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Types of Waiting Periods in Health Insurance

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Buying the best health insurance plans is important, but that doesn’t mean they come without terms and conditions. One of the terms that can get your claim request rejected is waiting periods. It refers to the time between when you purchase a Mediclaim policy and when you can actually use it to receive benefits. This is put in place to prevent individuals from only buying health insurance coverage when they need it most, for instance, when they are already sick. It also helps insurance companies manage their financial risk and keep premiums affordable for policyholders. Let’s talk about waiting periods in health insurance in detail.

Purpose of Waiting Periods in Health Insurance

The waiting period in health insurance is the time that you, as a policyholder, must wait before you can avail of the benefits of the policy. During the waiting period, you cannot raise any claims. The waiting period starts from the day the policy commences, and the duration can vary from insurer to insurer. Let us try to comprehend it better by using an example. Ayushi buys a health insurance plan with a sum insured of Rs 5 lakh. Within 10 days of taking the policy, she suffers a heart stroke and gets hospitalised. But when she makes a claim, she is shocked to know that the insurer will not cover the treatment expenses because the policy’s waiting period of 30 days is not yet over. Her claim is not accepted, and she needs to pay everything from her pocket.

Similarly, pre-existing diseases have a waiting period of 1-3 years, and you need to complete the waiting period to avail of the coverage benefits.

The purpose of the waiting period is to encourage individuals and families to buy a healthcare plan early in life and stay prepared for unforeseen medical expenses. With waiting periods in place, people cannot wait and buy a healthcare policy only when they get diagnosed with a health condition. This important clause helps reduce the financial liabilities of insurance companies, especially during expensive and long-term medical procedures.

Types of Waiting Periods in Health Insurance

There are various types of waiting periods in health insurance, such as:

1. INITIAL WAITING PERIOD:

Also known as the cooling period, the initial waiting period is typically 30 days from the day the policy starts. This applies to both planned and emergency hospitalisations. However, there can be exceptions like accidental claims wherein the policyholder needs immediate hospitalisation after an accident.

2. PRE-EXISTING DISEASES WAITING PERIOD (PED) :

As per the IRDAI, any medical condition, illness, or injury diagnosed 48 months before buying the health insurance policy is considered a pre-existing disease. Some examples of PEDs are hypertension, diabetes, thyroid, etc. Usually, the waiting period is from 1 to 3 years, depending on your healthcare plan and insurer. At the time of purchasing the best health insurance plans, you must inform the insurance company if you have any pre-existing diseases.

3. WAITING PERIOD FOR SPECIFIC DISEASES:

For specific diseases and procedures like hernia, osteoporosis, ENT disorders, cataract, joint replacement surgery, and neurodegenerative disorders like Alzheimer’s and Parkinson’s disease, the waiting period ranges from 1 to 3 years.

4. MATERNITY BENEFIT WAITING PERIOD:

Maternity benefit covers all expenses related to delivery and childbirth but after a waiting period that ranges between 9 months and 6 years. This means if you plan to start a family in the near future and want to avail of maternity benefits, you should consider buying this plan now. The newborn will be covered for the first 90 days, including vaccinations.

5. CRITICAL ILLNESS WAITING PERIOD:

The waiting period to cover critical illnesses is 90 days. There is also a survival period of 30 days, which means the insured has to survive for at least 30 days after being diagnosed with a critical illness. Those aged 60 years and above are at high risk of critical illnesses, so having senior citizen health insurance along with critical illness coverage comes in handy.

6. WAITING PERIOD FOR ACCIDENTAL HOSPITALISATION:

If an unfortunate accident requires emergency hospitalisation, the initial waiting period will be waived. Zero waiting period health insurance is applicable only in case of immediate accidental hospitalisation.

7. WAITING PERIOD FOR ANNUAL HEALTH CHECK-UPS:

Most health insurance policies offer complimentary annual health check-ups to policyholders. However, you have to wait for one year to avail of this benefit.

8. WAITING PERIOD FOR BARIATRIC SURGERY AND PSYCHIATRIC ILLNESS:

The waiting period is usually 1 to 2 years, before which you cannot raise any claims.

Exceptions and Exclusions of Waiting Periods

The health insurance policies in India have some exceptions to waiting periods. As per these exceptions, policyholders can use their health plan immediately or sooner than the usual waiting period. The following are some important exceptions and exclusions to waiting periods —

1. Accidental injuries:

As stated before, there is no waiting period in health insurance if the policyholder meets with an accident. Insurance companies cover medical expenses arising from accidents from day one.

2. Group health insurance:

Employer-sponsored/group health insurance policies usually offer coverage to employees without any waiting period. If you are covered under group health insurance, the insurer may cover your medical bills from day one. Some insurance companies may offer this health plan with a reduced waiting period.

