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What is Waiting Period in Health Insurance?

The waiting period in health insurance, as the name suggests, is the period when you need to wait after purchasing your health insurance plan. You cannot avail the benefits of the health insurance policy during this period. The waiting period starts from the date of the commencement of the policy, and the duration may vary for different insurers. It is always advised to check the waiting period of a health insurance plan before you purchase it.

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There are many terms, inclusions, and exclusions specifically mentioned in your health insurance policy, one of which is a waiting period. The different components of your health insurance policy do not get activated at the same time; whilst some get activated instantly after the purchase of the policy, others can be used after a certain time period has passed. The aforementioned time period is referred to as the health insurance waiting period.

What Is A Waiting Period In Health Insurance

Waiting period in health insurance means the quantum of time that must pass for a particular cover or benefit of the policy to be activated and usable. Simply put, before the waiting period for a particular cover has not been completed, you cannot avail of the cover and benefits thereof. It is advisable to check the different types of health insurance waiting periods mentioned in your policy before you purchase it.

What Are The Different Types of Waiting Periods In Health Insurance

There are several types of waiting periods in every health insurance policy to specify the timeline for the activation of different benefits. Here are the major types of waiting periods in health insurance policies that you must be mindful of.

 

    1.Initial Waiting Period:

 

The initial waiting period in a health insurance policy is the time that must pass before you can start using the benefits of the policy. Also referred to as the cooling period of the policy, the initial health insurance waiting period usually lasts up to 30 days. However, the exact initial waiting period shall vary depending on the health insurance provider you select.

 

    2.Waiting Period For Pre-existing Diseases:

 

A pre-existing disease is any disease that you have been diagnosed with up to 48 months before the purchase of a particular health insurance policy. At the time of the policy purchase, you are required to submit the details of any pre-existing diseases to your health insurer. These diseases could be diabetes, thyroid, or any other type of ailment.

If you end up requiring any medical treatment and/or hospitalisation owing to a pre-existing disease, then you cannot use your health insurance policy unless the minimum waiting period for health insurance for pre-existing diseases has been exhausted. This period can last from one to four years depending on your health insurance provider.

 

    3.Waiting Period For Specific Diseases:

 

The waiting period for using the benefits of your health insurance policy for the treatment pertaining to a specific disease depends upon the type of the disease. Usually, the waiting periods for different diseases are specifically mentioned in your health insurance policy to prevent any confusion at a subsequent stage.

Therefore, the waiting period for, say, Cataracts shall be different to that for Arthritis. You must check the health insurance waiting periods for different ailments before finalising a policy.

 

    4.Waiting Period For Maternity Cover:

 

If your health insurance policy does not have a cover for maternity expenses and the expenses pertaining to a newborn baby, then you must choose this cover as an add-on. As its name suggests, a maternity cover provides you with financial assistance for the medical cost of pregnancy, delivery, and post-natal expenses, including vaccinations. The type and degree of the coverage varies from one insurer to another.

A maternity cover usually gets activated two to four years after the purchase of a health insurance policy. Therefore, you must buy a health insurance policy with a maternity cover well in advance.

 

    5.Waiting Period For Accidental Hospitalisation:

 

There is no health insurance waiting period for medical treatment, including hospitalisation, that is required in the wake of an accident. The initial waiting period of your health insurance policy also does not apply in case you meet with an accident. Therefore, the accidental injury benefit of your health insurance policy is available to be used from the moment you purchase the policy.

 

    6.Waiting Period For Psychiatric Ailments:

 

As important as your physical health is, you must not underestimate the significance of your mental health. With the severe stress of a modern lifestyle, it is common for individuals to suffer from a wide gamut of psychiatric ailments.

A majority of the health insurance policies these days comprise a cover for mental health related expenses. However, as is the case with most of the benefits of health insurance plans, the aforementioned cover can be availed of after the exhaustion of a health insurance waiting period, which is usually between one to two years.

What Is The Need For Waiting Periods In Health Insurance

The purpose of a health insurance policy is to provide you with the necessary support in the event of any health-related emergencies. However, it is important to remember that, akin to all insurance contracts, a contract of health insurance is built on the premise of full disclosure and good faith.

