Waiting Period in Health Insurance

With our modern lifestyle habits and the rising cost of medical treatment in our country, the importance of having a Health Insurance Policy is evident to anyone. Anyone can face a medical emergency and it could be a tough task to manage finances when anyone has to pay a hefty sum as medical expenditures. This is exactly why several people have started to opt for a Health Insurance Policy so they don’t need to struggle financially in tough times. But do you know about the Waiting Period in a Health Insurance Policy?

The waiting period is one of those things related to Health Insurance Policy about which several policyholders have little to no clue. But it remains to be one of the crucial things in health insurance. The reason: an individual cannot enjoy the benefits of his or her policy until the pre-defined waiting period completes. Simply put, the waiting period is the time a person needs to wait before availing all the benefits of his or her Health Insurance policy. Without understanding the concept of Waiting Period on your health insurance, it would be difficult to choose the right policy for you.

That’s why, in this post, we will be providing all the details related to the Waiting Period in Health Insurance such as what exactly it is, types of the waiting period in health insurance, etc. Keep reading.

The Concept of Waiting Period

When an individual opts for a Health Insurance, all the benefits are not unlocked immediately. For them to get unlocked, an individual needs to wait for a certain period. This period is known as the Waiting Period and it varies from one Health Insurance policy to another. Also, it depends on your insurance company.

Let’s say an individual has opted for fresh Health Insurance. Just after a few weeks, he got diagnosed with the stone for which he needs to undergo surgery urgently. So, he got admitted into a hospital thinking he will get insurance cover with his newly bought policy. But he is unaware of the waiting period of 1 year in his Health Insurance Policy related to any surgery related to Stone, and thus his claim would not be accepted. Because of this, he would have to bear all the expenses by himself which can deter his finances a bit as he wasn’t prepared for it. That’s why it is important to know about the waiting period in health insurance before going for any plan that you want to choose.

Different Types of Waiting Period

Different Health Insurance Companies have different terms and conditions when it comes to the Waiting Period during which you will not benefit. So, it’s important to know about the types of Waiting Period in Health Insurance. We are showing some of them below. The first one is the Initial Waiting Period. Please check them.

Initial Waiting Period 

This is the first type of waiting period in Health Insurance, which is also known as the Cooling Period. As you can see from the name, this is the initial period for which you have to wait until you can actively start using the Health Insurance Policy. This period starts right from the time when you purchase your policy. Within this waiting period, a customer cannot claim any kind of benefits whether planned hospitalization or emergency hospitalization. To get reimbursement from your insurer, you will need to wait until your Initial Waiting period completes.

Among all the Insurers, the minimum initial waiting period is fixed at 30 days, although it can go upto as long as 90 days after the issuance of a policy. You need to remember this thing in mind that the initial waiting period can vary from one insurer to another and you should check before finalizing the one for you. Also, the Initial Waiting period does not apply to the case related to the hospitalization due to an accident. In this case, the person will get full claims even if the waiting period of a minimum of 30 days hasn’t been completed.

Pre-existing Disease Waiting Period

Whenever a person goes for a Health Insurance Policy, the insurer asks about if he or she has any pre-existing illnesses. The insurer may ask a person to undergo a few tests to check whether he or she has any of the pre-existing diseases. According to the Insurance Regulatory and Development Authority of India (IRDAI), any condition, ailment or injury or disease that has been diagnosed upto 48 months before the issuance of policy can come under a Pre-existing Disease.

So, you can understand that a person needs to wait for a certain period before getting any claims related to these pre-existing diseases. This period is known as the Pre-existing Disease Waiting Period, which usually ranges from 1 to 4 years of continuous policy coverage. You need to remember this waiting period depends on the pre-existing illness you have. It can vary from one insurer to another and on the type of plan you choose. So, within this Pre-existing Waiting period in Health Insurance, a person cannot get any claim for any hospitalization or treatment related to the illness.

In case a person has been diagnosed with some disease during the waiting period, it will not be treated as a pre-existing disease. Your insurer will be liable to provide any claims for such disease. So, you don’t need to worry.

Waiting Period for Specific Diseases

There are several diseases specified by insurers that always come with a definite waiting period in health insurance. Some of the specific diseases are Cataract, Glaucoma, Hernia, Cancer, Kidney Ailments, Stoke, Dengue at All stages, etc. While going for Health Insurance, you can see the list of specified diseases and their respective waiting period that can vary from one insurer to another.

The specific disease clause can vary from one insurer to another. Based on the clause, the waiting period can also change from one insurer to another. On average, the waiting period for a Specific disease usually ranges from one to two years. So, if a person has any disease specified by the insurer and he or she wants to claim for a particular disease, it would not be possible until the waiting period completes.

Maternity Waiting Period

As it is clear from the name, this waiting period is related to any claims made on the maternity. So, a person can claim any kind of maternity benefits until this waiting period completes. There are a few Health Insurance Companies that provide Maternity Benefits with their respective policies, but to avail benefits of them, the waiting period needs to complete which usually ranges from 9 months to 36 months.

So, if a customer is planning to have a baby, it is advised to purchase the policy early. By doing this, customers can enjoy the maternity benefits. Any benefits cannot be claimed within this Maternity Waiting period. Some insurers provide the option to reduce the waiting period by paying some additional premium amount for their health insurance policy. So, if you can afford to do so, you can enjoy the maternity benefits a lot earlier than usual. Each plan may have a different waiting period, so it’s important to explore various plans before choosing the one with the lowest waiting period.

Accidental Hospitalization Waiting Period

Accidents can happen to anyone and that’s why there is no waiting period in Health Insurance when it comes to claims related to Accidental Hospitalization. A person can easily claim all the expenses even if he or she has just purchased a Health Insurance Plan. The insurer will be liable to accept the person’s claim in case of hospitalization due to some accidents.