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What is Waiting Period in Health Insurance?

The waiting period in health insurance refers to the time period the insured is required to wait for, from the date of issue of the health insurance policy, to be able to avail the benefits under the policy. The terms and conditions of a waiting period vary from insurance company to insurance company.

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The waiting period in health insurance is a specific span of time before which the insured individual is not eligible to avail coverage benefits for some listed ailments even during the policy term of a particular health insurance policy. For instance, a waiting period for pre-existing illnesses is a standard clause in most health insurance plans. This means that any insured person will be able to avail of coverage benefits for pre-existing diseases only after completing the waiting period of 4 years, The waiting period is calculated from the date of commencement of the policy.

Types of Waiting Period in Health Insurance

There are several types of waiting periods in health insurance plans. To understand what they imply, read below:

1. Initial Waiting Period

In order to make any claim after the policyholder has been issued a health insurance policy, he/she is required to wait for a specific number of days to be able to receive any claim benefit under the policy. This period is known as the initial waiting period or cooling period in health insurance. As a standard in the health insurance industry, all health insurance plans come with a waiting period of at least 1 month and a maximum of 90 days. The only exception to the initial waiting period is accidental claims wherein the claims are approved only when the insured is involved in an accident and requires immediate hospitalisation. Note that the initial waiting period completely varies from insurer to insurer.

2. Pre-Existing Diseases (PED) Waiting Period

It is a special waiting period for some diseases that the policyholder discloses at the time of policy purchase, that are known as pre-existing diseases. As per the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing disease is any condition, injury, ailment, or disease that is diagnosed up to 48 months before the policy purchase. Examples of some pre-existing diseases are thyroid, hypertension, and diabetes. Generally, the waiting period for pre-existing disease in health insurance plans is 1-4 years. However, the pre-existing disease waiting period varies with the health condition of the insured as well as the health insurance plan they choose.

3. Waiting Period for Specific Diseases

There are several diseases like hernia, tumor, ENT disorder, cancer, stroke, cardiac ailments, that come with a specific waiting period. The waiting period for these plans usually ranges between 2 year and 4 years. The ailments that qualify for this waiting period vary from insurer to insurer and can be found in the policy details provided by each insurer.

4. Maternity Waiting Period

Under health insurance plans for individuals and families, the policyholders get the benefit of including maternity and newborn baby cover as an add-on cover. Many health insurance plans come with the in-built feature of maternity cover. Either way, the cover can be availed after completing a waiting period of 2 years to 4 years. However, there are some health insurance companies that offer lower waiting periods but to avail that, the policyholders are required to pay additional health insurance premiums.

5. Waiting Period for Bariatric Surgery

Some health insurance policies cover bariatric surgery too. Bariatric surgery is surgery on the stomach and/or the intestines that helps the patient with extreme obesity-related issues. The surgery is usually recommended to those with a BMI over 40 and those going through health issues due to the same.

6. Waiting Period for Coronavirus

With the increasing case of coronavirus in India, many people are buying coronavirus specific health insurance plans for themselves and their families. But to avail of coverage benefits like hospitalisation and treatment under these plans, the insured needs to complete a waiting period of up to 30 days.

What is the Importance of Waiting Period in Health Insurance?

Waiting period in health insurance is implemented to avoid the wrong intention of an individual to claim benefits under a health insurance policy. There have been cases wherein the customers without any health insurance policy, after being diagnosed with a specific disease, did purchase a health insurance policy without disclosing the condition to the insurance provider. So, to avoid unethical practices like these, the concept of a waiting period is implemented in health insurance policies.

IRDAI’s Notifications on Waiting Period

It is recommended that insurance companies be allowed to incorporate waiting periods for any specific disease or condition for up to 4 years. Also, waiting periods for specific conditions such as diabetes, hypertension, cardiac conditions, etc. should not exceed 30 days. As many people are suffering from these conditions, the move will be of great help.

Is it Possible to Reduce Waiting Period?

