Understanding Waiting Periods in Health Insurance and Its Types

 

A health insurance policy provides financial support and security after a medical emergency. These plans enable you to focus on recovering since they help take care of your hospital bills. Health insurance policies have various terms and conditions that explain how and when your coverage works. If you do not understand all these terms, you could end up filing an invalid claim. One such term is waiting period. Let’s understand this better.

What Is Health Insurance Waiting Period?

A waiting period in health insurance refers to the time during which the policyholder cannot file claims for certain issues. You must wait for a stipulated time before you can enjoy certain health insurance benefits. The waiting period starts from the day the policy commences. Let’s look at an example. Sanjay purchases a health insurance policy for the first time on 1^st July. Just 20 days later, he suffers a stroke and gets hospitalised for treatment. Unfortunately, Sanjay’s insurance policy has a 30-day waiting period for all claims, so he cannot file a claim for his treatment.

Understanding the Types of Waiting Periods in Health Insurance

When you purchase a health insurance policy, you may notice a few different waiting periods. Let’s find out what they are:

• Initial Waiting Period

  Health insurance companies refer to the initial waiting period as the cooling period. Insurance companies typically have a 30-day period from the day the policy starts during which they will not accept any claims. The waiting period extends to both planned and emergency hospitalisations, as we saw in the above example. However, many insurance providers make exemptions in cases when the policyholder requires immediate hospitalisation after an unfortunate accident.

• Pre-Existing Disease Waiting Period

  When you buy a health policy, the insurance company asks about any medical conditions you already have. If you get diagnosed with diabetes, hypertension, a thyroid condition or other medical issue before you purchase a policy, you must declare it as a pre-existing disease. Your insurance policy will stipulate a waiting period during which you cannot file claims for treatment related to these issues. Insurance companies may have a waiting period of up to four years for pre-existing illnesses.

• Specific Diseases Waiting Period

  Some conditions, like hernias or osteoporosis, require care over several months or even years. Insurance providers will provide coverage for such issues, but only after a stipulated insurance waiting period. You should check your policy details to note which specific diseases or procedures have a waiting period under your health insurance plan.

• Maternity Waiting Period

  When you purchase health insurance, your policy may include maternity coverage or you can opt for it as an add-on cover. The coverage lets you grow your family without worrying about the cost of childbirth. All medical insurance companies have a waiting period during which you cannot file claims against this cover. The waiting period can range from nine months to up to four years. Depending on when you intend to get married and have children, you can choose a health insurance plan that offers an optimal maternity coverage waiting period.

• Health Check-Up Waiting Period

  Certain health insurance policies allow policyholders to avail complimentary health check-ups. Often, insured individuals have to wait at least one year before they can enjoy this benefit. Ideally, you can complete the check-up at the start of the second year of coverage.

• COVID-19 Waiting Period

  The COVID-19 pandemic continues to cause disruptions with the emergence of new strains. Your health insurance policy will help you deal with the cost of hospitalisation or treatment of the disease after a short waiting period. Once you purchase a health insurance plan, you have to complete a 30-day waiting period before filing a claim against your COVID-19 coverage.

• Accidental Hospitalisation Waiting Period

  An accident could lead to severe consequences. If a policyholder must get hospitalised and receive treatment after an accident, they do not have to worry about a waiting period. Insurance companies may waive off a waiting period in case of an unfortunate accident.

Why Do Health Policies Have Waiting Periods?

Health insurance companies created waiting periods to prevent a few individuals from taking undue advantage of the coverage. Individuals may purchase plans after getting diagnosed with an illness simply to cover the cost of an expensive treatment or surgery. Some people attempt to hide a diagnosis and then purchase insurance to get the coverage for a pre-existing condition or illness. By creating these waiting periods, insurance companies prevent unethical behaviour.

Crucial Things to Remember

When you purchase health insurance for the first time, you must be completely honest about your health and medical records. Your insurance company will investigate every claim and if they find out that you deliberately misrepresented yourself, they will reject your claim and cancel your policy. If you’re concerned about your insurance waiting period, you can check if you can pay a higher premium amount to reduce the waiting period. Or, to fully enjoy the benefits of a health policy, purchase a plan when you’re young and less likely to have health issues that require you to file claims. Before you purchase a policy, check which add-ons are available and customise your plan based on your needs.

As the incidence of lifestyle diseases continues to rise, purchasing a health insurance policy is more important than ever. Make sure you understand all the terms and conditions before you buy a policy.

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ARN: ED/08/22/28708