Waiting Period in Health Insurance - Complete Guide 2024

By Okbima 25 Jan 2024
waiting-period-in-health-insurance

 

A waiting period in health insurance is a specific period of time that a policyholder must wait before certain benefits can be claimed under a health insurance plan in India. It is usually imposed for pre-existing conditions or specific treatments. 

 

What is the Waiting Period in Health Insurance?

Waiting Period in health insurance is like a waiting time before certain health conditions are covered by your insurance. It's also called a cooling period. This waiting period starts when your insurance policy begins. For example, if there's a 4-year waiting period for pre-existing conditions, it means those conditions won't be covered for the first 4 years of your policy.

If you make a claim before this waiting period is over, the insurance company can say no to your claim. However once the waiting period is done, they can't reject your claim for those specific conditions. For instance, if the waiting time for a particular health issue is 90 days, and you make a claim in the first 60 days, the insurance company can reject it. However, if you wait for more than 90 days and then make a claim, they can't deny it.

 

What is the Survival Period in Health Insurance?

The survival period in health insurance refers to the waiting time that you must endure after buying a policy before certain benefits become available. During this period, if you develop an illness or have a pre-existing condition, the insurance may not cover the related expenses. 

It's like a health cover waiting period to make sure you don't buy insurance only when you already know you need medical care. Once the survival period is over, your coverage becomes active for all applicable conditions.

 

Types of Waiting Period in Health Insurance

There are various types of waiting periods, including the initial waiting period, pre-existing condition waiting period, waiting periods for specific procedures or treatments, and more.

  1. Pre-existing Diseases (PED) Waiting Period: If you have existing health issues like diabetes or high blood pressure when you get health insurance, they're called pre-existing diseases. Most plans cover these conditions after a waiting period, usually 2 to 4 years. This means you can claim expenses related to these ailments only after 2 to 4 years with the insurer.

  2. Waiting Periods for Specific Ailments/Procedures: Some health insurance plans have waiting periods for certain listed ailments or procedures, such as ENT disorders, hernia, joint replacement surgery, etc. This waiting period is typically one or two years. You can claim expenses for these conditions only after the waiting period is over.

  3. Initial Waiting Period: The initial waiting period for most health insurance plans typically lasts for one month or 30 days. During this period, claims are not processed, with the exception of accidental cases. After this period, regular claims can be made.

  4. Critical Illnesses Waiting Period: Regular health insurance plans cover critical diseases, but there's a waiting period of 90 days. Claims for such diseases are rejected if submitted during this 90-day waiting period

  5. Maternity Benefit Waiting Period: Some health insurance plans offer maternity benefits, but you can only claim them after a waiting period, which can range from 9 months to 36 months. This waiting period applies to maternity-related expenses and newborn baby coverage.

 

Difference Between Survival Period and Waiting Period in Health Insurance

The survival period and waiting period are two important terms in health insurance that may sound similar but have different meanings

Criterion

Survival Period

Waiting Period

Applicable for

Critical illness policies.

All types of health insurance policies.

What is it?

The policyholder must survive a predetermined time period after being diagnosed with a critical illness in order to receive the claim amount in one lump sum.

The amount of time it takes for the policyholder to file a claim against the policy.

What’s the time period?

14 - 180 days

During the initial waiting period of 0 to 30 days, and for pre-existing diseases, the waiting period extends from 0 to 3 years.

Factors affecting the time period

Waiting periods for initial phase and pre-existing diseases vary depending on the critical illness and insurance provider's policies.

Depends on the disease and the insurance provider

Continuity of the coverage

Ends after the single, one-time payment of the insured amount.

After the designated waiting period, individuals can maintain their coverage by consistently paying their premiums.

 

Which Insurance Has No Waiting Period?

There are several types of policies with zero waiting period health insurance like Aditya Birla Activ Health Platinum Plan, Care Supreme Plan with Instant Cover, HDFC ERGO Energy Health Insurance Plan, and many more.

 

Health Insurance Plans with No Waiting Period

Sum Insured

Pre-Existing Diseases (PED) with Zero Waiting Period

 

Aditya Birla Activ Health Platinum Plan

Rs 50,000 to Rs 2 crore

  1. Diabetes

  2. High blood pressure

  3. High cholesterol

  4. Asthma

Get a Quote

Care Supreme Plan with Instant Cover

Rs 5 lakh, 7 lakh, 10 lakh and 15 lakh

  1. Diabetes

  2. Asthma

  3. High blood pressure

  4. Hyperlipidemia

Get a Quote

HDFC ERGO Energy Health Insurance Plan

Rs 2 lakh to Rs 50 lakh

  1. Type 1 diabetes

  2. Type 2 diabetes mellitus

  3. High blood pressure

  4. Impaired Fasting Glucose (IFG)

  5. Impaired Glucose Tolerance (IGT)

Get a Quote

Niva Bupa ReAssure 2.0 Plan with Smart Health+

Rs 3 lakh to Rs 1 crore

  1. High blood pressure

  2. Diabetes

Get a Quote

Star Diabetes Safe Insurance Plan

Rs 3 lakh, 4 lakh, 5 lakh and 10 lakh

  1. Diabetes

Get a Quote

Universal Sompo A Plus Plan - Diamond

Rs 3 lakh to Rs 1 crore

  1. Diabetes

  2. High blood pressure

Get a Quot

Don't Wait Until It's Too Late. Buy the Best Health Insurance Plan!