There are several insurance companies offering health insurance plans that allow insured individuals to reduce the waiting period. But to avail of this benefit, the insured is required to pay an extra premium. Normally, there is no waiting period in health insurance plans offered by employers to their employees. Even in some cases if it exists, then the waiting period is shorter than a regular individual health insurance policy. But the Insurance Regulatory and Development Authority of India (IRDAI) allows the employees who are a part of group health insurance plans to convert their group health insurance plan to an individual health insurance policy when leaving the employer. In this case, the individuals will be given the policy without any waiting period as they had spent waiting time in group health insurance cover provided by the employer.

Things to Note About Health Insurance Waiting Period

Listed below are some things that you should know about the waiting period in health insurance:

  • If the insured suffers from an illness for the first time during the waiting period, then it will not be considered as a waiting period and the policy will cover that ailment as per the policy terms and conditions.
  • With time, health insurance companies designed plans for senior citizens where waiting periods have been eliminated or reduced by adding a co-payment clause. Co-payment is when the insured and the insurance company partially bear the healthcare expenses, which can be a certain percentage or an amount from the entire claim amount. For instance, if there is a co-payment of 30% in a claim of Rs. 1 Lakh, then the policyholder will have to pay Rs. 30,000 from his/her own pocket.

The waiting period, also known as the cooling period in health insurance, is a certain span of time for which the insured has to wait in order to avail specific coverage benefits under a particular health insurance policy. There are several factors on which the waiting period depends. Some of these include the type of health insurance policy (individual health insurance policy, family floater health insurance policy, or group health insurance policy), medical history of the policy buyer, his/her age, etc. To make an informed decision, you must read the policy documents carefully and opt for a health insurance policy that comes with a minimum waiting period. However, the waiting period should not be the sole factor to consider when buying a health insurance policy online. Instead, it is also recommended to consider other factors such as premium, sum insured, type of health insurance policy, members to be covered, etc.

Also, it is recommended to buy a health insurance policy early. This is because when you are young, you are at the peak of good health. This implies that you can easily complete the waiting period without any need of making a claim. Hence, you will be able to make a claim even for the illnesses that come with a waiting period, in later years of life, as this is when you might actually be in need to avail those benefits. Hence, to be eligible to avail of those benefits, it is recommended to buy a health insurance policy now if you have not already.

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FAQ About What is Waiting Period in Health Insurance?

  • What is the waiting period in health insurance?

    Waiting period in health insurance is the time span during which you cannot claim any benefit from the insurance company under your health insurance plan. As the name suggests, you are required to wait for this period before making a claim. There are different types of waiting periods in health insurance such as the initial waiting period, pre-existing waiting period, maternity waiting period, etc. Note that the terms and conditions of the waiting period may vary from one insurance company to another. 

  • What are the different types of waiting periods in health insurance?

    There are different types of waiting periods in health insurance. These include the initial waiting period, disease-specific waiting period, maternity waiting period, waiting period for pre-existing diseases, etc. You cannot make a claim under your health insurance plans unless you complete the specific waiting period.  

  • What is the initial waiting period in health insurance?

    Initial waiting period in health insurance is the initial period from the date of commencement of the health insurance policy for which the insured is not covered in case he/she falls sick and makes a claim. The initial waiting period may vary from one insurance company to another. However, generally, it is between 30 days and 90 days. 

  • Why is the need for a waiting period in a health insurance policy?

    Health insurance plans have waiting periods so as to prevent the misuse of health insurance plans by policyholders in order to manipulate claims for specific diseases. In short, the waiting periods help to control unethical practices by the policyholders. 

  • What is the waiting period for specific diseases in health insurance plans?

    In health insurance plans, there is a waiting period for specific diseases or ailments, as mentioned in the policy document, that varies between one year and two years such as a tumour, hernia, ENT disorder, osteoporosis, etc. Note that the list of specific diseases varies from one insurance company to another. 

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