Waiting period in health - everything you need to know
Updated On Apr 07, 2022
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As the name suggests, waiting period is quite literally the amount of time you need to wait. And in health insurance, it refers to the amount of time you need to wait for, from the start of your policy, to be able to use the benefits of it.
One of the most common types of waiting period is the time you need to wait to be able to use special benefits such as a Maternity Cover; in this case most health insurers will include a waiting period of 2-4 years i.e. before you can actually benefit from the maternity cover, you should have your policy for at least 2 years (the amount of time is dependent on the health insurance policy you buy).
Types of Waiting Periods in Health Insurance Waiting Period
There are various kinds of waiting periods present in every health insurance policy. Let’s have a look at what they imply:
1. Initial Waiting Period
An initial waiting period, also known as the cooling period in health insurance, refers to the amount of time you’ll have to wait from the date of issue to actively start using your health insurance policy and benefiting from it.
Today, the standard in the industry for initial waiting periods is up to 30 days with all health insurance policies.
2. Pre-Existing Diseases Waiting Period (PED)
Typically, when you buy a health insurance policy, you will be asked about pre-existing diseases, and/or will also be asked to take a few medical tests that may conclude the same. As per the IRDAI, a pre-existing disease refers to any condition, ailment, injury or disease that has been diagnosed up to 48 months before buying your health insurance policy.
Some examples of preexisting diseases include diabetes, hypertension, thyroid, etc. Thereby, if you do have a pre-existing disease, you will have to wait for the prescribed waiting period before you can claim for any hospitalization or treatment that is related to the disease.
Usually, the waiting period for the pre-existing disease is from one to four years, depending on your health insurer and type of health insurance plan chosen.
3. Waiting Period for Specific Diseases
The title is perhaps self-explanatory, i.e. waiting periods for specific diseases imply that you will need to wait for the prescribed amount of time when it comes to claiming for treatment and hospitalization related to a list of specific diseases. Generally, the waiting period for these situations is one to four years.
The specific list of diseases this is applicable to are listed below.
- Non-infective Arthritis, Osteoarthritis and Osteoporosis (if age related), Systemic Connective Tissue Disorders, Dorsopathies, Spondylopathies, Inflammatory Polyarthropathies, Arthrosis and Intervertebral Disorders (unless due to accident).
- Pancreatitis, Calculus disease of gallbladder/biliary tract and urogenital system, Gastric Vs Duodenal Erosions/Ulcers,
- Varices of GI Tract, Cirrhosis of Liver, Rectal Prolapse.
- Cataract, Glaucoma and Disorder of Retina.
- Hyperplasia of Prostate, Urethral Strictures, Hydrocele/Varicocele and Spermatocele.
4. Maternity Benefit & Newborn Baby Cover Waiting Period
As part of most health insurance policies for individuals and families, there is an option to also include a Maternity Benefit and Newborn Baby add-on for those planning a family soon and apart from just planning for the baby, it is wise to also plan financially for the expenses that arise during and post labor.
Typically, the waiting period with most health insurance policies ranges from one year to four years. This means you can only claim for maternity-related expenses once you’ve completed two years of your policy.
Therefore, if you’re planning on starting a family sometime soon and would want to ensure your health insurance policy covers for it, then take in consideration the 9-months of the pregnancy term, plus the rest 15-months to complete your two- years waiting period. The maternity benefit add-on covers for delivery expenses and the baby for its first 90 days; including its necessary vaccinations and any other medical care required otherwise.
5. Waiting Period for Accidental Hospitalization
Accidents can cause the most unexpected injuries and other medical concerns. Therefore, given the nature of accidents; all health insurers do not account for any waiting period when it comes to accidental hospitalizations.
This means, one can claim for accidental hospitalizations even just days into their new health insurance policy. The initial waiting period doesn’t apply here either.
It is good to read the policy document carefully and speak to your policy agent in detail to understand the finer points of the policy you select for you and your family. You can also visit the health insurance company's official website to have a deeper understanding.
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