Waiting Period in Health Insurance

Posted on: May 29, 2019 | 3 mins | Written by: HDFC ERGO Team

Waiting Period in Health Insurance

People who have a health insurance are aware about the term ‘waiting period'. And, people who are planning to buy a health insurance might wonder what it means and how does it affect a hea/lth insurance. In this blog, we get a detailed understanding of the term waiting period.

What is waiting period?

As the name suggests it's a period of time, which has to pass for you to avail certain covers or benefits under a health insurance plan. It is that period when a certain ailment or illness is not covered and you have to wait for that time to pass by making consecutive renewals to waive off the waiting period and start availing the benefits of your plan. Insurance companies may deny claims if intimated within the waiting period, however once the waiting period is over you are free to register claims.

Types of waiting period

• Pre-existing Diseases (PED)

The policyholder, at the time of purchase, has to declare to the insurance company if they suffer from pre-existing diseases like diabetes, high blood pressure, thyroid, etc. Almost all health insurance plans cover pre-existing diseases, after usually between 2 years waiting period of usually to 4 years. This means that any hospitalization expenses related to the stated ailments can be claimed only after 4 successful years with the insurer.

• Specific diseases/procedures

Ailments and procedures such as ENT disorders, hernia, osteoporosis, joint replacement surgery, cataract, etc., health insurance policies normally have a one or 2 years of waiting period.

• Initial Waiting Period

Almost all health insurance plans have an initial waiting period of one month or more during which no claims are accepted. This depends on the policy terms and conditions.

• Critical Illnesses Waiting Period

Regular health insurance plans cover critical diseases after a waiting period of 90 days.

• Maternity Benefit Waiting Period

Many health insurance plans that offer maternity benefits and newborn baby cover only after a waiting period ranging from 9 months to 36 months is over.

Know More: Types of Waiting Periods in Health Insurance

Under what circumstances waiting period is implied?

• Maternity cover

Insurance companies do not pay for maternity expenses such as pre-post natal and new born expenses as soon as you buy the policy or when you are pregnant. Most of the health insurance companies imply a waiting period of 3-4 years, hence you can claim under maternity cover post completing this waiting period with your insurer. Some insurance companies offer this as an add on cover, while some make it a part of their basic health policy.

• Pre-existing diseases

At the time of buying a health insurance plan if you are suffering from health ailments or you've had any sort of medical history such as diabetes, high blood pressure,thyroid, hypertension etc then you have to declare this to your health insurance company. Bases your medical reports, health insurer either accepts the case by implying an additional premium or rejects the case depending upon medical adversity. Once your waiting period is covered for the declared diseases you can make claim under it.

• Survival period

For critical illness insurance there is a survival period of usually 30 days. With HDFC ERGO critical illness insurance you have a survival phase of 30 days before receiving the lump sum payment.

• New born babies

Usually, new born babies are covered post 90 days.

Is it possible to reduce waiting period?

Yes, it is possible to reduce the waiting period under a health insurance policy. There arehealth insurance companies that offer an option to reduce the waiting period by opting for a waiting period waiver. These waivers can be obtained by paying an extra premium amount.

Usually, in case of group health insurance plans offered by companies to employees, insurance companies do not insist on waiting periods. Employees can get a zero waiting period health insurance if they convert their group health plan to an individual plan. According to IRDA guidelines, employees who are a member of a group health plan offered by their employers can convert their group cover to an individual retail health policy at the time of quitting their jobs. In such scenarios, they will get a health insurance without waiting period as they have already spent the waiting time in the group health cover provided to them by their companies.

What more should you know about waiting periods?

• If any new ailment is detected during the policy period it will get covered and is not a part of pre existing waiting period.

• However, if an already existing ailment is not declared at the time of policy issuance and claim has been registered then claim will not get honored.

• Some insurance companies offer an option to reduce waiting period by paying additional premium.

• There is also a common cooling period of waiting period of 1 month for accidental hospitalization or overall any claim to be registered. Hence you may not be able to immediately register a claim post buying a policy.

Conclusion

With this the concept of waiting periods in medicalinsurance reads clear and is easily understood. The best way to escape waiting period is to buy your health insurance early. At an early age you are less susceptible to diseases and hence if you buy the health insurance plan at an early age there are lesser chances of having any pre-existing diseases.

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

Health Insurance is Better than a Medical Loan: Here's Why

Is there an Age Limit for Buying a Health Insurance Policy?

Handy Tips to Help You Prepare for Health Insurance Premium Payments

All You Need To Know About Obesity And Overweight - Causes, Symptoms, And Treatment

5 Safe Remedies To Cure Anxiety Without Medication