health insurance for this disease.

The waiting period in health insurance plans that cover COVID-19 disease is up to 30 days.

Also Read: Types of COVID Insurance in India

Why is there a Waiting Period related to Health Insurance Plans? 

The need for a waiting period in health insurance has arisen because of the unethical practices to get insurance benefits. Many individuals buy health plans with the intention of getting insurance cover.

Think of the situation in which an individual is diagnosed with a critical illness but did not have health insurance. The doctor recommended an expensive surgery, which he could not afford through the regular income. As a solution to this problem, he bought health insurance but did not disclose the disease.

A waiting period in health insurance was introduced to prevent such unethical practices. 

Why is there a Waiting Period related to Health Insurance Plans? 

The need for a waiting period in health insurance has arisen because of the unethical practices to get insurance benefits. Many individuals buy health plans with the intention of getting insurance cover.

Think of the situation in which an individual is diagnosed with a critical illness but did not have health insurance. The doctor recommended an expensive surgery, which he could not afford through the regular income. As a solution to this problem, he bought health insurance but did not disclose the disease.

A waiting period in health insurance was introduced to prevent such unethical practices.

 

What More Should You Know? 

  • In case an existing disease is not declared during health insurance purchase and a claim is registered for it, it will not be considered, irrespective of the waiting period in health insurance
  • You may find options to reduce the waiting period in health insurance by paying an extra premium
  • You need not worry much about the waiting period for health insurance by buying a plan at an early age when you are less susceptible to diseases
  • You can also buy health cover for critical illness under a term insurance policy through a rider. You can check term insurance premium for the same 

Frequently Asked Questions (FAQs)

Q. Is a health insurance claim admissible if a disease is diagnosed during the plan term?

A. If the insured is diagnosed with a new ailment during the policy period, its claim gets covered. The only condition is that the initial waiting period in health insurance has ended before filing the claim.

Q. Are all claims filed during the waiting period in mediclaim policy denied? 

A. Most claims are denied by health insurance companies if they are filed during the initial waiting period. The only exception is accidental hospitalization, the rules of which may vary from one plan to another.

Q. Why is it a smart decision to buy health insurance when you are young? 

A. Buying a health insurance plan at a young age is beneficial in several ways. You get the health cover at an affordable premium, choose extended benefits easily, and need not worry about the waiting period in health insurance because of low risk.

Q. Can I eliminate waiting period in health insurance policies? 

A. It is only possible when the chosen insurer allows removal of the waiting period clause on certain conditions. Otherwise, there is no such possibility.

Q. How to check if my existing ailments are covered in a health insurance plan? 

A. For such details, refer to the policy document or ask your insurer. 

Please read the policy terms and conditions before concluding a sale, the information mentioned above may vary.

Sources:

[1] https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3916&flag=1 (2019)

https://www.irdai.gov.in/ADMINCMS/cms/Uploadedfiles/RTI_FAQ/FAQ_RTI_HEALTH_DEPT.pdf

ARN No : Aug21/Bg/19A

Calculate Term Insurance Premium