Reasons To Check the Waiting Period in A Health Insurance Policy

One hospitalisation can mean a substantial medical expense due to the rising cost of healthcare facilities. Health insurance acts as a shield to ensure that one doesn't end up using all his/her savings. But can you buy a health insurance policy and avail the benefits right after learning that you have been diagnosed with an illness? The answer is no because there is a component called the 'waiting period'. At times, claim requests get denied because of this. That's why learning more about what it means for the insurance company and the policyholder is important. Read on to know more.

 

Waiting to get your driver's license, waiting for the board exam results to be declared, or waiting to get promoted in your office… waiting may not be a pleasant experience. But in the world of health insurance, it can be quite necessary. You must have heard about the ‘waiting period’ clause while buying a health insurance plan. But are you aware of its purpose? Many people focus mainly on the inclusions and premiums of the policy but forget to pay attention to this important clause. So, let’s discuss the reasons why you need to assess the waiting period carefully when buying health insurance policies. 

 

What does the waiting period in health insurance mean?

 

The waiting period is the amount of time you need to wait before you can claim the benefits of a health insurance policy. Simply put, if you raise any claim during the waiting period, your insurer is not liable to cover the expenses. For instance, if your healthcare plan has a waiting period of 2 years for pre-existing ailments, you have to wait till the completion of 2 years to make any claim relating to your pre-existing condition. The waiting period varies between insurers. 

 

Types of waiting periods in health insurance

Now that you know what is a waiting period, let us understand the types of waiting periods in health insurance policies :

 

Initial Waiting Period: After purchasing a health insurance policy, you have to wait for a certain period to raise a claim. This is called the initial waiting period or cooling period, which is up to 30 days from the policy start date. During this period, the insurer will not compensate for any claims except in case of an accident; accidents are covered from day one.

 

Waiting Period for Pre-existing Diseases: Pre-existing diseases like diabetes, hypertension, or thyroid are covered after a waiting period of 1-3 years. The IRDAI defines a pre-existing ailment as any disease, ailment, or injury the insured has been diagnosed with 48 months before buying the policy. 

 

Waiting Period for Specific Diseases: There are some specific ailments like osteoporosis, hernia, ENT disorders, joint replacement surgeries, etc., which have a waiting period of 1-2 years.  

 

Maternity Benefit Waiting Period: Most health insurance plans have a waiting period of 9 months to 4 years for maternity benefits. The newborn child is covered up to 90 days of birth. 

 

Waiting Period for Accidental Hospitalisation: There is no waiting period for hospitalisation due to an accident. This means you can claim for expenses incurred for hospitalisation if you meet with an accident, even during the initial waiting period.  

 

Waiting Period for Critical Illnesses: Critical illnesses like stroke, cancer, heart attack, kidney failure, etc., are covered after a waiting period of 90 days. 

 

Waiting period for health check-ups: Many insurance providers offer complimentary health check-ups to the insured and his/her family, but only after one year of policy purchase. This means you can avail of the benefit from the second year of the policy.   

Reasons to check the waiting period in a health insurance policy.

 

It’s important to be aware of the waiting period for several reasons, such as :

 

Avoid Claim Rejection: When you file a claim for treatment without knowing the waiting period of that disease, it will definitely get rejected by the insurer. Looking at the rising healthcare expenses, a single hospitalisation in a reputed hospital can drain your savings. So, it’s crucial that you check the waiting period, and if the treatment is not an emergency, you can wait till the period is completed. This will help prevent claim rejections and serve the purpose of a health plan, which is financial security.  

 

Reduce or Remove the Waiting Period: Some insurers offer the option of reducing the waiting period or waiving it but they charge a higher premium. For instance, if you have a pre-existing disease like diabetes and don’t want to wait for 2-4 years to avail of the coverage benefits, you can choose a pre-existing disease waiting period waiver or shorten the waiting period. 

 

Helpful in senior citizen’s health insurance: Senior citizens, due to their frail health condition and low immunity, may require frequent medical attention and treatments. Moreover, emergencies can occur at any time after a certain age. It’s crucial to check the waiting period for senior citizen healthcare plans or health insurance for parents and choose a plan with a minimal waiting period. A long wait of up to 3 years can hit them hard financially.  

 

Choose the best insurance plan: Before buying a health insurance policy, it’s important to fully understand its terms and conditions, including the waiting periods. The reason is the waiting period differs from insurer to insurer. For instance, specific ailments like hernia, osteoporosis, and joint replacement are covered after 1-2 years of the policy start date. Now, if you understand the waiting period of different insurers, it will help you choose the best insurance plan. 

 

Financial preparedness: When you are aware that all treatments related to a pre-existing ailment like high blood pressure or diabetes will be covered after 3 years, you will be financially prepared for out-of-pocket expenses till the completion of the waiting period.  

 

Plan in advance: Checking the waiting periods helps you make well-informed decisions about your needs. When you know that maternity benefits will be covered after 2-4 years, you can purchase it now if you plan to get married soon or start a family in a few years. The waiting period will be over when you actually need to use the policy benefits. 

 

Facts About Waiting Periods

 

• Buying health insurance early when you are less susceptible to falling sick is a wise option. This is because you are likely to complete the waiting period by the time you want to avail of the policy benefits.
• The waiting period differs for different medical conditions and also between insurers.
• Waiting periods can be waived by paying an additional premium if your insurance provider has the option.
• After buying health insurance, you have to wait for up to 30 days before filing any claim except in case of accidents, which are covered from day 1. 
• Group health plans provided by employers do not have any waiting period.

 

Why is there a waiting period for health insurance?

Waiting periods are mainly imposed to reduce the risk from the insurer’s side. The claim payouts are made from the premiums collected from policyholders and only if the insurer has a corpus fund, it can pay the claim amount. So, the waiting period helps to collect the premium. The second reason is to prevent misuse of the policy or unethical practices by customers to claim insurance benefits. If there's no waiting period, an individual may buy the policy after being diagnosed with a disease and make a claim, expecting the insurer to cover the medical expenses. 

 

Waiting Period vs Survival Period

 

Many people confuse the waiting period with the survival period, but they are not the same. Let’s take a look at the differences:

 

The waiting period is applicable to all healthcare policies, including critical illness insurance plans, but the survival period is applicable only to critical illness plans.

 

The waiting period is the time you have to wait before making a claim for your medical expenses. The survival period is the time you must survive after being diagnosed with any critical illness covered in the policy to avail yourself of the benefits of critical illness insurance. The insurer will provide a lump sum compensation after you survive this period.

 

Waiting periods in a health insurance policy can range between one to three years, depending on the medical conditions and insurer. Survival periods are shorter, ranging between 14 and 30 days, depending on the plan and insurance provider.  

 

Conclusion

Knowing the different waiting periods in a health insurance policy is crucial not only to prevent claim rejections but also to make knowledgeable decisions and safeguard oneself against unforeseen medical expenses. When shopping for health insurance plans for family, don’t forget to check the waiting period along with other policy terms and conditions so that you can choose the best healthcare plan. 

 

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wording and prospectus before concluding the sales.