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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 their changing health conditions.

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, be aware of its waiting period. Don’t know what waiting period is? In this section, we have explained everything you need to know about the health insurance waiting period.

What is a 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

Waiting period in health insurance are of the following types:

1. The Pre-Existing Diseases (PED) Waiting Period

When seeking health insurance, you must inform the insurer regarding any pre-existing illnesses like diabetes, high blood pressure, thyroid, etc. The insurer may even ask you to take a medical examination when buying health insurance. The results of the medical test determine the severity of your health conditions based on which the insurer decides whether to issue the health insurance policy or not.

If the insurer agrees to grant you health coverage, a pre-existing disease waiting period will be mentioned in your policy document. The standard waiting period for pre-existing diseases is 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.

Besides, some pre-existing diseases are permanently excluded from your health coverage. Make sure that any queries regarding your health insurance waiting period are resolved before buying the policy. Ask your insurer about the pre-existing ailments excluded from the coverage. Based on it, you can then choose a plan that fulfils your and your family’s medical needs.

2. 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.

3. 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.

4. Newborn Cover Waiting Period

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

5. 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.

6. 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.

7. 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.

8. 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.

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.

This concludes everything you need to know about the health insurance waiting period. Now, let us understand how you can buy health insurance online in India.

Buy Health Insurance at Finserv MARKETS

Thanks to the internet, we have everything available at a click of a button. You no longer have to visit the insurer in person to buy health insurance. You can buy a comprehensive health insurance policy at Finserv MARKETS. Follow the steps below to buy the policy online –

  1. Visit the Finserv MARKETS website and go to the ‘Health Insurance’ section.
  2. Choose the types of policy you need – individual health insurance or family health insurance.
  3. Select the coverage required.
  4. Fill the application form with personal and health-related details
  5. Review the policy terms and conditions before paying the premium amount.
  6. Pay the premium amount online.
  7. The insurer will assess your application and issue the policy shortly.

You can also buy/renew your health insurance plans using our health insurance app. In case you are worried about the policy cost, use the health insurance calculator to determine the same.

Wrapping it up!

Let’s face it; medical contingencies arise without any prior warning. You cannot buy a health insurance plan and raise a claim on it immediately after the purchase, especially for pre-existing diseases. You must go through the stated waiting period for a successful claim settlement. Hence, it advisable to seek medical insurance early in life. Also, if you are buying health insurance at a younger age, the policy premiums are affordable.

You can browse the health insurance plans available on Finserv MARKETS and choose a plan that best suits your and your family’s needs. So, why wait? Get a health insurance plan at Finserv MARKETS today!

Best Health Insurance Plans Available at Finserv MARKETS

FAQs On Waiting Period In Health Insurance

  • ✔️What will happen if I raise a claim on my health insurance plan before completing the waiting period?

    When you raise a claim against your health insurance policy during the waiting period, the request is rejected by the insurer.

  • ✔️How to claim health insurance at Finserv MARKETS?

    To submit your claim request, follow the steps below -

    1. Visit Finserv MARKETS and go to the ‘Health Insurance’ section.
    2. Fill the claim application form with the necessary details.
    3. Upload the supporting documents and submit the claim application.
    4. The respective insurer will assess your claim request and pass a decision.
    5. If the claim request is approved, the insurer will either settle the claim directly with the insurer (known as cashless claim settlement) or reimburse the amount into your account.
  • ✔️What are the different types of health insurance claims?

    There are two types of health insurance claim settlements -

    1. Cashless claim settlement
    2. Reimbursement claim settlement
  • ✔️Is the waiting period in health insurance mandatory?

    Yes. The waiting period in health insurance is mandatory and is usually for four years.

  • ✔️Does buying health insurance at a young age help reduce the waiting period?

    The chances of you acquiring a life-threatening disease at a young age are low. Therefore, when you buy a health insurance plan at a younger age, you can easily complete the waiting period without raising any claims against critical health conditions. So, when the time comes, you do not have to worry about your health policy covering the expenses of the illness.

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