How does Health Insurance with a Waiting Period work?

Waiting Period in Health Insurance

A Waiting Period is a certain pre-mentioned time where the Insured has to wait for a specific duration in order to make a claim under the Health Insurance Policy. However, this Waiting Period will not apply to accidental /traumatic injuries requiring more than 24 hours of hospitalisation.

The Waiting Period in a Health Insurance Policy may vary based on the type of Health Insurance Policy chosen by the Policyholder and the Insurance company providing the Policy. 

Types of Waiting Periods

Let us understand the different types of Waiting Periods.

First 30 days Waiting Period

Initial Waiting Period, or the cooling period, refers to the specific number of days the insured is required to wait to receive any claim benefit under the Policy. The initial Health Insurance Waiting Period will be the first 30 days from the inception of the Policy.

Pre-Existing Diseases (PEDs) Waiting Period

When you buy a Health Insurance plan, you need to disclose any pre Existing Diseases (PEDs) or health conditions.

Pre-existing diseases/conditions refer to any condition, ailment, injury or disease that is diagnosed by a physician and is on treatment within 48 months prior to the effective date of the Policy issued by the insurer. Some of the pre-existing ailments include Diabetes, Thyroid, Hypertension, heart disease, kidney disease, etc. 

If you are suffering from such PEDs, then you need to complete the PED waiting period applicable for the Policy to avail the coverage for the treatment expenses.

That is before the Waiting Period ends, you cannot claim any hospitalisation or treatment expenses incurred for such pre-existing conditions. This period can last for 6,12,24,36 and 48 months, depending on the Health Insurance Policy opted for.

Disease-specific Waiting Period

Some diseases like Osteoporosis, Hernia, Cataract, kidney stone, few ENT-related disorders have specific Waiting Period to offer coverage. This list may vary from one insurer to another. Make sure to check the list of specific diseases provided in the Policy clause. The disease-specific Waiting Periods are usually 24 months and may vary from insurer to insurer. 

Waiting Period for maternity expenses

Not all Health Insurance policies cover maternity expenses in their policies. But some health policies allow you to get benefits for maternity expenses too.

However, Insurance companies levy a Waiting Period before you can make a claim for maternity expenses under your Health Insurance plan.

Some health plans offer maternity benefits. Waiting Periods for the same can range from 2 to 3 years. After completing the Waiting Period, you can claim maternity benefits on your Health Insurance plan.

Waiting Period for accidental hospitalisation expenses

There is no Waiting Period in your Health Insurance plan for accidental hospitalisation. The coverage for treatment expenses for accidental injuries starts from day 1 of the Policy commencement.

The initial Waiting Period of your Health cover is not applicable in case you meet with an accident. 

The insured can opt for the Buyback of Pre Existing Disease by paying an additional premium for the first year of the Policy. The Waiting Period will be reduced from 36 months to 12 months for the declared Pre-existing disease, subject to approval from the Underwriter.

However, this reduction of the Waiting Period will not be applicable for specified 2 years Waiting Period diseases/ conditions.

Conclusion

Overall, the Waiting Period in a Health Insurance Policy depends on the type of Health Insurance opted by the Policyholder.

Hence, it is wise to check the Policy clause and wordings and choose a plan with a minimum Waiting Period.

And it is always advisable to invest in a Health Insurance plan when you are young, that is, at the peak of good health. This means you can easily pass the Waiting Period without requiring insurance coverage.

As your age advances, you would have already crossed the Waiting Period and would be eligible for availing the Policy benefits.

Star Health Insurance offers a range of Health Insurance Plans which cover the medical expenditure of the Policyholders after certain Waiting Periods. To know the details on the Waiting Period of the Health Insurance Policy, please refer to the Policy wording and clause.