Waiting Period in Health Insurance Plans

Today, health problems have become a common topic of worry in all Indian families. The major causes behind this increase in health problems are the deteriorating environmental conditions and stressful lifestyle. With the increase in health problems, there is a proportionate and rapid increase in the prices of medical facilities every single day. As a result of this, a situation of medical emergency which can come up in an unprecedented manner can become a reason of financial and mental turmoil.

Moreover, we all want to have the best of medical facilities for ourselves as well as our family members. This is only feasible by having private health insurance plans. Private health insurance plans help in providing coverage against all expenses incurred in medical care during a condition of physical emergency. But, while you are purchasing health insurance it is quite important for you to be conscious of the basic terms and conditions associated with the health insurance plans.

One such important point to consider while purchasing a health insurance plan is the Waiting Period of the health insurance plans.

What is a Waiting Period in a Health Insurance Plan?

Waiting period in health insurance plan is defined as the specified time period which has to pass before a particular mentioned list of illnesses start being getting included in the coverage provided by the health insurance plan. During health insurance waiting period, the claims made with reference to those particular illnesses are not being considered. Waiting periods are also known as the Cooling period for a health insurance policy.

The best of Health Insurance plans also have waiting period and usually, the benefits related to the health insurance plan can be availed only after the completion of the waiting period.  This can also be applicable in case of up-gradation of the health insurance plan and any other benefits associated with them.

Health insurance waiting period will prevent the insured person from making an instant withdrawal from the health policy. After the completion of the waiting period, the person who is insured can claim a higher amount of insurance coverage or opt for immediate admission into hospital if it is an emergency situation and it needs immediate medical assistance.

Types of Waiting Period in Health Insurance Plans

 The major categories of Waiting period can be listed as below:

• Initial Waiting Period

This is usually for a time period of 90 days starting from the date of commencement of the policy. Any treatment which is needed for that particular illness during this period is not made available other than any accidental criticality which needs a minimum hospitalization of 24 hours. 

• Pre-existing Waiting Period

Pre-existing diseases are those diseases for which the symptoms and information are already known to the policyholder or to the family members of the policyholder. There are many insurance providers who perform medical tests in order to get a confirmation on the severity of the pre-existing disease in the patient’s body. After this confirmation, usually pre-existing diseases are covered after a waiting period of 2 years to 4 years. This waiting period is known as pre-existing waiting period.

• Ailment Specific Waiting Period

In case of every insurance provider, there is a list of illness for which they maintain a waiting period of 1 to 2 years.  After a period of 1 to 2 years only, any claims related to these illnesses are addressed by the insurance provider. Some of these ailments are Osteoporosis, ENT disorders, hernia, etc. and this waiting period is known as ailment specific waiting period.

•  Maternity Waiting Period

Many insurance providers provide maternity cover along with health insurance plans after a waiting period of around 9 months to 36 months. This is known as maternity waiting period.

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Is it feasible to change the health insurance waiting period?

It is practically not feasible to change the waiting period. Mostly, all Insurance providers have decided upon their initial waiting period as a period of 30 days and in case of pre-existing diseases the minimum waiting period is 2 years. 

There are some insurance providers who can reduce the waiting period but on payment of additional premium.  Usually, in case of Group Insurance Plans, there is no waiting period for the health insurance plans which are offered to the employees.

Why have Insurance Providers set up a waiting period of 90 days?

The insurance providers have decided on the waiting period of 90 days because many times people take up health insurance plans after been diagnosed with a serious illness. In order to avoid such situation, a minimum waiting period of 30 days to 90 days has been fixed by insurance providers.

Moreover, many times certain people plan and create fraudulent practice like seeking a claim against a pre-determined but not life-threatening ailment. To prevent such practices from spreading, insurance providers have set up the waiting period of 30 days to 90 days.

Health Insurance Policies Without Waiting Period

It is mostly not possible to have a health insurance policy without a waiting period. Every applicant has to serve a waiting period depending upon the ailment or illness for which he is claiming the health insurance.

Sometimes, it might happen that you are a member of a group health insurance policy and you are getting your group insurance policy converted into an individual health insurance policy. In such a case, you do not have to serve the waiting period for the health insurance policy.

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Important Points to Consider Related with Waiting Period

There are some major points which we can consider with reference to the Waiting Period of a Health Insurance Plan:

Firstly, while the waiting period for a health insurance plan is being continued and the policyholder or the insured person is diagnosed with a disease or illness for the first time. Then, in such a scenario the illness would not be termed as pre-existing illness.  The health insurance plan will provide coverage against this illness.

Moreover, there are a number of health insurance providers who have added up a new concept into the health insurance plans. A concept of co-pay clause has been added up into the health insurance plans for senior citizens. By this co-pay clause, the concept of health insurance waiting periods have been eliminated and the policyholders agree to bear a certain percentage of the claim amount and the rest of the amount will be paid off by the insurance provider.

Hence, it is always advisable for the people purchasing health insurance policies to have a thorough study and research on the waiting periods of the health insurance plans being provided by various insurance providers.  You should compare the insurance policies of different insurance providers and should opt for a health insurance plan which has a low waiting period.

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Moreover, it is further advisable to read the policy document very carefully in order to be aware of all the details related to waiting period of ailments. A very concrete understanding of the waiting period is necessary to avail the benefits properly.  If you find out certain discrepancies or any unsatisfactory clauses you can reject or discontinue the insurance policy within the free look period available initially.

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