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What is Waiting Period in Health Insurance?

With age, the human body becomes prone to diseases. Sedentary lifestyle and the junk-food culture is another reason why diseases are catching up so early.  Quite expectedly, health insurance policies have increasingly important, today. Annual health checkups and preventive services like screenings and counseling are covered under such policies and therefore it is a wise step to take health insurance early in life.

Waiting period is a certain span of time before a select list of ailments start getting covered under your intended health policy. Waiting period of 4 years for pre-existing diseases is a standard clause in almost all health policies. This is helpful to the policy holder because an insurance company cannot deny a claim after 4 years, i.e., once the waiting period is over.


Let us understand the concept of waiting period in detail.

Types of Waiting Period in Health Insurance

  1. Pre-Existing Diseases (PED)
    At the time of taking health insurance, if an insured declares that he has specific ailments say diabetes, high blood pressure, thyroid, etc., these are called pre-existing diseases. In such cases, insurance company’s health underwriters insist for medical tests for assessing the level of impact of the diseases on the policyholder. Based on the reports, they decide if a proposal is to be accepted or not. In case they accept the proposal, they prescribe a waiting period usually of 4 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 4 successful years with the insurer.  Hence, it is important to take health insurance policy early in life to avoid any waiting period.
  2. One/Two Years Waiting Periods for Particular Ailments
    There are certain listed ailments such as ENT disorders, hernia, osteoporosis, etc. for which health policies normally have one or two years of waiting period.
  3. General health insurance waiting period is one month for every policy except for accidental cases.
  4. There is a 90 days waiting period for infants or new born babies.
  5. There are a few Insurance companies that offer maternity benefits, but with a waiting period ranging from 9 months to 36 months.

Is it Possible to Reduce Waiting Period?                               

  1. Some companies offer an option to reduce waiting period by paying extra premium.
  2. Normally in group health plans offered by employer to employees, Insurance companies do not insist on waiting periods for health insurance.

As per IRDA guidelines, employees who are member of 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. They will be given a policy without a waiting period as they have has already spent waiting time in the group health cover provided to them by their respective employers.

Other Important Points Related to Health Insurance Waiting Period:

  1. 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. The policy will cover such ailment.
  2. With changing times insurance companies have designed plans for senior citizens where health insurance waiting periods have been done away with by adding a co-pay clause. Co-pay clause implies that policy holders will have to bear a certain percentage of claim amounts. For example, for a co-pay of 30%, in a claim of Rs. 1 lakh, policy holder will have to bear Rs 30000.

We’re sure now you understand everything about the waiting period. Under health insurance, waiting period is also termed as cooling period. It is a certain span of time before insurance start getting covered under health plan.

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. 

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