What Is The Waiting Period In Health Insurance?

That healthcare expenses are at an all-time high is no hidden secret. Today, a routine visit to a general practitioner costs about ₹800 to ₹1,000. The costs increase when you need hospitalisation for a few days, while long-term hospitalisation can impact your savings. One way to ensure your savings remain untouched is to invest in health insurance. However, you should read all the terms and conditions associated with health insurance policies. One such term is the waiting period. Continue reading to understand health insurance is what is waiting period in health insurance.

What is Health Insurance?

A health insurance policy is a contract between a policyholder and an insurance company. Per the agreement, the insurance company covers your medical costs up to a sum insured mentioned in the policy document. In exchange, the insurer asks you to pay annual premiums and renew your policy yearly to receive uninterrupted coverage. The premium you have to pay depends on the type of mediclaim policy you choose, each of which comes with a different waiting period. Let us understand what is meant by waiting period in health insurance.

What Is Waiting Period In Medical Insurance?

In health insurance, waiting period is the period of time you need to wait before you can start making health insurance claims. If you file a claim during the waiting period, your insurance provider is not liable to approve it. For instance, if you buy a general health insurance policy with a waiting period of two years and need to undergo treatment during this time, you cannot file a claim. 

Different medical insurance policies have different waiting periods. Even within the same policy, various diseases, conditions or treatments can have different waiting periods. Typically, the more critical the illness, the higher the waiting period. That said, insurers allow you to decrease the waiting period by either paying a higher annual premium or purchasing a waiting period reduction rider.

Why Do Health Insurance Policies Have A Waiting Period?

Now that you know what is the waiting period in health insurance, you should understand why it exists. 

Previously, people would often misuse health insurance policies by purchasing them days before a significant medical expense. Insurance companies began adding the waiting period clause in the mediclaim policy terms to reduce such risks. By renewing your policy each year, you can automatically ride out the waiting period and file your insurance claims successfully. 

Types Of Waiting Period In Medical Insurance

Besides knowing what does waiting period mean in health insurance, you should know the various types of waiting periods. They include the following.

• Initial Waiting Period 

An initial waiting period is known as a cooling period. It is the minimum amount of time you need to wait to encash your policy from the policy issuance date. During this time, your insurance company does not accept your insurance claims, whether the claim was made for a planned medical treatment or a medical emergency, barring an accident. The initial waiting period may differ across insurance providers. The minimum initial waiting period is usually one to six months, depending on the insurer.

• Pre-Existing Diseases (PED) Waiting Period

Per the Insurance Regulatory Department and Authority of India (IRDAI), a pre-existing disease is a condition that is either diagnosed or for which you received medical attention 48 months before purchasing the medical insurance policy. Diabetes, high blood pressure, cholesterol, thyroid, asthma, etc., are classified as pre-existing conditions. The health insurance waiting period for pre-existing diseases can range from one to four years. 

Note that you must disclose the necessary information about your pre-existing diseases to your insurance provider while purchasing your insurance plans. Failure to do so can cause insurers to reject your claims and also cancel your policy. Moreover, insurers may blacklist you from ever purchasing health insurance plans. In many cases, insurers may ask you to undergo medical tests to screen for pre-existing conditions. 

• Waiting Period For Maternity Cover 

Delivering a baby, whether via normal delivery or a caesarean section, can be expensive based on factors like the location or hospital type. If you plan to have a baby soon, you can purchase a maternity cover rider under your health insurance plan. Such a rider covers maternity-related expenses like prenatal care, delivery, hospitalisation, post-natal care, etc. Additionally, you can add a new-born cover to take care of the baby’s expenses during the first 90 days.

The waiting period for such coverage in a typical medical insurance plan can range from one to four years. If maternity cover is part of your policy which you have renewed multiple times, the waiting period shouldn’t come in the way of your baby planning. You can consider a maternity add-on rider with lower waiting periods of one to two years by paying a higher premium, which can differ from insurer to insurer. 

• Waiting Period For Accidental Hospitalisation

Health insurance provides coverage for accidental injuries. The coverage pays for medical expenses associated with treating injuries sustained in a road accident. The policy may cover emergency in-patient hospitalisation and ambulance charges. Since accidents can result in loss of life, insurance companies don’t count them as a cover that needs a waiting period. 

Typically, the health insurance waiting period for accidental hospitalisation is waived off, i.e., you can file claims in case of accidents from day one of policy commencement. Ensure you read your policy terms thoroughly, or speak to your insurance provider or agent to clarify concerns pertaining to waiting periods. 

• Waiting Period For Specific Diseases

Certain conditions or illnesses come with specific waiting periods. Conditions like osteoporosis or joint replacement surgery require long-term care. Therefore, insurance companies designate different health insurance waiting periods for such treatments. Depending on the insurer, the disease-specific waiting period can vary from two to four years. 

Health insurance plans may cover conditions of the middle ear, cholesteatoma, septum deviation, nasal polyp, sinusitis, tonsilitis, cataract, glaucoma, etc. Treatment for benign tumours, cysts, polyps, and lumps in the external and internal body parts can also have different waiting periods. Neurodegenerative and psychiatric disorders like Alzheimer’s, Parkinson’s, schizophrenia, and stress-related disorder may also be part of your mediclaim policy. 

