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Before Buying a Health Insurance Policy, Don't Forget to Check the Waiting Period

Published On Oct 15, 2019 12:00 AM By Chinansuka Agarwal

No matter how much you earn or save, sudden illnesses and hospital treatment can take a toll on your hard-earned money. People easily lose out on their savings or earnings to rising medical expenses. Buying medical insurance becomes imperative to take care of exorbitant medical bills or post-hospitalisation treatment expenses.

While buying health insurance people do consider the prime elements of the product in addition to the inclusions and exclusions under the policy. However, very few pay heed to another important factor under the policy, i.e. the waiting period.

The waiting period is a specific period wherein the insured cannot claim any benefit for specified diseases or ailments. The coverage for the treatment commence only after the waiting period has elapsed. Different insurers follow different waiting period rules. The types of waiting period remain more or less the same; however, the period differs from one insurer to another.

Some common types of waiting periods:

1) Initial waiting period: Most of the insurance plans comes with the initial waiting period of 30 days to 90 days before any claim can be made by the insured. Anand Roy, Joint Managing Director of Star Health & Allied Insurance Company, said that the initial waiting period for insurance policies generally range between 30 days and 90 days in certain cases and starts from the policy start date. During this period, no medical expenses incurred on treatment of illness or any medical condition is covered unless and until caused due to an accident. This concept is added in health insurance policies to avoid any misuse.

2) Disease-specific waiting period: There is a waiting period for specific diseases such as congenital disorders, lifestyle diseases and any other specifically mentioned illnesses. This differs from insurer to insurer and policy to policy. Mayank Bathwal, CEO of Aditya Birla Health Insurance says that the health insurance policies in India generally comes with an initial waiting period of 30 days to 2 years or so for specific diseases. There is waiting period for specific illnesses such as hernia, cataract, etc. as these diseases take time to manifest. The waiting period is applied in such cases so that the policyholder shouldn’t take the policy only to get cover for these existing diseases.

3) Pre-existing disease waiting period: At the time of buying a health insurance policy, it is prudent to notify the insurer about the pre-existing diseases. Every insurer has a waiting period applied for pre-existing conditions before which a claim can be availed. Jaideep Devare, Managing Director of Mahindra Insurance Brokers Limited, says that the waiting period clause for the pre-existing disease is a standard clause in most of the health insurance policies. If any person has certain pre-existing conditions such as hypertension, cancer, diabetes, etc. then it is advisable to disclose such conditions at the time of purchase of the policy. The claims related to such ailments are generally covered after a waiting period of 4 years and disclosing such illnesses offers hassle-free cover for diseases after the specified waiting period gets over.

4) Maternity-related waiting period: Most of the health insurance plans doesn’t come with the maternity benefit feature. However, some plans that offer maternity benefit has the waiting period ranging anywhere between 9 months to 3 years. Hence, it is advisable to buy a maternity plan ahead of time. Rashmi Nandargi, Head – Health, Travel & PA Underwriting of Bajaj Allianz General Insurance says that since maternity is a planned event, hence most of the insurers have a waiting period before the maternity benefit can be availed under the plan. Thus, it becomes essential to know the waiting period for the maternity cover under the policy at the time of purchase. If bought at an early stage, the maternity benefit can be availed along with the coverage for pre and postnatal expenses. Some of the health insurance plans even offer cover for newborn baby expenses along with the maternity cover benefit.

Now the questions arises, what is the significance of waiting period? The waiting period clause is introduced into the health insurance policies to safeguard the interest of the insurance companies. It is introduced to protect the insurers from paying claims with false intent. The waiting period clause ensures that the person seeking the policy discloses his/her medical condition in terms of any specific or pre-existing diseases at the time of purchase and thereby be eligible for cover only after the lapse of the waiting period.

However, with the recent guidelines set by the IRDAI regarding standardisation of exclusions, the insurer needs to specify the waiting period for diseases such as HIV/AIDS, epilepsy, chronic kidney diseases, etc. in their policy document. This waiting period can range from 30 days to 1 year after which coverage would begin. Also, for pre-existing diseases, the insurer is adhered to provide coverage for these illnesses after the waiting period of 48 months or sooner as specified in the policy wording. These guidelines would help the policyholders to know the exact period after which they can claim coverage. Also after standardisation, no insurer can set the undue waiting period and is bound to offer cover to the insured after the lapse of the pre-declared waiting period. 

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