3. Policy portability:

If you opt for health insurance portability with the same coverage, the new insurance company may waive waiting periods you have already served with the previous insurer. However, there should not be any coverage gap. This benefit may differ from insurer to insurer and is subject to certain terms and conditions.

Importance of Waiting Periods in Health Insurance

Waiting periods can benefit insurance companies and policyholders in several ways. Let’s take a look at the importance of waiting periods in health insurance —

1. Better financial planning:

Waiting periods encourage people to invest in health insurance early in life. When they know they have to serve certain waiting periods, they will not wait for medical contingencies to strike before they buy health insurance.

2. Reduced financial liabilities:

Waiting periods help reduce the financial liabilities of insurance companies and policyholders. With waiting periods in place, insurers are not liable to cover pre-existing conditions and expensive treatments immediately after policy inception. This reduces their financial liabilities and helps them offer affordable premiums to policyholders.

3. Encourages continuous coverage:

This important clause also encourages policyholders to maintain continuous health insurance coverage rather than keeping their health plan active only till the time they need medical care.

4. Promotes timely healthcare:

When individuals know that their healthcare plan is under a waiting period, they will take extra care of their health and seek timely medical attention to prevent the condition from worsening. Timely treatment can expedite recovery and reduce medical bills.

Tips for Managing Waiting Periods in Health Insurance

The following are some tips that can help you manage waiting periods in health insurance —

1. Buy health insurance early:

The simplest way to manage waiting periods is by buying health insurance early in life when you are fit and healthy. This way, the waiting period will be long over by the time you may want to use your health plan to cover your medical bills.

2. Maintain emergency funds:

It is important to maintain sufficient emergency funds for medical contingencies during the waiting period.

3. Compare different health plans:

When buying health insurance, shortlist some good plans and compare their scope of coverage, waiting periods, and premiums before zeroing in on one. It is important to ensure that the waiting periods of the policy you choose align with your healthcare needs. It is wise to choose a comprehensive health plan that offers shorter waiting periods for the conditions you may require healthcare sooner.

4. Know policy wording:

Read the terms and conditions of your health plan minutely to understand the duration of waiting periods for different conditions. If you think you may need coverage for a condition sooner, you can talk to your insurance provider about the available options. Some insurance companies may reduce or waive the waiting period for an additional policy premium.

5. Maintain continuous coverage:

Maintaining continuous health insurance coverage will save you from the hassles of serving new waiting periods, especially for pre-existing conditions and specified diseases. Remember to pay policy premiums on time before the grace period is over for continuous coverage. If you plan to switch policies or insurance providers, ensure there is no coverage gap.

6. Follow healthy lifestyle habits:

Following healthy lifestyle habits will promote your overall well-being and minimise your need for medical treatments. When you are fit and healthy, you won’t have to worry about your policy being in the waiting period.

FAQs

1. What is the waiting period for health insurance?

The waiting period for health insurance is the duration policyholders must wait before they can start filing health insurance claims. The initial waiting period in health insurance is up to 30 days, but you may have to wait up to 3 years or more to file claims for pre-existing conditions, specified diseases, and other health issues.

2. How do I know the waiting periods in my health insurance policy?

Waiting periods are specified in the policy terms and conditions. So, make sure you check the same before finalising the purchase. You can also get in touch with your insurance provider for better clarity.

3. What if I get hospitalised during the waiting period?

The insurer will cover your medical bills if you get hospitalised for an accidental injury. However, you must pay the bills from your pocket if you get hospitalised for an illness, pre-existing condition, or specified disease during the waiting period.

4. Can waiting periods for the same conditions differ from policy to policy?

Yes, waiting periods for the same conditions can differ from policy to policy. Therefore, checking and comparing the waiting periods in different policies is essential to make an informed purchase decision.

5. If I get diagnosed with a disease during the waiting period, will the insurer cover the claim?

Yes, if you get diagnosed with a condition for the first time during the policy period, your insurance provider will cover the bills. However, they will consider your claim only if you file it after the initial waiting period has ended.

Conclusion

Having the best health insurance plans or senior citizen health insurance doesn’t mean you can avail of the coverage benefits from the first day of purchasing the policy. There’s a waiting period in health insurance for specific diseases and an initial waiting period which you have to complete before raising any claims. Any claim filed within the waiting period will get rejected. However, if you want zero waiting period health insurance, some insurance providers offer the option of a 'waiting period waiver' or 'reduce the waiting period' but charge a higher premium for it. It is, therefore, advised to buy health insurance when you are young for two reasons – one, the premium will be less and second, the waiting periods will, most probably, be over by the time you need to use the benefits. Remember, just buying a Mediclaim policy is not enough; you should be aware of all the terms and conditions of the policy, including the waiting period in health insurance.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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