Discover Waiting Period In Health Insurance

If you go through the policy document of a health insurance plan, you will notice the mention of the term 'waiting period.' What exactly is this waiting period, and why do you need to have one in a health insurance policy? Continue reading to know more about this concept.

What Is the Waiting Period? 

IRDAI, the regulatory body for insurance companies in India, has specified waiting period as an exclusion. Thus, the insurance company is not liable to pay for any claim under a health insurance policy in the waiting period. In simple terms, the waiting period in health insurance is the time you have to wait after the commencement of the policy, to be able to avail the benefits of it.

Why Is Waiting Period Necessary?

The general idea behind the waiting period is to discourage from taking undue or fraudulent benefits of a health insurance policy. Consider this example.

You do not have a health policy, at present. Suddenly, you have been diagnosed with a severe ailment that requires expensive surgery. You take out a health insurance policy without declaring the pre-existing disease and also go on to cover the surgery. You intend to take undue advantage of the health insurance policy. IRDAI has specified waiting periods to discourage people from adopting such unethical practices.

Different Types Of Waiting Periods

Generally, there are following different types of waiting periods:

• The Initial Waiting Period

This waiting period applies to all health insurance policies. It is also referred to as a cooling period. 
IRDAI stipulates a minimum initial waiting period of 30 days after the commencement of the policy. It is a mandatory requirement where you cannot claim any benefit on the policy for 30 days from its issuance. However, there are exceptions.

1. The waiting period is not applicable if you meet with an unexpected accident that requires immediate life-saving surgery and hospitalisation.

2. The waiting period is not necessary for subsequent and continuous renewals.

• Pre-Existing Disease Waiting Period

When you purchase a health insurance policy, you have to declare pre-existing ailments if any. IRDAI has clarified that any illness, medical condition, disease, or injury diagnosed within 48 months before the issuance of the health insurance policy qualifies as a pre-existing disease.
Such diseases do not get immediate insurance cover. There is a pre-existing disease waiting period between three to four years (depending on the insurer) before the policy covers such pre-existing ailments.

• Specific Waiting Period

Besides the pre-existing ailments, the following medical conditions are also not covered immediately after the issuance of the policy. These diseases have a waiting period of 24 months before they become eligible for coverage.

1. Stones in urinary systems

2. Lumps, cysts, internal tumours, and nodules

3. Gastric and Duodenal ulcers

4. Tonsils or adenoids surgery

5. Ortho diseases like osteoarthrosis, arthritis, spondylitis, spondylosis, invertebrate disc prolapse, gout, and rheumatism

6. Cataracts

7. Fissure, fistula, haemorrhoids, hernia, and hydrocele

8. Chronic renal failure or end-stage renal failure

9. Sinusitis, tympanoplasty, chronic suppurative Otitis media, and deviated nasal septum

10. Benign prostatic hypertrophy

11. Knee or Hip joint replacement

12. Varicose veins

13. Dilatation and curettage

14. Dysfunctional uterine bleeding, fibroids, endometriosis, and prolapse uterus

15. Diabetes and related complications

16. Hysterectomy

17. Bariatric surgery (if included in the policy)

• Maternity Benefit and Newborn Baby Cover Waiting Period

Generally, health insurance policies come with a special maternity benefit waiting period of two years. Thus, you can avail this benefit after the completion of two years from the issuance date. It includes the nine-month pregnancy period. Newborn babies generally get coverage after 90 days of their birth.

• Coronavirus waiting period

Generally, the waiting period for coronavirus-related treatment and hospitalisation is 30 days.

Conclusion

The waiting period is essential in a health insurance policy to prevent people from adopting unethical practices. After the waiting period, the diseases are covered for their full value. The waiting period can differ from one health insurance policy provider to another, in exceptional cases.

You May Also Like To Read:

Exclusions and Waiting Period: Know Them Before Choosing a Health Policy

Waiting Period in Health Insurance-All You Need to Know

Best Health Insurance with the Minimum Waiting Period for Pregnancy

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.