Waiting Period in Health Insurance: A Detailed Guide

Know in-depth about waiting period in health insurance, its types, and application.
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Waiting Period in Health Insurance: A Detailed Guide
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3 mins
20-July-2023

Health insurance has become essential, particularly in today's fast-paced world, where we are increasingly exposed to stress and lifestyle diseases. Health insurance guarantees that you have access to quality healthcare without having to worry about funds. However, when it comes to health insurance plans, it is essential to understand what it entails, including the waiting period.

What is waiting period in health insurance?

A waiting period is the duration that you must wait after purchasing your health insurance plan before you can claim certain benefits. It is a period that an insurance company demands before offering full coverage. During this period, the insurance company does not pay for certain treatments or illnesses. You will have to wait for the waiting period to end before you can claim coverage for it.

What is survival period in health insurance?

Another concept that people often confuse with waiting period in health insurance is the survival period. The survival period is the minimum period that the insured must live after the diagnosis of specific medical conditions. This especially applies for critical illnesses. The insurer pays the sum insured in the policy only after the survival period gets over.

Different types of waiting period in health insurance

Here are different types of waiting period applied to health insurance:

Initial waiting period

When you purchase health insurance, there is an initial waiting period that lasts up to 30 days. During this period, the insurer will not compensate for any claims made by the policyholder. You can make the claims after completing the initial waiting period.

Waiting period for Pre-existing Diseases (PED)

Pre-existing diseases are diseases that you may have before buying health insurance. These include asthma, blood pressure, cholesterol, diabetes, etc. It is important to disclose pre-existing diseases to the insurer when purchasing the plan. The insurance companies generally impose a waiting period of 2-4 years for specific diseases. The insurers start covering the medical expenses incurred for treatments of pre-existing diseases only after the waiting period gets over.

Waiting periods for specific ailments or procedures

Waiting periods also exist for specific illnesses or procedures, such as cataract surgery, bariatric surgery, or hernia, and work similarly. The waiting period for such treatments can vary from one insurance company to another. You should read the policy documents, and the terms and conditions stated on them carefully.

Waiting period for maternity benefit

Most health insurance plans have a waiting period of 9 months to 2 years for maternity benefits. Maternity insurance includes prenatal care, delivery and postnatal care, and other related expenses. You can claim coverage for these benefits only after serving the specified waiting period on the policy.

Waiting period for accidental hospitalisation

In health insurance, the waiting period for accidental hospitalisation is typically minimal, often ranging from 24 to 48 hours. This means policyholders can access coverage for accidental injuries soon after obtaining the policy, ensuring immediate financial support during emergencies.

Waiting period for health check-ups

Health insurance plans may impose a waiting period, usually ranging from 30 to 90 days, before covering the cost of health check-ups. This waiting period helps insurers assess pre-existing conditions and establish a baseline for the insured's health status, allowing for fair and accurate coverage.

Here’s a quick look at the types of waiting period and its duration.

Health conditions

Waiting period levied

Initial waiting period

30-60 days

Pre-existing diseases

Between 30 days and four years, depending on the insurer.

Maternity benefit

Between 9 months and two years, depending on the insurer.

Accidental coverage

Zero waiting period

Specific illnesses

Between one and two years, depending on the insurer.

Difference between survival period and waiting period in health insurance

Here’s a quick look at the difference between survival period and the waiting period in health insurance.

Features

Waiting period

Survival period

Meaning

A duration during which a policyholder cannot claim specific benefits.

The minimum time a policyholder must survive after the diagnosis of the critical illness to claim benefits.

Duration

30 days to four years (depending on the insurer and condition)

Ranges 15-90 days

Policy coverage

You can make claims for treatments specified under waiting period after completing the period.

Policyholders can claim benefits only after surviving the specified period for general illnesses or specific treatments.

Applied to

All types of health insurance policies.

Mostly critical illness policies.


Key points that you must know about waiting period in health insurance

Here are some key points you must note about waiting period in health insurance.

  • Be aware of the waiting periods that apply to your health insurance plan.
  • It is essential to disclose pre-existing illnesses and conditions to your insurance company.
  • The waiting period for pre-existing diseases can last up to four years.
  • Read through your policy documents thoroughly to understand your waiting period.
  • Compare  best health insurance plans from different insurance providers to find plans with zero waiting period or short waiting periods.
  • It is important to choose a health insurance plan that fits your healthcare needs and budget.
  • Consider opting for long-term health insurance plans to avoid the hassle of renewing the policy annually.

The best way to overcome the hassle of waiting period is to buy a health insurance policy at an early age. Many recommend buying health insurance at a younger age because you are less likely to make claims at that age. This not only helps you serve the waiting period smoothly, but also accumulates the cumulative bonus for having claim-free years. You can also look for health insurance policies with a zero waiting period, so your insurer can cover the medical expenses from day one.

Check what is health insurance and its types.

Frequently asked questions

What is a ‘zero waiting period’ in health insurance?

A ‘zero waiting period’ in health insurance refers to a policy type where the insurer starts covering the medical expenses from day one of policy inception. This means that there is no waiting period for any illnesses or treatments covered under the policy.

How does the waiting period in health insurance work?

A waiting period typically applies to pre-existing diseases, maternity benefits, specific ailments, or procedures. During this period, the policyholder cannot make a claim, and the insurer does not pay for these medical expenses. Once the waiting period gets over, the policyholder can claim benefits for the covered treatments or illnesses. It is crucial to read policy documents thoroughly to understand the waiting period clauses.

Is a health insurance claim admissible if a disease is diagnosed during the plan term?

Yes, a health insurance claim is admissible if a disease is diagnosed during the plan term, provided the disease falls under the policy's terms and conditions. However, the claim will be subject to the policy's terms and conditions, including any applicable waiting period.

Can I eliminate waiting period in health insurance policies?

In most cases, it is not possible to eliminate waiting periods in health insurance policies. Waiting periods are a standard feature of health insurance policies and are designed to prevent insurance fraud and misuse. However, some insurance providers offer policies that have reduced waiting periods, depending on the overall health risk profile of the insured.

How to check if my existing ailments are covered in a health insurance plan?

To check if your existing ailments are covered under a particular health insurance plan, you should review the policy terms and conditions carefully. You should also speak to the insurance provider's customer service or sales representative to confirm if any specific conditions are excluded from coverage. Additionally, some health insurance plans require you to undergo a medical examination before issuing the coverage, which can help identify any pre-existing conditions that may affect your coverage.

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