Owing to the ever-rising instances of individuals purchasing health insurance plans with the intent of defrauding an insurer, the concept of waiting periods has been incorporated in health insurance policies. Therefore, if someone has a pre-existing disease but does not disclose it to their health insurance provider at the time of the purchase of a health insurance policy, then the waiting period for pre-existing diseases is meant to protect the insurer.

Similarly, if someone is pregnant and wishes to buy a health insurance policy, then they cannot avail of the benefits of a maternity cover until the minimum health insurance waiting period has passed. Health Insurance waiting periods, thus, primarily exist to prevent individuals from engaging in unethical practices with regard to their insurance covers through the concealment of material information and/or the provision of inaccurate information to the concerned insurer.

How Can You Reduce The Waiting Period In Your Health Insurance Policy

If you wish to get health insurance without a waiting period, then you can opt for an add-on rider termed as the 'Waiting Period Waiver Rider'. With the payment of an additional premium, this rider can enable you to do away with health insurance waiting period. For instance, if you have a pre-existing disease and wish to buy a health insurance policy without a waiting period for pre-existing diseases or a reduced waiting period, then you can opt for the aforementioned rider.

The terms of the waiting period waiver rider also vary depending on the insurance provider you opt for. Another instance in which the waiting period of a health insurance policy can be waived off is the conversion of a Group Health Insurance Policy into an Individual Health Insurance Plan.

In this context, the Insurance Regulatory Development Authority of India (IRDAI) has stated that if someone leaves their organisation and wishes to convert their employer-issued Group Health Insurance Policy into an individual plan, then they shall get health insurance with no waiting period. This is because they would have already adhered to the terms of a health insurance waiting period whilst the policy was a Group Health Insurance Policy.

What Things Should You Keep In Mind About Health Insurance Waiting Periods

Here are some important things about the waiting periods for health insurance policies that you must be aware of.

 

    1.First diagnosis of a disease:

 

If you get diagnosed with a disease for the first time after the purchase of a health insurance policy, then said ailment cannot be classified as a pre-existing ailment. Barring any specific exclusions in your health insurance plan, such an ailment shall be covered under the plan.

 

    2.A Co-pay clause:

 

Several health insurance policies these days enable policyholders to get health insurance with no waiting period by virtue of a co-payment or co-pay clause. The aforementioned clause entails that the policyholder shall have to bear a pre-decided percentage of the amount of a health insurance claim. This way, you can avail of the benefits of health insurance without a waiting period. It is pivotal to check the terms of a health insurance policy to check the particulars on the co-payment clause.

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To Sum It Up

It is critical to be aware of the various kinds of health insurance waiting periods that are a part of your health insurance policy. This way, you can be sure about the timeline of the activation of the different covers in the plan, as well as any exclusions that may affect your ability to avail of any benefit under the plan. The easiest way to ascertain the aforementioned information is reading the policy document with utmost attention.

 

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Frequently Asked Questions About Waiting Period In Health Insurance

✔️Can I file a health insurance claim for a pre-existing disease?

Yes, you can file a health insurance claim for a pre-existing disease, provided:

  • Your health insurance policy covers pre-existing diseases

  • The health insurance waiting period for pre-existing diseases has been completed 

✔️Can I buy health insurance with no waiting period?

Yes, you can buy health insurance without a waiting period if your health insurance provider offers a 'Health Insurance Waiting period Waiver Rider'. The aforementioned rider carries an additional premium and can enable you to reduce or eliminate your health insurance waiting period. 

✔️If I meet with an accident, will the waiting period clause of my health insurance policy be applicable?

The waiting period clause of health insurance policies is generally not applicable to injuries resulting from an accident. In most health insurance policies, the cover for accident-induced injuries is available right from the purchase of the policy. 

✔️If I file a health insurance claim whilst the waiting period for a particular benefit under the policy is still going on, will my claim be accepted by the insurer?

If you file a health insurance claim on a particular cover under the policy whose waiting period is yet to be exhausted, then your health insurance provider is likely to reject the claim application. 

✔️What are the different types of health insurance waiting periods?

Some of the common types of waiting periods for health insurance are as follows:

  • Initial Waiting Period

  • Waiting Period For Pre-existing Diseases

  • Waiting Period For Specific Diseases

  • Waiting Period For Maternity Cover

  • Waiting Period For Psychiatric Ailments