What is Waiting Period in Health Insurance?

The importance of health insurance has increased significantly. Due to rising medical inflation, health insurance has become increasingly important for individuals and families. Approximately 500 to 700 million individuals purchase health insurance in India each year, including both government and private plans. 

However, a claim is sometimes rejected due to a waiting period in health insurance, even when the policy is valid. Many new customers misunderstand and think that insurance starts operating from the moment they purchase a policy. The reality is different: some conditions may not be covered for a specific period, known as a waiting period in health insurance. 

Let’s discuss what a waiting period in health insurance is, the types of waiting periods, how they affect claims, and after how many days health insurance can be claimed.

What is the waiting period in Health Insurance?

It is crucial to understand the essence of a waiting period in health insurance before enrolling in one. The waiting period is a predefined period set by an insurance company during which certain medical expenses are not covered. Even though the insurance policy takes effect immediately after purchase, some of its benefits will not be available until the waiting period elapses.

The purpose of this condition is to prevent exploitation of the health insurance policy and to maintain coverage for all other policyholders. If there were no waiting periods, people could take advantage of the insurance policy as soon as they got sick and claim benefits.

The insured remains unaware of after how many days health insurance can be claimed, which highly depends on the type of waiting period. Once it matures, the real coverage on medical conditions and treatments kicks in.

What is the survival period in health insurance?

The survival period is another aspect that confuses people when it comes to understanding the waiting period in health insurance policies. The insured must survive for a specified period after being diagnosed with a disease. It’s important to know that the survival period applies only to critical illness, and it starts only after you have survived it.

Difference between waiting period and survival period

The difference between the survival period and the waiting period is given below:

Why Do Insurance Companies Impose Waiting Periods?

A waiting period is an effective risk-mitigation tool for insurance companies. Health insurance protects against future financial losses related to health matters, not current ones. Because in many cases, the policyholder applies for a claim to obtain immediate treatment of pre-existing conditions. 

Waiting periods enable effective risk management on the insurer's side. They prevent potential clients from engaging in unethical practices, such as purchasing insurance only to address their immediate health problems. This, in turn, helps ensure that insurance premiums remain low for all policyholders.

How Does a Waiting Period Affect Claims?

Whether the claims are approved or disapproved depends on the waiting period. If a patient is hospitalised for a particular disease during the waiting period, the insurer may not honor the claim, even when the insurance policy is in effect.

For example, if the patient is undergoing cataract treatment during the waiting period, the insurer may reject the claim regardless of whether the policy is active.

Types of Waiting Periods in Health Insurance

All waiting periods are not alike. The health insurance policy generally has several waiting periods, depending on the circumstances and medical conditions covered. Knowledge of these types is necessary for the policyholder to determine their coverage period.

Initial Waiting Period in Health Insurance

The initial waiting period in health insurance is the period following the purchase of a health insurance plan. It lasts for 30 days. During this period, medical illnesses do not entitle one to a claim, whereas accidents requiring hospitalisation still allow coverage. However, an illness, such as a 20-day fever, may not be covered.

Add PBPartners As A Trusted Source

Pre Existing Disease Waiting Period

The pre existing disease waiting period applies to diseases before the purchase of the insurance policy, including diabetes, asthma, and high blood pressure. The insurers generally set a waiting period of 2 to 4 years. For instance, hospitalisation for diabetes might not be covered until the waiting period has expired.

Specific Disease Waiting Period

Some diseases and surgeries have their own waiting periods, even if they are not considered pre-existing conditions. Common examples include cataracts, hernias, piles, and kidney stones, with waiting periods that may range from 1 to 2 years. In such cases, for instance, costs related to cataract surgery will not be paid out by the insurer in the first policy year.

Maternity Waiting Period

While some health insurance schemes offer maternity cover either as part of the basic plan or separately. These benefits help those planning to become parents who are concerned about the cost of maternity care. The waiting period for maternity cover may range from 1 to 3 years. It is important to be aware of the waiting period before opting for such coverage while purchasing a health insurance scheme.

Health Check-Up Waiting Period

Health Check-Up reimbursement is another benefit offered under various health insurance schemes. But this can be availed generally after a 1-year waiting period from the date of plan purchase. 

This kind of waiting period is called the Health Check-Up waiting period. The expense claim for the annual health check-up must be submitted in the second policy year.

COVID-19 Waiting Period

The coronavirus outbreak has shaken the world and affected many people financially, due to the costs of medical treatment. People decided to enrol in COVID-19 health insurance schemes to protect themselves from such an economic predicament.

But buying the scheme without being aware of the COVID-19 waiting period could cost you.

Accidental Hospitalisation Waiting Period

Accidents may occur unexpectedly and cause serious harm, requiring urgent medical treatment. In case of accident-based admission into the hospital, a person can miss out on timely treatment, which in some cases may result in death. 

But it should be noted that the waiting period does not apply to accidents, nor to the initial waiting period for accident admission.

Waiting Period Types

While each type has its respective waiting periods depending on its coverage, here is a quick rundown of the waiting periods and their durations

Can Waiting Periods Be Reduced or Waived?

Yes, indeed. You may choose to reduce your waiting period in health insurance. It all depends on what kind of insurance you choose. Some insurance companies offer reduced waiting periods, but only if you pay a slightly higher premium. The add-ons that come with your basic insurance package allow you to reduce the waiting period. Nonetheless, the waiting period for group health insurance is much shorter than that for individual health insurance.

Tips for Choosing a Health Insurance Policy with Better Waiting Period Terms

Make sure to consider the waiting-period clause in the policy before buying health insurance.

• It is important to disclose all pre-existing conditions to avoid future claim rejection.
• Compare health insurance policies offered by various companies and choose those with shorter waiting periods.
• Check the policy's waiting period clause regarding pre-existing illness, illness, and maternity coverage.
• Select a suitable health insurance policy that meets your medical requirements without making a hole in your pocket. 
• Understanding the different types of health insurance plans can also help you choose a policy with waiting period terms that align with your healthcare needs.
• You can select a health insurance policy that offers long-term coverage rather than short-term coverage.
• Take out a health insurance policy at an early age or one with no waiting periods.
•  

It is essential to understand the waiting period in health insurance if you have decided to purchase one. Although the insurance will start on the very first day, certain illnesses or treatments may be excluded during a waiting period. So, knowing those terms will definitely come in handy, because you need to make sure you are covered.