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 Waiting Period in Health Insurance?

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.

What Is Survival Period in Health Insurance?

A health insurance policy’s survival period simply refers to a specific time period the policyholder has to remain alive after he/she is diagnosed with a critical disease such as kidney or heart failure, cancer, etc. It ranges from 14 days to 3 months based on the illness and policy type.

In case a policyholder with a critical illness insurance plan or a rider¹ files a claim, the insurer will pay a pre-determined amount in a lump sum. However, the sum insured will be paid by the insurance company only if the policyholder survives through the specified period. Once the insurer pays out the lump sum to the policyholder, the policy gets terminated.

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.

How Does the Waiting Period in Health Insurance Work?

The waiting period refers to the period for which the policyholder needs to wait before he/she can file for an insurance claim and benefits. During this period, the policyholder cannot raise claims; this starts right from the policy commencement date. Most insurance policies have a cooldown period or initial waiting period when no claims are settled by the insurance company. 

The waiting period is also applicable for several types of illnesses but it is usually applicable for pre-existing lifestyle illnesses such as diabetes, hypertension, etc. It is crucial to go through the policy documents carefully and understand the terms and conditions of the policy. Having a clear understanding of the health cover waiting period is important, as it may not apply to some illnesses, while it might for others.

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.

Is it Possible to Reduce the Waiting Period in Health Insurance?

Yes, it is possible to reduce the waiting period of a health insurance policy. There are some insurance providers in the market who provide an option to reduce or waive the waiting period of a policy. This can be done by opting for a waiting period waiver and by paying an additional amount over and above the base premium. 

For instance, a health insurance policy you have chosen comes with a 3-year waiting period applicable for pre-existing diseases. Now, if you choose to waive the waiting period, you can opt for a waiting period waiver (if available) by paying an additional premium. 

Moreover, it is important to note that most group health insurance policies offered by employers do not have a waiting period. Therefore, the employee can also convert their group health insurance policy into an individual policy without any waiting period. However, as per IRDA norms, an employee covered under a group health insurance policy can convert it into an individual policy only at the time of leaving the company (employer).

Difference Between Survival Period and Waiting Period in Health Insurance

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.

FAQs on Waiting Periods in Health Insurance

1. What is the purpose of a waiting period?

The waiting period is a clause provided by an insurance company. During this period, policyholder will not be able to get any claim settled. However, please note that the waiting period is not applicable to all the illnesses covered by the insurer, it is applicable to certain specific illnesses or treatments or any pre-existing diseases.

2. What is the 'Zero Waiting Period' in health insurance?

A zero waiting period is a certain type of health insurance policy which starts covering all the specified illnesses right from the date of policy commencement. It simply means that this type of insurance policy does not have any waiting period for any illnesses.

3. Is a health insurance claim admissible if a disease is diagnosed during the plan term?

Yes, your claim filed will be admissible if the illness is diagnosed within the tenure of the policy, provided that the illness is covered by the policy, i.e. mentioned in the policy document.

4. How to check if my existing health conditions are covered by my health insurance policy?

You can check whether your existing health conditions are covered under your existing policy, and you can consider reviewing the policy documents carefully. You can also get assistance from the insurer by contacting their customer service executive for clarification.

5. How can I reduce my waiting period for health insurance?

Yes, you can reduce or eliminate your medical insurance waiting period by opting for a waiting period waiver (if provided by the insurer). But for this, you will have to pay an additional amount over and above the base premium. 

ARN - ED/06/24/12366