 

Is it Possible to Reduce the Waiting Period?

Yes, it is possible to reduce the waiting period for health insurance policy through certain options such as waiting period waiver, and buying a group health plans.

Waiting Period Waiver

Some insurance companies allow policyholders to reduce the waiting period by opting for a waiting period waiver. However, this usually involves paying an extra premium. For instance, there are health insurance plans that offer a Pre-existing Disease (PED) waiver, reducing the waiting period for such conditions from, let's say, 4 years to 2 years.

 

Group Health Plans

Group health plans offered by employers to employees often do not have waiting periods. Additionally, employees may have the option to get an individual health policy without a waiting period by converting their group health plan to an individual plan. According to IRDA guidelines, when employees leave their employer, they can convert their group cover to an individual retail health policy. 

In such cases, they receive a policy without a waiting period, as they have already completed the waiting period during the time they were covered under the group health plan provided by their employer.

 

Important Points Related to Health Insurance Waiting Period

Health insurance waiting periods are an important aspect to consider when purchasing a health insurance policy. It is crucial to understand the waiting periods before signing a health insurance contract to ensure coverage when needed.

First-Time Diagnosis during the Waiting Period

If the insured is diagnosed with a disease for the first time during the waiting period, it won't be considered a pre-existing disease. The policy will cover the expenses related to such a newly diagnosed ailment.

 

Health Insurance Plans for Senior Citizens

Today, there are health insurance plans specifically designed for senior citizens where waiting periods are eliminated by incorporating a co-pay clause. Co-pay means that policyholders need to bear a certain percentage of claim amounts, while the remaining portion is covered by the insurance provider. For example, with a co-pay of 30% on a claim of Rs 1 lakh, the policyholder would pay Rs 30,000, and the insurance company would cover the rest.

 

Consideration of Waiting Periods

When choosing a health insurance plan, it's advisable to check the waiting periods. Plans with shorter waiting periods can be beneficial, especially if you have specific health needs or concerns.

Get Covered Today. Buy the Best Health Insurance Plan!

 

Conclusion 

In conclusion, the waiting period in health insurance is a necessary measure implemented by insurance companies to prevent people from taking advantage of the system. While it may be frustrating for individuals who require immediate medical attention, the waiting period ensures that insurance companies do not face adverse selection, where only those who are already in need of medical care sign up for coverage. However, you should consult with okbima experts before buying a best health insurance plan to make an informed decision.

 

FAQs

Can I raise a claim during the waiting period for health insurance?

No, typically, you cannot raise a claim during the waiting period for health insurance. Waiting periods exist to prevent immediate claims and ensure policy stability.

 

What is the benefit of a lower waiting period in health insurance?

A lower waiting period in health insurance provides quicker access to coverage benefits. It reduces the time you must wait before making claims for specific medical treatments or pre-existing conditions.

 

Why is there a waiting period for health insurance?

Waiting periods in health insurance are designed to prevent fraud and ensure that individuals do not purchase coverage solely for imminent, known medical needs.

 

How to check if my existing health conditions are covered by my health insurance policy?

Review policy documents, contact insurer's customer service, inquire about specific conditions, and understand coverage details for existing health conditions.

 

What is the waiting period for mediclaim policy?

Waiting periods vary. Check policy details for specifics on pre-existing conditions, initial waiting periods, and specific coverage waiting periods.

 

What is the waiting period for mediclaim policy?

Waiting periods differ among policies. Consult your mediclaim policy documents for details on pre-existing conditions, initial waiting periods, and specific coverage waiting periods.

 

What is the meaning of the waiting period?

Waiting period is the span between policy inception and when certain coverages, like pre-existing conditions, become eligible for claims.

 

What is 9 months waiting period in health insurance?

A 9-month waiting period in health insurance typically refers to the duration before coverage for maternity-related expenses becomes effective.

 

Can I claim health insurance after 1 month?

Coverage details vary. Some health insurance policies have waiting periods. Check your policy documents or contact the insurer for specifics.

 

What is the longest waiting period for health insurance?

Waiting periods in health insurance vary. Some policies may have longer waiting periods, especially for pre-existing conditions. Check policy details.

 

How can I reduce my waiting period for health insurance?

Reducing waiting periods depends on the insurer's policies. Consider policies with shorter waiting periods or inquire about options for adjustments.

 

Can I buy health insurance and claim immediately?

Most health insurance policies have waiting periods before certain coverages become active. Immediate claims may not be possible; check policy details.

 

Which health insurance gives immediate coverage?

Immediate coverage depends on the insurance policy. Some short-term plans may offer quicker coverage, but they might have limitations. Check policies carefully.

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