Waiting Period in Health Insurance - Complete Guide 2024

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

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.

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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.

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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.