All You Need To Know About Waiting Periods In Health Insurance

Health Insurance

Are you among the ones who want some clarity on waiting periods in health insurance? If you are buying a health insurance policy for the first time, you might not be aware of different types of waiting periods, their duration, and what they mean.

Read away everything you need to know about waiting periods in health insurance plans in India.

Waiting period in health insurance

Waiting period is one of the most important terms you must understand before buying health insurance plans in India. You need to wait for a specific period before you can use the benefits of most policies. The waiting period is the amount of time you are required to wait. It is calculated from the policy start date. 

Health insurance plans come with varying waiting periods for different coverages. Waiting periods may vary from insurer to insurer. For a comprehensive health insurance policy, the waiting period is a fixed period in which you cannot avail coverage or certain benefits. Only after you serve the waiting period, can the coverage for that specific condition be availed. Insurance companies put waiting periods to avoid any misuse of the policy for pre-existing diseases.

For example, if you have a maternity cover benefit, you need to wait for 2-4 years before actually benefiting from it. You are required to have your policy for at least two years before you can use it.

Types of waiting periods

While there are waiting periods in most policies, there is no waiting period on hospitalisation in case of an accident. Once the policy gets issued, a claim for hospitalisation because of an accident can be filed on the very next day. 

Many insurance companies have in place a two-year waiting period on illnesses like hernia, cataract, and knee replacement. These illnesses are slow-growing, and hence they attract waiting periods for all insurance plans.

There are many types of waiting periods for most health insurance policies. Let us have a broad look at different types of waiting periods, their implication, and the industry average. 

Initial waiting period

A new comprehensive health insurance plan in India comes with a waiting period of 30 days. You have to serve the 30-day waiting period before you file a claim for hospitalisation. This is termed as the initial waiting period for a health insurance policy.  

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An initial waiting period is also known as the cooling period. It is the amount of time one has to wait for from the date of policy issuance to start using health insurance policy and start benefiting from it.

As a standard, all health insurance plans in India today have a waiting period of up to one month. However, the 30-day waiting period doesn’t apply to claims related to accidental hospitalisation.

Waiting period for specific diseases

Under the waiting period for specific diseases, you are required to wait for a particular amount of time before claiming for treatment and hospitalisation for specific diseases. Generally, the waiting period for specific diseases is two to four years.

Maternity benefit and newborn baby cover waiting period

Along with most health insurance plans for individuals and families, you can include an add-on of maternity benefit and newborn baby cover. For those who are planning a family shortly, it is wise to also plan for the financial expenses arising during and post-labour.

The waiting period for maternity benefit and newborn baby cover ranges from one to four years. You can claim maternity-related expenses only after completing the waiting period as per your policy. Consider the 9-month pregnancy term in the waiting period as well.

The maternity benefit covers delivery expenses, the baby for the first 90 days, and necessary vaccinations apart from any other medical care required.

Pre-existing diseases waiting period

As per the IRDAI, any condition, ailment, injury or disease diagnosed up to 48 months before buying a health insurance policy is termed as a pre-existing disease. Critical illness insurance covers pre-existing diseases. 

Most insurance companies in India apply a waiting period on pre-existing diseases in critical illness insurance. While purchasing a health insurance plan, companies ask if you have any pre-existing conditions like hypertension, diabetes, kidney-related diseases or any other disease that requires continuous medication. For such pre-existing conditions, companies apply a waiting period of 12 to 48 months from the policy issuance date.

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Note that some illnesses fall under the permanent exclusion category. No insurer provides cover for illnesses like HIV, cosmetic surgeries, hepatitis B, and malignant Neoplasms. 

Again, you can reduce the waiting period of any particular ailment by paying a little extra. Also, if you have served the waiting period and are porting your policy to a different insurer, no fresh waiting period is applied. Generally, the waiting period for pre-existing diseases is three to four years.

Accidental Hospitalisation Waiting Period

Accidents cause the most unexpected injuries and related medical concerns. Thus, given the nature of accidents, all health insurers do not have in place any waiting period for accidental hospitalisations. One can claim for accidental hospitalisations just days after buying their new health insurance policy.

Waiting Period for Bariatric Surgery

Bariatric surgery is included in health insurance policies nowadays. It is a surgery done on the stomach or the intestines to help individuals with extreme obesity-related issues. Bariatric surgery can have a waiting period of 2 years.

Complimentary Annual Health Checkup Waiting Period

Many health insurance policies also offer complimentary annual health checkups as a part of the health insurance plan. However, a small waiting period is required for this as well. The waiting period to avail annual health checkups can be around one year. Thus, you can get the benefit of free yearly health checkups from the second year of your policy.

Waiting Period for Coronavirus

With the cases still rising and the number striking up post-Diwali, many people are buying corona-specific health insurance policies to get covered in trying times. Most insurance companies offering cover for Corona have in place in-built waiting periods. Almost all plans come with a waiting period of 30 days. 

In the latest circular by IRDAI, it has said that when a Corona policy is renewed, an additional waiting period of 15 days would not be imposed and the coverage would be continued seamlessly.

One Reply to “All You Need To Know About Waiting Periods In Health Insurance”

  1. beautifully crafted thanks for sharing an article on health insurance. Much needed information in such times.

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