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Waiting Period in Health Insurance
Waiting period in health insurance refers to the duration after which the insurance company covers certain diseases and medical conditions. Policyholders can find the waiting period applicable to their policy by going through its terms & conditions. Experts recommend buying a medical insurance policy with a minimal waiting period so that coverage for certain diseases can be obtained as soon as possible.
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- Waiting Period in Health Insurance
What is a Waiting Period in Health Insurance?
Waiting period refers to the duration during which certain benefits or coverage are not available in a health insurance policy. Essentially, it is a time period the policyholder must wait from the policy start date to claim coverage for listed diseases and medical conditions. For instance, a waiting period of 1 to 3 years to cover pre-existing diseases is applicable in most medical insurance plans.
If the policyholder raises a health insurance claim with the insurer before the expiry of the waiting period, the insurer can reject it. However, if the policyholder raises the claim after the completion of the waiting period, the insurance company cannot deny it.
For example, if the waiting period for diabetes in health insurance for parents is 90 days and a claim is filed after 60 days, the insurer will reject it. But if the claim is filed after 90 days, it will not be denied.
Common Types of Waiting Periods in Health Insurance
Some of the most common types of waiting period in mediclaim insurance are as follows:
- Pre-existing Diseases (PED) Waiting Period: At the time of buying health insurance, if the insured has any existing ailments, like diabetes, high blood pressure, thyroid, etc., they are called pre-existing diseases (PED). Almost all medical insurance plans cover PED after a waiting period of 1 to 3 years. This implies that any medical expenses resulting from declared pre-existing illnesses can be claimed only after 1 to 3 years of successful renewals, depending on the plan.
- Waiting Periods for Specific Ailments/Procedures: Certain ailments and procedures, such as hernia, joint replacement surgery, ENT disorders, osteoporosis, cataract, etc., come with a waiting period of up to 3 years. Any medical expenses resulting from such diseases/ procedures are covered by insurance companies only after the said waiting period is over.
- Initial Waiting Period: Almost all health insurance plans have an initial waiting period of 30 days, during which no claims are accepted other than accidental cases.
- Critical Illnesses Waiting Period: All critical illness insurance plans come with a waiting period of up to 90 days. The insurer rejects any claims for listed critical illnesses received during this period.
- Maternity Benefit Waiting Period: Most health plans offer maternity insurance and newborn baby cover only after a waiting period of 3 months to 6 years is over.
Is it Possible to Reduce the Waiting Period in Health Insurance?
Yes, it is possible to reduce the waiting period in a health insurance policy. Several insurance companies offer the option to reduce the waiting period for pre-existing diseases and specified illnesses/procedures with the reduction in waiting period cover. Moreover, some health plans offer PED coverage from day 1 or day 30 of the policy. However, such covers can be purchased by paying an extra health insurance premium.
For example, several medical insurance plans come with a reduction in the PED waiting period optional cover to reduce the waiting period for such diseases from 3 years to 2 years or 1 year.
Cooling Off Period in Health Insurance
Many people confuse the cooling off period in health insurance with the waiting period, but they are different. The cooling-off period is the time period after recovering from a medical condition that a person must wait before purchasing a mediclaim policy. Health insurance companies use this period to assess the risk of recurrence of the disease before providing medical coverage.
For example, if an elderly person has recently recovered from cancer, insurers may impose a cooling-off period ranging from a few days to a couple of months, depending on the patient's condition and their underwriting policy. During this time, the person cannot buy a new senior citizen health insurance policy or may have to undergo additional medical tests before the insurer decides on coverage terms.
Things to Keep in Mind About the Waiting Period in Health Insurance
Take a look at the things to keep in mind about the waiting period in health insurance:
- If the insured is diagnosed with a disease for the first time during the waiting period, it will not be called a pre-existing disease. In such a case, the insurer will cover the ailment.
- Zero waiting period in health insurance is available for accidental claims.
- When switching insurers, the waiting period already served may be credited to the new policy, as per the health insurance portability guidelines of the Insurance Regulatory and Development Authority of India (IRDAI).
- Different mediclaim policies have varying waiting periods for the same coverage.
- Always check the policy document before buying medical insurance to know the exact waiting periods applicable.
Waiting Period in Health Insurance: FAQs
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Q1. Is there a waiting period for health insurance?
Ans: Yes. Almost all health insurance plans have a waiting period. Only accidental claims are accepted without a waiting period. -
Q2. What is the maximum waiting period for health insurance?
Ans: The maximum waiting period for health insurance is 3 years for pre-existing diseases and specified diseases/procedures, and 6 years for maternity benefit. However, this may vary from plan to plan. -
Q3. Can I claim health insurance after 1 day?
Ans: Yes. You can claim your health insurance policy after 1 day for accidental claims. However, you cannot file a claim after 1 day for non-accidental medical expenses or pre-existing diseases, as they come with a waiting period. -
Q4. How do waiting periods work?
Ans: A waiting period gets activated as soon as the health insurance policy is in effect. You have to wait for the time period mentioned as the waiting period to file a claim. Once this period is over, you are free to file a claim. -
Q5. Can I buy health insurance and claim immediately?
Ans: You can buy a health insurance policy and claim it immediately, but only for accidental claims. -
Q6. Do all health insurance have a waiting period?
Ans: Yes. Almost all health insurance plans have a waiting period. Only accidental claims can be filed during the waiting period. -
Q7. What does 12-month waiting period mean?
Ans: A 12-month waiting period means that you cannot file a health insurance claim unless 12 months from the start of the policy are over. -
Q8. Can I claim health insurance after 1 month?
Ans: Whether you can claim your health insurance policy after 1 month depends on the type of claim. For most illnesses, you can make a claim after 1 month. However, pre-existing diseases and specific conditions/procedures may have a longer waiting period, usually up to 3 years. -
Q9. What is the purpose of a waiting period?
Ans: The purpose of a waiting period is to prevent people from buying medical insurance only when they are already sick and need immediate treatment. This helps insurance companies manage risks and keep premiums affordable for everyone. -
Q10. How can I reduce my waiting period for health insurance?
Ans: Some health insurers allow you to reduce the waiting period by purchasing a reduction in waiting period cover on the payment of an extra premium. -
Q11. What is the minimum waiting period in health insurance?
Ans: The minimum waiting period in health insurance is the initial waiting period of 30 days. However, there is no waiting period for accidents, meaning you get coverage from day 1. -
Q12. How to calculate waiting period in health insurance?
Ans: You can calculate the waiting period in health insurance by going through the policy document. For every successful policy renewal, your waiting period will be reduced by 1 year. -
Q13. What is the waiting period rule?
Ans: As per the waiting period rule, you cannot file a non-accidental claim under your health insurance policy unless the waiting period is over. -
Q14. What is the zero waiting period?
Ans: Zero waiting period means you do not have to wait to file a health insurance claim. You can file a claim even on the first day of the policy. -
Q15. Which health insurance has a zero waiting period?
Ans: All health insurance plans have a zero waiting period for accidental claims. However, only a few plans cover pre-existing diseases without a waiting period. -
Q16. What does 30-day waiting period mean?
Ans: A 30-day waiting period means that you can file a health insurance claim after 30 days of policy commencement. Most mediclaim policies come with a 30-day initial waiting period. -
Q17. Can waiting periods be waived?
Ans: Yes. Many health insurance plans come with the waiting period waiver option on the payment of an additional premium.
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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
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