Waiting Period in Health Insurance

A health insurance policy can be defined as a contract that you and the insurance company sign. As per this contract, the insurer agrees to pay financial compensation to you in the event of a medical emergency in return for payment of premiums from your end. In an insurance policy document, various terms are listed that clarify the coverage provided under the health insurance plan. Under these, a clause related to the waiting period is also mentioned. What is the waiting period, and what is its significance in your health insurance policy experience? Let’s take a deep dive into the same.

What is the Waiting Period in Health Insurance?

The waiting period refers to the duration during which the policyholder cannot raise a claim, despite the policy being active. Only after the specified time span has ended, can a claim be raised. During the waiting period, you may not be able to raise a claim against any disease, even if your insurance policy covers it. You need to pass the requisite waiting period, as per the insurer’s guidelines, to be able to raise a claim. Therefore, when you’re purchasing a health insurance plan, you must know the time you’re supposed to wait before raising a claim. Waiting periods can be found in multiple kinds of insurance policies and are also present in different types as per the health insurance coverage you choose.

Here are different types of waiting periods

Depending on the kind of coverage you choose, you may come across waiting periods of the following types:

Initial waiting period

This refers to the basic waiting period that every insurance policy has, which lasts for about 30 days. This means the policy shall cover no medical benefits for the first 30 days, except for accidental hospitalisation claims.

Waiting period for pre-existing conditions

It is wise to purchase a health insurance policy when you’re young as the chances of you falling sick or contracting a medical condition are less compared to older people. A medical condition, which is already afflicting a person at the time of buying the health insurance policy, is known as a pre-existing disease. Common pre-existing diseases for which waiting periods are common include diabetes, hypertension, thyroid, and so on. In this case, you will be asked by your insurer to wait for a specific period before you can raise a claim to avail of treatment.

Waiting period for maternity benefits

Many health insurance companies have a waiting period before allowing a maternity benefit insurance claim. Depending on the terms and conditions of the company, this same period can range from a few months to a few years. Therefore, always purchase a health insurance plan with maternity coverage in advance. This waiting period may also be applicable for insurance coverage for newborns. *

Group plan waiting period

Most companies offer health coverage to their employees. For the new employee to be able to make a claim, they must wait for a specific period before claiming against the group policy. The waiting period might apply to someone who’s recently joined the company and is serving probation.

Waiting period for specific illnesses

Some health insurance plans may also have specific waiting periods for certain ailments, such as cataracts, hernias, ENT disorders, etc. This waiting period may usually be one to two years long.

Difference between the waiting period and survival period in health insurance

It can be quite natural to get the waiting period and survival period confused with each other. They are both components of health insurance and refer to a period before one can benefit from a claim. However, the similarities end there. The differences between both can be summarised in the following points:

Meaning

The waiting period refers to the time before one can raise a claim for health insurance. On the other hand, the survival period refers to the duration for which the policyholder must survive, after being diagnosed with a critical illness to receive the benefits of the critical illness insurance policy. *

Applicability

The waiting period refers to different coverage aspects, such as pre-existing conditions, maternity coverage, etc., while the survival period applies only to critical illnesses. *

Coverage continuance

The policy coverage continues after the end of the waiting period, allowing coverage for the medical expenses that follow. On the other hand, the insurance provider makes a lump sum pay-out at the end of the survival period. The critical illness policy terminates after the pay-out. *

Other commonly used terms in health insurance

Now that you may be familiar with what a waiting period is, you should also get a strong understanding of other commonly used terms in health insurance:

Top-up covers

Policyholders can purchase top-up covers to increase coverage as required. At times, the base plan may not have an adequate sum insured or the sum insured after a few years is starting to fall short considering the current treatment costs. This is when you require a top-up health insurance plan. These plans can also be opted for as a standalone cover. *

Coverage provided

Coverage is the financial support that the insurance company provides you with upon purchase of the health plan. You can raise a claim in the case of emergencies and receive coverage for the sum insured. The amount of sum insured will then decide the premium amount. *

List of inclusions & exclusions

One must go through the policy documents carefully before buying the plan and peruse the list of inclusions and exclusions. If your insurance provider does not cover a certain disease and you file a claim for it, your claim will be rejected. *

Claim

In order to receive payment for treatment, you will need to notify the insurance company. This process is also known as raising a claim with your insurer. The compensation can be availed through the reimbursement process or via the hassle-free cashless option. Analyse your requirements and then go ahead with buying a health insurance policy that meets your needs. Know and understand all the above-mentioned basic terms to gain more knowledge about your policy and choose the best one. *

FAQs

1. Why should one choose a policy with a short waiting period?

A shorter waiting period helps you receive coverage within a short period of time after buying the policy. A long waiting period can be disadvantageous since you are uncovered against medical emergencies for that time despite having insurance coverage.

2. Do critical illness insurance plans have waiting periods too?

Yes, apart from the survival period aspect, a critical illness insurance plan has a waiting period, too. As with regular health plans, the waiting period of a CI insurance plan also refers to the time period before the coverage begins.

3. Can I raise a claim during the waiting period?

No, you cannot raise a claim for medical treatments during the waiting period, except in cases of accidental hospitalization, which may be covered immediately.

4. What happens if I don’t meet the waiting period requirements?

If you attempt to file a claim before the waiting period ends, your insurer will likely reject the claim, and you will need to wait until the period expires to be eligible for coverage.

5. Can I switch health insurance policies without resetting my waiting period?

Some insurers may allow you to carry forward your waiting period if you switch plans, but this depends on the terms and conditions of both the new and old insurance providers. Always confirm this before making a change. * Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.