Waiting Period In Group Health Insurance

Group Health Insurance Waiting Period

The concept of a waiting period in a group health insurance refers to the period of time a policyholder has to wait before getting coverage for specified ailments in the insurance policy documents. The waiting period in a group health insurance is usually 30 to 90 days however it depends on the insurance company and its specified terms and conditions and it can also be waived off since you are covered under a group health plan.

Apart from this, there is one other thing called pre-existing disease coverage. Let us tell you about it and how it works under a group health insurance policy.

Waiting Period for Pre–Existing Diseases

When you join a company and the employer provides group health insurance coverage, there is a waiting period that you have to serve before getting coverage for specified pre-existing diseases. The waiting period for pre-existing diseases is usually 4 years. Once the waiting period is over, the insurer cannot deny providing coverage for those specified pre-existing diseases.

How Does It work?

While purchasing the group health insurance plan, the buyer has to tell about the pre-existing diseases they are suffering from such as diabetes, thyroid, etc. After that, it depends on the insurer whether they would grant cover for that pre-existing disease or not.

Once they decide on providing coverage for a particular pre-existing disease, they will then force 4 years waiting period. This means that the policyholder has to serve the 4 years waiting period to get coverage for any particular pre-existing disease.

However, there are some specific diseases for which the waiting period is 1 to 2 years such as ENT disorders, hernia, etc. Talking about maternity cover, the waiting period for this is 9 months to 3 years but it can also be removed so that the insured can get coverage starting from the 1st day.

Moving on, let us tell you about other types of waiting periods under a health insurance policy.

Reduction Of Waiting Period

Usually, if you are covered under a group insurance plan provided by your employer, the insurance companies do not make you serve the waiting period. As per the guidelines of the Insurance Regulatory & Development Authority of India, if the employee while leaving the company converts the group health plan into an individual health plan, then they will not have to serve the waiting period.

Group Health Insurance Various Waiting Periods

The advantage of group health insurance policy is that the waiting period can be waived off. Here are some of the waiting periods that you should about and how they are implicated?

9 Months Waiting Period

The insurer that offers maternity benefits under their group health insurance plans, the policyholder has to serve a 9-month waiting period before raising a claim. If the company wants then this waiting period can be waived off eventually providing coverage from day 1.

1 Year Waiting Period

The group health insurance provided by the insurance companies usually excludes high incidence diseases such as Gallbladder, Cataract, Kidney stones, etc. It varies from insurer to insurer and the insured has to serve a 1-year waiting period before raising a claim. However, if the company wants the waiting period can be waived off.

FAQs