Waiting Period in Health Insurance

What is the Waiting Period?

A waiting period is a pre-decided time span post which a selected list of ailments starts getting covered under your health insurance policy. Also known as the cooling period, it begins with the commencement of the policy. For instance, a waiting period of 2 to 3 years for pre-existing diseases is an extremely common clause in most health policies.

If the policyholder raises a claim with the insurer before the expiry of the waiting period, the insurer can reject the claim. But if the policyholder raises a claim after the completion of the waiting period, the insurance provider cannot deny the claim.

For example, if the waiting period for diabetes is 90 days and you raise a claim in 60 days, the insurer will reject your claim. But if you raise a claim after 90 days, your claim will not be denied.

Types of Waiting Period in Health Insurance

The different types of waiting period in medical insurance are as follows:

Pre-existing Diseases (PED) Waiting Period: At the time of taking health insurance, if the insured has any existing ailments like diabetes, high blood pressure, thyroid, etc., they are called pre-existing diseases. Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 3 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 2 to 3 successful years with the insurer.
Waiting Periods for Specific Ailments/Procedures: There are certain listed ailments & procedures, such as hernia, joint replacement surgery, ENT disorders, osteoporosis, cataract, etc., for which health policies normally have a waiting period of up to 3 years. Any medical expenses resulting from such diseases/ procedures are covered only after the said waiting period is over.
Initial Waiting Period: Almost all health plans have an initial waiting period of 30 days during which no claims are accepted other than claims related to accidental cases.
Critical Illnesses Waiting Period: Regular health insurance plans cover critical diseases after a waiting period of 90 days and reject any claims for such diseases received during this period.
Maternity Benefit Waiting Period: There are several health insurance plans that offer maternity benefits and newborn baby cover only after a waiting period ranging from 3 months to 48 months is over.

Is it Possible to Reduce the Waiting Period in Health Insurance?

Yes, it is possible to reduce the waiting period under a health insurance policy. Some health insurance companies offer an option to reduce the waiting period by opting for a waiting period waiver. However, such waivers can be purchased by paying an extra premium amount. For example, several health insurance plans come with a PED waiver that reduces the waiting period for such diseases from 3 years to 2 years.

Important Points Related to Health Insurance Waiting Period

Take a look at the following important points related to the health insurance waiting period:

If during the waiting period, the insured is diagnosed with a disease for the first time, it will not be called a pre-existing disease. In such a case, the policy will cover such ailment.
Several senior citizen health insurance plans are available where waiting periods can be removed by adding a co-pay clause. A co-payment clause means that the policyholders will have to pay a certain percentage of medical insurance claim amount while the remaining will be paid by the insurer. For example, with a co-pay of 20% in a claim of ₹1 lakh, the policyholder will have to pay ₹20,000. The rest ₹80,00 will be paid by the insurance provider.

To Summarize

Understanding the waiting period in health insurance is crucial, as it directly impacts when you can start availing benefits for certain ailments and conditions. By thoroughly reviewing the terms and opting for plans with shorter waiting periods or waiver options, you can ensure timely coverage without unnecessary delays. So, if you have been planning to invest in a good health insurance plan, do well to check out the plan with the shortest possible waiting period.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

*The values taken for effective cost calculation are indicative values and may change as per the selected plan.

*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

*The scope of coverage may vary from plan to plan.

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