• Waiting Period For Covid-19

The Covid-19 pandemic was the worst infection the world has witnessed. The air-borne SARs-CoV-2 virus causes this infectious disease. Most people experience mild to moderate respiratory illness symptoms that you can treat at home with over-the-counter medication. However, people with underlying conditions like diabetes or chronic respiratory diseases are more likely to develop a severe infection. Covid-19 has resulted in millions of deaths across the globe. 

During the pandemic, many insurance companies rolled out Covid-19-specific plans – particularly the Corona Kavach mediclaim policy launched under a mandate by the Indian government. Given the nature of the disease, the health insurance waiting period for this policy has been capped at 30 days. Several insurance companies may also provide a waiting period of as low as seven days. This means you can claim hospitalisation expenses due to Covid-19 seven days after your policy commences.

The virus can also cause health complications of the heart, liver or kidney. Ensure you factor in the waiting period for such ailments before finalising the insurance plan. 

What is Survival Period and How is it Different from Health Insurance Waiting Period?

Besides knowing what is waiting period for health insurance, you should understand what the survival period in insurance policies means. The survival period is defined as the duration you need to survive after being diagnosed with a critical illness. Depending on the insurer, this duration can range from 14 days to six months. Besides the waiting period, you also need to ride out the survival period to file an insurance claim. 

The survival period is primarily associated with critical illnesses like multiple sclerosis, cancer, or major surgeries like organ transplants or coronary artery bypass grafts (CABG). Like all other medical insurance policies, critical illness health insurance also has a waiting period. After it is over, you can claim the entire sum insured amount to pay for various medical and non-medical expenses.

Reducing The Health Insurance Waiting Period

As mentioned earlier, insurers allow you to reduce your policy’s waiting period. Here’s what you can do:

• Select the waiting period waiver add-on

Various insurance providers offer this option that reduces your waiting period. However, you need to pay an additional premium to enjoy this benefit. For instance, a pre-existing disease waiting period waiver may reduce the waiting period from four to two years. That said, insurers cannot provide a complete waiver to protect their financial interests. 

• Utilise group health insurance plan

Employers offer medical insurance to their employees to boost morale and reduce attrition. Such policies are known as group health insurance policies. These policies typically cover employees and their kin, and the employer pays the premium for the same. Group health policies generally do not come with waiting periods, and you can file claims almost instantly. However, when employees leave the organisation, the policy ceases to exist. 

Note that, you may be able to convert the group cover to individual retail policies after leaving the company without having to ride out an additional waiting period. Generally, the scope of coverage in group health insurance plans may not meet your requirements. Therefore, it helps to purchase an additional mediclaim policy. You must also ride out the health insurance waiting period for the new policy purchased.

Waiting Period For Enhancing Your Sum Insured

Inflation can cause medical costs to rise, and your basic insurance plan may not suffice. You can enhance your basic sum insured by opting for a top-up plan at the time of policy renewal. In this case, a fresh waiting period may apply. Assume your existing plan offers a ₹5 Lakh sum insured, and you have ridden out the waiting period. You then decide to purchase an additional plan or a top-up plan of ₹3 Lakh with a one-year waiting period. In such a case, you must wait another year to use the entire sum insured of ₹8 Lakh. 

Waiting Period, Portability & Migration

As a policyholder, you may change your insurance provider via the insurance portability facility. You can transfer your mediclaim policy at the time of renewal. Portability also impacts the health insurance waiting period. According to the IRDAI, if you have fulfilled the waiting period in your existing policy, you can carry forward this benefit even if you change the insurance company. In this case, the new policy’s waiting period should be similar to that of the existing policy. 

However, if the new policy comprises certain diseases, conditions or treatments with more extended waiting periods, you need to fulfil the additional waiting period. 

Assume you have completed the two-year waiting period of your existing health insurance plan. You then decide to port the policy with another insurer, and the policy has a four-year waiting period for maternity cover. Therefore, you must complete the additional two-year health insurance waiting period to cover your maternity expenses.

Conversely, migration of health insurance means you can change policies with your existing insurance provider. The waiting period clause is similar to that of portability. If the existing policy’s waiting period is over, you only need to complete any residual waiting for the new policy.

If you are covered under a family floater or group plan, you need to convert it into an individual health insurance policy. You can then opt for health insurance portability or migration. 

Why is a Health Plan better than Health Insurance?

Traditional Health Insurance generally covers Hospitalization expenses when admitted for over 24 hours. LivLong Health Plan on the contrary covers not just hospitalization expenses (powered by IRDAI approved Insurer) but also expenses around Doctor consultations, lab tests, pharmacy, and more, providing much higher value for money.

Final Note

The waiting period is an essential aspect of health insurance. Ensure you read your policy wordings thoroughly and understand the waiting period you need to ride out before filing an insurance claim. You must also inform the insurer about any pre-existing condition you may have to reduce the chance of claim rejections and being blacklisted. The health insurance waiting period prevents people from misusing the policy and encourages them to buy health insurance early in life.