Waiting Period in Health Insurance

What is a Waiting Period in Health Insurance?

The waiting period refers to the duration during which certain benefits or coverage are not available under your health insurance policy. Essentially, it is a period you must wait after your policy's start date before you can claim benefits for those particular situations. 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 health insurance claim with the insurer before the expiry of the waiting period, the insurer can reject the claim. However, if the policyholder raises a claim after the completion of the waiting period, health insurance companies 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 mediclaim 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 (PEDs). Almost all medical insurance plans cover PEDs after a waiting period of usually 2 to 3 years. This implies that any hospitalisation expenses related to the declared illnesses 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 insurance 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 mediclaim 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 plans that offer maternity insurance benefits and newborn baby coverage 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 medical insurance policy. Some health insurance companies offer an option to reduce the waiting period by opting for a waiting period waiver add-on. However, such add-ons can be purchased by paying an extra health insurance 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.

Cooling Off Period in Health Insurance

Many people mistake the cooling-off period with the waiting period, but they are different. Here's what the cooling-off period in health insurance means.

The cooling-off period is the duration after recovering from a medical condition during which a person must wait before purchasing a mediclaim policy. Insurance companies use this period to assess the risk of recurrence before providing medical coverage.

For example, if a person has recently recovered from cancer, insurers may impose a cooling-off period ranging from a few days to a couple of months, depending on the condition and the insurer's policy. During this time, the person cannot buy a new policy or may have to undergo additional medical tests before the insurer decides on coverage terms.

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 under which 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 the 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.
• When switching insurers, the waiting period already served may be credited to the new policy, as per the Insurance Regulatory and Development Authority of India (IRDAI) guidelines.
• Different insurers and policies have varying waiting periods for specific coverages.
• Always check the policy documents to understand the exact waiting periods before purchasing health insurance.