Understanding Waiting Period In Health Insurance

Based on the medical insurance policy selected by the insured individual, here's all you need to know about health insurance waiting periods in detail.

Know More
waiting-period.jpg

All You Need To Know About Waiting Periods For Health Insurance Policy

When you subscribe to a health insurance plan, you must understand various policy aspects before making a final decision. In case of a medical emergency, you may not have the chance to read the fine print and might regret a hastily taken decision. Here we will discuss an important aspect of medical insurance, the waiting period in health insurance.

Understanding Waiting Period in Health Insurance

The waiting period in a health insurance policy may vary from policy to policy. It will also depend on the type of health insurance policy chosen by the insurer and the company providing the policy. While the periods may vary, there is most definitely a waiting period in a health insurance policy.

Definition of a waiting period

The waiting period can be defined as the period during which the insurance company will not pay any of the medical expenses of the insurer. This means even though you have purchased a plan, you may not receive any compensation if you submit a claim during that period.

Let us understand the different types of waiting periods

Waiting period at the start

This period begins with your policy cover and typically ranges between 15 to 30 days, depending on your insurance company. During this period, the health insurance policy will not provide you with any compensation or cover your medical expenses except accidental injuries that may lead to hospitalization for more than 24 hours.

Pre-existing conditions and the waiting period

This waiting period is applicable if you are suffering from any illness already declared by you while purchasing the policy. These pre-existing conditions could be diabetes, hypertension, low blood pressure, thyroid, and many others. The policyholder may have to wait for one to four years to claim compensation for these pre existing diseases. This waiting period depends on the health insurance provider and on the plan you select.

Waiting period which could be illness-specific

Some illnesses like hernia, cataract, kidney stone, few ENT related disorders could have a specific waiting period of one to two years. The health policyholder can check all this information and a list of such illnesses and their specific waiting period in the application form or the health insurance policy brochure. This list may vary from one insurer to another.

Maternity coverage and waiting period

The waiting period for maternity coverage could be between nine months to three years. Most health insurance policies will cover the expenses related to maternity only after this period. It would be advisable to plan accordingly.

Coronavirus and waiting period

With the pandemic raging in India, many people buy coronavirus-related health insurance plans for their families. But to avail of the benefits of these plans, like hospitalization and treatment, the policyholder needs to complete a waiting period of 15 days.

Survival period

The policyholder for critical illness insurance must complete a specified survival period of typically ranging from 30-90 days depending upon critical illness.

New Born Babies Health Insurance

A health insurance policy for a new born typically start only after 90 days.

Complimentary annual health check waiting period

Some health insurance companies give an annual health check-up as part of the policy. There is mostly a one-year waiting period for getting the check-up done

Reduction in waiting period

A waiting period will always be a part of any health insurance policy you take. Some insurance companies do let you reduce the waiting period if you are ready to pay a higher premium. It is called premium loading and a good way to enjoy the benefits of your policy sooner.

More information

  • Any health insurance policy's waiting period depends on health insurance plan you select. Sometime basis your age, overall health, and medical conditions waiting period may be proposed by health insurance company.
  • In case the policyholder does not declare a pre-existing ailment at the time of policy issuance, and the claim has been made for the same, it may not be honoured.
  • Some insurance companies are also doing away with the waiting period for senior citizens by adding a co-pay clause. A co-pay clause means the policyholder will bear a certain percentage of the claim amount. For e.g. – if the claim is for Rs 100,000 and the co-pay is for 30%, the policyholder will have to bear Rs. 30,000.

It is good to read the policy document carefully and speak to your policy agent in detail to understand the finer points of the policy you select for you and your family. You can also visit the health insurance company's official website to have a deeper understanding.

FAQs

Q. Why is there a waiting period for health insurance?

The waiting period for a health insurance policy is mandatory to avoid any misuse of the policy. The policyholder may manipulate claims for a specific disease or in some other way; therefore, the insurance companies introduced the concept of a waiting period. If a person is suffering from cancer and any other illness, cannot buy a policy and expect the company to start paying their claims the next day. This concept helps control unethical practices by anyone as the premium is always lesser than the claim pay-out.

A health insurance policy works best with gradual premium collection and risk-sharing. Then the health insurance company can also start paying claims once those insured have paid the health insurance premium.

Q. What is the waiting period in a health insurance policy?

Most health insurance companies have a waiting period for different reasons. The initial waiting period for any health insurance is 30 – 90 days. Apart from there could be a waiting period for specific diseases and pre-existing conditions.

Q. What is the significance of the waiting period?

The waiting period signifies the time period after the issuance of policy during which the policy coverage will not be available for specified health conditions. This period might vary across companies but is an integral part of a health care insurance policy.

Q. Can waiting periods be waived?

Yes, some insurance companies do let you reduce the waiting period if you are ready for a higher premium. This process is known as premium loading and is a good way to enjoy the benefits of your policy sooner. However, insurance company decide if they can offer reduced waiting period to you basis declared health condition.

Q. What is the waiting period for maternity expenses in health insurance policies?

The waiting period for maternity expenses could vary between 2-4 years. Most health insurance policies will cover the expenses related to maternity only after this period. It would therefore be advisable to plan for the pregnancy accordingly.

Q. What is the waiting period for a pre-existing condition?

There are various health conditions that are listed by insurers as pre-existing conditions such as diabetes, hypertension, low blood pressure, thyroid, and many others. The coverage for these defined health conditions will start only after the specified waiting period has been completed. Normally, the waiting period can vary between 1-3 years, depending on the ailment. This waiting period depends on the health insurance provider and on the plan you select.

Q. What will happen if I fail to disclose my pre-existing conditions to the insurer?

If you fail to explicitly mention any pre-existing conditions in the policy form, then the policy is void ab-initio. Moreover, the insurer might also forfeit the premium in such cases. It is therefore advisable that you specifically list out all health conditions and complete the waiting period rather than exposing yourself to the hassles of policy cancellation.


Share This page


Navi General Insurance Limited
IRDAI Registration No: 155 | CIN: U66000KA2016PLC148551