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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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How Does the Waiting Period in Health Insurance Work?

Health insurance plans have different components that do not get activated at the same time. Whilst some get activated instantly after policy purchase, others will only be activated after a certain time period. Many healthcare services and treatments have a waiting period of 3-4 years. Once you have completed this waiting period in health insurance by opting for continuous renewal, you can start benefiting from the medical facility without any limitations. 

Types of Waiting Periods in Health Insurance

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 (PED)

A pre-existing ailment is any disease that you have been diagnosed with up to 48 months before the purchase of a particular health insurance plan. At the time of policy purchase, you are required to disclose any pre-existing diseases that you may suffer from to your health insurer.

If you end up requiring any medical treatment and/or hospitalisation owing to pre-existing illness, then you cannot claim insurance coverage unless the minimum PED waiting period has been exhausted. This period can last from one to four years depending on the health insurance provider.

3. Waiting Period for Specific Diseases

Health insurance policies also have a waiting period applicable for the treatment pertaining to a specific disease or ailment. Usually, the waiting periods for different diseases are specifically mentioned in your health insurance policy document. Therefore, you must read the fine print and understand the terms and conditions applicable for specific illnesses.

4. Waiting Period for Maternity Cover

If your health insurance plan doesn’t offer coverage for maternity costs and the expenses pertaining to a newborn baby, then you can opt for a maternity add-on cover. As its name suggests, the maternity add-on provides you with financial assistance and covers the medical cost of pregnancy, delivery, and post-natal expenses, including vaccinations. Most maternity covers come with a waiting period of two to four years after purchase. Therefore, you must plan for a child accordingly to enjoy extensive insurance coverage.

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, you can enjoy coverage for accidental injury 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 the 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 provide a cover for mental health-related expenses. However, such a cover can be opted for after the exhaustion of the waiting period applicable, which usually ranges between one to two years.

7. Waiting Period for Bariatric Surgery

Bariatric surgery is a procedure that makes changes to the digestive system to help with extreme obesity or weight-related issues. You can easily find health plans offering coverage for bariatric surgery but a waiting period of one to two years is applicable.

What is a Zero or No Waiting Period?

As most health insurance policies come with a waiting period clause, there are only two circumstances under which no waiting period is applicable: 

 

  • Emergency hospitalisation due to accidental injury

  • Pre-existing disease coverage available from policy inception

In the event of an accident, the policyholder can opt for medical care and claim the expenses even during the initial waiting period. Similarly, if the health policy safeguards the insured against pre-existing ailments from day one of the plan, then the policyholder can get the benefits without any PED waiting period.

Need for a Waiting Period 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 a contract of health insurance is built on the premise of full disclosure and good faith. Owing to the rising instances of fraudulent health insurance claims, the concept of waiting periods was introduced in health insurance. Thus, such a waiting period primarily exists to prevent individuals from engaging in unethical practices by concealing material information and/or by providing inaccurate information to the insurance company.

How to Reduce Waiting Period in Your Health Insurance Policy?

If you wish to get health insurance with a reduced waiting period, then you can do so by paying an additional premium. For instance, if you have a pre-existing ailment and wish to buy a health insurance policy with a reduced waiting period, then you can contact the insurer and pay an extra amount. The terms of the waiting period waiver also vary depending on the insurance provider you opt for. 

Another instance in which the waiting period can be waived off is the conversion of a Group Health Insurance Policy into an Individual Health Insurance Plan. The Insurance Regulatory Development Authority of India (IRDAI) has stated that employees can convert their employer-issued Group Health Insurance Policy into an individual plan and get health insurance without a 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.

Things to Keep in Mind About Health Insurance Waiting Periods

Here are some pointers about waiting periods in health insurance that you should keep in mind:

 

  • First Diagnosis of an Ailment

If you get diagnosed with an illness 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.

  • A Co-Pay Clause

Several health insurance policies these days enable policyholders to get health insurance with no waiting period by introducing a copayment or co-pay clause. Such a clause entails that the insured shall have to bear a pre-decided percentage of the amount of a health insurance claim. This way, you can enjoy 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 of the co-payment clause.

Difference Between Survival Period & Waiting Period in Health Insurance

Parameters

Survival Period

Waiting Period

Applicable to

Critical illness health insurance

All kinds of health insurance

Definition

The time period during which the insured must survive after getting diagnosed with a critical ailment covered under the insurance policy

The time duration that the policyholder must complete to start claiming certain health insurance benefits

Time Duration

14-180 days

30-35 days for the initial waiting period

2-4 years for pre-existing disease

Dependent on

Type of critical illness and the insurance provider

Type of healthcare service or treatment and the insurance provider

Continuity of Insurance Coverage

The health insurance policy gets terminated after the insurer pays out a lump sum benefit

The health insurance policy remains active after continued renewal

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 plan. This way, you can know the activation period of the various covers under health insurance as well as any exclusions and conditions. But if you still haven’t opted for extensive coverage under health insurance, head over to Bajaj Markets and check out our insurance offerings today!

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FAQs on 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 pre-existing disease, provided you meet these terms:

    • 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?

    You can buy health insurance with a reduced waiting period by paying an additional premium. 

  • ✔️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. Hence, most health insurance policies offer coverage for accidental injuries.

  • ✔️If I file a health insurance claim without completing the waiting period, will my claim be accepted by the insurer?

    Your health insurance provider is likely to reject your claim application if you haven’t exhausted the waiting period.

  • ✔️What is the minimum waiting period in health insurance for pre-existing ailments?

    The minimum waiting period in health insurance for pre-existing ailments consists of two years.

  • ✔️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

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