Waiting Period in Health Insurance

Health Insurance and Waiting Period

In today's world, obtaining health insurance is crucial, yet numerous individuals acquire coverage without fully understanding the complex features of health insurance plans. One such critical aspect is the waiting period within health insurance. You may have heard individuals mention that they are unable to receive health insurance benefits due to the waiting period not yet expiring.
The waiting period for health insurance refers to the period that an insured individual must wait before they can receive some or all of the benefits from their health insurance coverage. It is important to note that during this waiting period, it's typically not possible to file a claim against the policy. The waiting period may apply to specific health conditions or to the entire coverage, and it may differ depending on the insurance provider.

Types of waiting period in health insurance

Health insurance policies often have waiting periods that must be completed before coverage begins for certain medical conditions or procedures. Here are some common waiting period in health insurance you should be aware of:

Pre-existing disease waiting period: If you or other members of your health insurance policy have pre-existing medical conditions like high blood pressure, diabetes, or thyroid disorders, traditional health insurance plans typically require you to wait a certain period before coverage for these conditions kicks in. Group health insurance plans may have different terms and conditions, so it is important to check with your provider for details.
Specific illnesses/diseases waiting period: Some diseases or medical procedures may have a specific waiting period before coverage begins. For example, conditions like cataracts, ENT disorders, osteoporosis, hernia, and joint replacement surgery may require a waiting period of 2-4 years depending on the policy.

Maternity and newborn baby add-on waiting period: If you need maternity coverage or coverage for a newborn baby, most health insurance plans will require a waiting period of 9 months to 3 years before coverage begins. Some plans may not cover maternity expenses at all, so be sure to check the coverage details before purchasing a plan.

Initial waiting period:The initial waiting period is the time between the start of the policy and when you can begin using its benefits. Except for accidental hospitalization, no medical expenses are typically covered during this period.

Waiting period for accidental hospitalisation: Accidental hospitalization is usually covered from day 1 of the policy start date, with no waiting period required.

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Why is there a waiting period in health insurance?

Health insurance waiting periods were implemented as a response to unethical behavior aimed at obtaining insurance benefits. Some people purchase health plans with the primary objective of securing coverage. To illustrate, imagine a scenario where an individual is diagnosed with a severe illness but has no health insurance. The doctor recommends an expensive surgery, which the individual cannot afford with their regular income. To address this problem, the individual obtains health insurance but fails to disclose the illness. The introduction of waiting periods in health insurance was intended to deter such unethical practices.

Is it possible to reduce the waiting period in health insurance?

It is possible to decrease the waiting period in health insurance. Certain insurance companies offer a waiting period waiver option, which requires payment of an extra premium. For example, some health insurance plans include a PED waiver that shortens the waiting period for certain illnesses from 4 years to 2 years.
In general, insurance companies do not impose waiting periods on group health plans provided by employers to their employees. Additionally, employees can obtain a health policy without a waiting period by converting their group health plan into an individual plan. According to the IRDA guidelines, employees who are members of a group health plan offered by their employer can switch their group coverage to an individual retail health policy when they leave their employer. In these cases, they will receive a policy without a waiting period, as they have already served the waiting period in the group health cover provided by their employer.

Things you should know about waiting periods

Here are some key points to consider regarding health insurance waiting periods:

If a policyholder is diagnosed with a new illness during the waiting period, it will not be considered a pre-existing condition. In such cases, the policy will cover the treatment for that ailment.
Some health insurance plans designed for senior citizens do not have waiting periods. Instead, they have a co-pay clause which means that the policyholders will need to pay a certain percentage of the claim amount while the rest will be covered by the insurance provider. For instance, if the co-pay is 30% on a claim of Rs 1 lakh, the policyholder will be responsible for paying Rs 30,000.
If you are looking to purchase a good health insurance plan, make sure to check out the one with the shortest waiting period.

Difference between survival period and waiting period

	Survival Period	Waiting Period
Applicable for	Critical illness policies	All types of health insurance policies
Definition	The time period during which a policyholder needs to survive after being diagnosed with a critical illness to get the claim amount is called survival period	The time period before the policyholder can start submitting claims against the policy
Time Period	Usually, 14-180 days. Depends on the policy terms and conditions	30 days of initial waiting period, approx. 3 or more years in case of pre-existing diseases. Depends on the policy terms and conditions
Factors Affecting	Depends on the type of critical illness and the insurance company	Depends on the plan chosen and the insurance provider
Coverage	After one-time lump sum payment of the sum insured, it is discontinued	Coverage continues after the waiting period with continued premium payments

Conclusion

Once you have a clear understanding of what the waiting period entails in health insurance, it is time to select a plan that aligns with your specific needs. Purchasing a health insurance plan at a young age can minimize concerns about waiting period in health insurance.
It is recommended to opt for a health insurance plan that has minimum waiting period. Read the policy documents carefully before buying a health insurance policy.

Frequently Asked Questions on Waiting Period

1. Can a health insurance claim be accepted if a disease is diagnosed within the policy term?

A health insurance claim can be covered if the policyholder is diagnosed with a new illness during the coverage period, provided that the waiting period specified in the policy has elapsed before submitting the claim.

2. Do health insurance companies deny all claims filed during the waiting period in mediclaim policy?

While it is not accurate to say that all claims are denied during the waiting period in a mediclaim policy, most health insurance companies typically do so. The only exception is accidental hospitalization, although the specifics of coverage may differ from one plan to another.

3. What are the benefits of buying health insurance at a young age?

There are several advantages to purchasing health insurance at a young age. Firstly, the premium is generally more affordable. Secondly, extended benefits can be more easily selected. Finally, because young people are generally at lower risk for health issues, the waiting period in health insurance need not be a concern.

4. Is it possible to remove the waiting period in health insurance policies?

It may be possible to eliminate the waiting period clause in certain health insurance policies, provided that the insurer allows it and certain conditions are met. However, this is not always an option.

5. How can I determine if my pre-existing conditions are covered by a health insurance plan?

To find out if your pre-existing conditions are covered, consult the policy document or contact your insurer directly. However, it is important to carefully review the terms and conditions of the policy before making a purchase, as this information may be subject to change.