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Health Insurance Waiting Period

Health issues can arise anytime, anywhere. With the kind of work-life imbalance, we lead, having an appropriate health insurance plan is necessary. Moreover, everyone should conduct annual medical checkups to be aware of health issues. 

Regular health checkups and preventive treatments are covered under a few basic health insurance plans offered in the market. Therefore, it is wise to buy health insurance at an early stage in life.

But before you purchase a health plan for yourself or your family members, you must be aware of its waiting period. Don’t know what waiting period is? Read on to know everything about health insurance waiting period.

What is the Waiting Period?

The waiting period is a specific time before selective pre-existing diseases are covered under your health plan. Usually, the waiting period in health insurance is four years for most pre-existing ailment and is standard across all health policies. This comes in handy for you (the policyholder) as your insurer cannot reject claims after the 4-year waiting period is over.

Need for Waiting Period in Health Insurance

Anyone buying a health insurance plan in India would undoubtedly look to avail the benefits under it. However, to avoid the chances of fraudulent claims, the idea of a waiting period was introduced.

For instance, people buy health insurance to cover the medical expenses that arise from treatment and hospitalisation. Considering the medical costs are rising with each passing day, covering these expenses can burn a hole in your savings.

Now, let’s say that the person buys an adequate health policy but avoids disclosing their existing health condition to the insurer. Moreover, they seek treatment for the disease and are covered under the purchased health plan. Such a practice is unethical, and the insurer can face significant loss over time. Hence, the waiting period applies to health insurance plans in India.

Types of Waiting Period

There are five types of waiting period.

  • The Pre-Existing Diseases (PED) Waiting Period

When seeking health insurance, you have to inform the insurer regarding any pre-existing illnesses like diabetes, high blood pressure, thyroid, etc. To ensure the same, the insurance company will ask you to take a few medical tests. These tests will determine the level of impact of the diseases on you. Based on the medical reports, your insurer will then decide whether or not to grant you a Mediclaim policy.

If they agree, there will be a waiting period mentioned in your health plan, which is usually four years. This means any medical expenses related to the pre-existing diseases stated in your plan can be claimed after the waiting period is over.

  • Waiting Period For Particular Ailments (1-2 Years)

Certain diseases like ENT disorders, hernia, osteoporosis, etc. tend to generally have a waiting period of one to two years in health insurance plans.

  • Initial Waiting Period

If you are buying health insurance early in life, then the standard health plan will have a waiting period of one month (that is 30 days) except in case of accidental scenarios. It is also known as the cooling period in health insurance. Also, it is not applied to the claims related to accidental hospitalisation.

  • Newborn Cover Waiting Period

Waiting period for newborn babies or infants to be covered under the existing health insurance plan is about 90 days.

  • Maternity Cover Waiting Period

A few health insurance plans also offer maternity benefits. However, the waiting period for the same can range anywhere between 9 to 36 months. That means you can claim maternity benefits on your health insurance plan after completing the stated waiting period.

  • Bariatric Surgery Waiting Period

Nowadays, health insurance plans cover bariatric surgery as well. Bariatric surgery is performed on someone with obesity issued (wherein the BMI of the individual is above 40). You can use the BMI calculator to determine your BMI value based on your current height and weight. The minimum waiting period for bariatric surgery is usually two years.

  • Accidental Hospitalisation Waiting Period

Accidents can take place unexpectedly and can cause major injuries to an individual. The treatment of the same can save a human life. Hence, insurers in India do not have a waiting period for accidental hospitalisation. This means one can claim on their health insurance plan (even if the policy is new) without worrying about the completion of the waiting period.

  • Health Checkup Waiting Period

Most insurers in India offer a complimentary health checkup facility for their customers. However, it comes with a short waiting period of one year. Check with your insurance provider before you seek this benefit.

How to Reduce the Waiting Period?

Most insurance companies allow you to reduce the waiting period if you pay an extra premium. On the other hand, for group health plans offered by employers, there is no waiting period imposed on it by the insurance company.

According to the Insurance Regulatory and Development Authority of India (IRDAI) regulations, employees who are covered under a group health insurance plan offered by their employers can convert the policy into an individual health plan when leaving the company. This individual health policy is given without a waiting period as the waiting time is usually spent in the group health cover provided to them by their company.

Buy Health Insurance Online

Thanks to the internet, we have everything available at a click of a button. You no longer have to visit the insurance company to buy insurance plans. You can buy a cashless health insurance policy online through the official websites of the providers. Before purchasing any plan, you can compare the different programs available and choose the one with suitable premiums and benefits.

Health Insurance Calculator

Calculating insurance premiums can be a confusing and tedious task. To make it easier and less time-consuming, insurance providers have provided with online health insurance calculator. You can use this calculator to compute your premiums to be paid monthly. This helps you not only to plan your finances but also to understand your health plan more.

Things to Keep In Mind about Waiting Period

  • In case the insured is diagnosed with an illness for the first time, it is not considered a pre-existing disease. Therefore, the health plan will cover for the same.
  • With rising demands, insurers in India offer senior citizen health insurance plans as well. So, to get rid of the waiting period in such plans, insurers have added copay in health insurance clause. The clause implies that the insured is liable to pay a specific percentage of the claim amount from their pocket.

A Final Thought

Let’s face it; health emergencies can arise anytime and anywhere. You cannot buy health insurance and make a claim on it immediately a week after, especially for pre-existing diseases. You have to go through the 4-year waiting period to make a successful claim. Hence, it advisable to seek medical insurance early in life. Also, if you are buying health insurance now, check the waiting period before you make the purchase.

Buying the right health plan is vital. To make this simple, get in touch with us at Finserv MARKETS. With health insurance plans available on Finserv MARKETS can benefit from features like swift claim settlement, reinstatement benefits, bespoke insurance plans, extensive coverage, and so much more.

So, why wait? Get yourself insured with us today.

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