Waiting Period in Health Insurance

What is Waiting Period?

A waiting period is a pre-decided time span post which a select list of ailments starts getting covered under your health insurance policy. Also known as the cooling period, it begins with the commencement of the policy. For instance, a waiting period of 4 years for pre-existing diseases is an extremely common clause in most health policies.

In case the policyholder raises a claim with the health insurance company before the waiting period is over, the insurer can reject the claim. But if the policyholder raises a claim once the waiting period is over, the insurance company cannot deny the claim. For example, if the waiting period for diabetes is 90 days and you raise a claim in 60 days, the insurer will reject your claim. But if you raise a claim after 90 days, your claim will not be denied.

Types of Waiting Period in Health Insurance

• Pre-existing Diseases (PED) Waiting Period: At the time of taking health insurance, if the insured has any existing ailments like diabetes, high blood pressure, thyroid, etc., they are called pre-existing diseases. Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 4 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 4 successful years with the insurer.
• Waiting Periods for Specific Ailments/Procedures: There are certain listed ailments & procedures, such as ENT disorders, hernia, osteoporosis, joint replacement surgery, cataract, etc., for which health policies normally have a one or two years of waiting period. Any medical expenses resulting from such diseases/ procedures are covered only after the 1 year/ 2 years waiting period is over.
• Initial Waiting Period: Almost all health insurance plans have an initial waiting period of one month or 30 days during which no claims are accepted, except for accidental cases.
• Critical Illnesses Waiting Period: Regular health insurance plans cover critical diseases after a waiting period of 90 days and reject any claims for such diseases received during this period.
• Maternity Benefit Waiting Period: There are several health insurance plans that offer maternity benefits and newborn baby cover only after a waiting period ranging from 9 months to 36 months is over.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

Is it Possible to Reduce Waiting Period?

Yes, it is possible to reduce the waiting period under a health insurance policy. Some insurance companies offer an option to reduce the waiting period by opting for a waiting period waiver. However, such waivers can be obtained by paying an extra premium amount. For example, several health insurance plans come with a PED waiver that reduces the waiting period for such diseases from 4 years to 2 years.

Normally in group health plans offered by employers to employees, insurance companies do not insist on waiting periods. Moreover, employees can get a health policy without a waiting period if they convert their group health plan to an individual plan. As per IRDA guidelines, employees who are a member of a group health plan offered by their employers can convert their group cover to an individual retail health policy at the time of leaving their employer. In such cases, they will be given a policy without a waiting period as they have already spent the waiting time in the group health cover provided to them by their respective employers.

Important Points Related to Health Insurance Waiting Period

Take a look at the following important points related to the health insurance waiting period:

• If during the waiting period, the insured is diagnosed with a disease for the first time, it will not be called a pre-existing disease. In such a case, the policy will cover such ailment.
• Several health insurance plans for senior citizens are available today where waiting periods have been done away with by adding a co-pay clause. A co-pay or co-payment clause implies that the policyholders will have to bear a certain percentage of claim amounts while the remaining will be paid by the insurance provider. For example, with a co-pay of 30% in a claim of Rs 1 lakh, the policyholder will have to pay Rs 30,000.

So, if you have been planning to invest in a good health insurance plan, do well to check out the plan with the shortest possible waiting period.