What Is The Waiting Period In Health Insurance?

Posted on Jun, 2020

Health Insurance provides you with a sense of financial security when you need medical aid. Every policy comes with its own set of terms and conditions regarding renewal, encashment, claim procedures and so on. As such, it is imperative that you read your policy documents carefully before you purchase health insurance. You need to know what is and isn't included in your insurance plan. It also helps to understand the basic jargon related to health insurance as it enables you to decode the policy significantly. One of the most common terminologies you'll find in every health insurance policy is the 'waiting period'. Let's find out what it is, along with the different types of waiting periods.

What is a waiting period in health insurance?

When you buy a health insurance policy, the insurer doesn't offer coverage from the very first day of your policy term. Instead, you are required to wait for a certain period of time before enchasing your health insurance plan and filing a claim. This period is generally known as the 'waiting period' in health insurance. The waiting period may vary depending upon the type of insurance policy you have chosen.

What are the different types of waiting period?

Typically, there are five different types of waiting periods associated with health insurance policies. Here's a look at the various types of waiting periods.

  • 1. Initial waiting period

    After buying a health insurance policy, the standard waiting period is 30 to 90 days. During this time, the insurance provider is not obligated to accept your health insurance claim, in case you need treatment for an ailment or illness. However, the waiting period does not apply if the policyholder needs hospitalisation as a result of an emergency situation, like an accident. In case of accidents, you would be eligible for all the costs associated with hospitalisation, up to the sum insured. Note that the initial waiting period varies from company to company, so it is essential that you consider an insurer offering minimum waiting period while purchasing health insurance.

  • 2. Pre-existing disease waiting period

    If you're suffering from any pre-existing conditions like diabetes, high blood pressure, thyroid, hypertension, etc., then it is mandatory for you to declare these conditions at the time of buying health insurance. The insurer will go through your medical reports and history, and the waiting period will vary from one to four years. The waiting period for pre-existing diseases solely depends on your medical condition and the type of insurer from whom you choose to buy your health insurance plan.

  • 3. Maternity waiting period

    In recent years, a few health insurance providers have started providing maternity benefits with standard health insurance policies. This means that you can file an insurance claim for hospitalisation associated with pregnancy and childbirth. However, maternity waiting periods may differ from one insurance provider to another. Typically, the maternity waiting period could last from anywhere between 9 months to 4 years (48 months).

  • 4. Infant waiting period

    For new-born babies, the waiting period is 90 days which means you can claim coverage after 90 days after the baby is born. However, for the infant to be eligible for coverage, you need to add his/her name in a family floater or group health insurance policy. A few health insurance companies cover the costs associated with vaccines and other necessary expenses related to infants after the waiting period ends.

  • 5. Disease-specific waiting periods

    Most insurance providers include a clause regarding disease-specific waiting periods. This simply means that the waiting period for those diseases is typically higher than for other ailments. For instance, claims against treatments for kidney stone, cataract, hernia, etc., may be filed only after completing the waiting period of two to three years. Similarly, one needs to complete a minimum waiting period of 4 years before becoming eligible and filing a claim for joint or knee replacement surgery.

Important things to note about the waiting period

  • Insurers are obligated to honour your health insurance claims after you complete the waiting period.
  • If a policyholder is diagnosed with a new ailment during the waiting period, then this condition/illness cannot be considered as a pre-existing disease and will be covered under the existing health insurance policy.
  • Insurers have the right to reject your insurance claim if you purchase an insurance policy without declaring your pre-existing conditions. In such a situation, a claim filed for the pre-existing condition will not be honoured by the insurer.

Since the waiting period is an integral part of a health insurance policy, you need to have a thorough understanding of it. Perhaps the most effective way to ensure that the waiting period does not pose a problem to your health insurance needs, is to invest in insurance from an early age. The benefit is that you can easily ride out the waiting period, as you are less averse to health issues when you are younger. If you're still unsure about which health insurance policy is the best one for you, connect with us at Pinc Insurance. At Pinc Insurance, we endeavour to provide you with end-to-end assistance and help you make the right choice. Visit our website to get started!