Waiting Period In Health Insurance

What is Waiting Period in Health Insurance?

A Waiting Period in Health Insurance 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. 

What is the Survival Period in Health Insurance?

The survival period in health insurance (specifically in critical illness policies) is defined as the minimum amount of time a policyholder must stay alive after being diagnosed with a covered critical illness, such as, cancer, heart attack, or kidney failure to receive the lump sum payout from the insurer.

Understanding the Difference Between Survival Period and the Waiting Period in Health Insurance

Waiting period and survival period is often confused among the insurers, so here is a table that well explains the difference between survival period and waiting period. When choosing a health insurance plan, consider these factors to reduce these periods:

Why does insurance have waiting periods? 

Insurance companies have waiting periods to prevent fraud, manage risk, and review health and other factors. 

The duration of  waiting period for health insurance can significantly affect individuals financial planning. For example, individuals who are planning elective surgeries or maternity care, must account for these timelines to avoid out-of-pocket expenses. Early enrollment is necessary, starting a policy years before major health needs arise makes sure that you have served the waiting period when coverage is needed most.

What does waiting period mean for insurance?

A waiting period in insurance is the period following purchasing a policy when the insured has to wait before some or all coverage takes effect. The insurance waiting periods depend on the policy type. Understanding the medical insurance waiting period definition will help understand the effect of the waiting period in a policy.

Why Do Health Insurance Policies Have Waiting Periods?

Waiting periods are not arbitrary. They serve valuable purposes for both the insurers and the policyholders. Here’s why insurers implement them:

• Risk Management: Insurers impose waiting periods to dissuade individuals from purchasing policies at a time when they are certain that they'll be needing medical treatment promptly. It acts as a safeguard for insurance providers against sudden, potentially costly claims.
• Prevention of Misuse: Without a waiting period, one can purchase coverage upon developing an illness, raise a claim for the treatment costs, receive payment, and drop the policy.
• Premium Stabilisation: Waiting periods allow insurers to offer competitive premiums without raising prices for all.

Alternatively, waiting periods help keep the policy at an optimal price, enabling consumers to gain coverage for an amount within their budget.

Types of Waiting Periods

How does health insurance with a waiting period work? 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. 

Some insurers provide individuals  with zero initial waiting periods for specific groups (for example, younger people or corporate plans). It is recommended to always compare different policies to find such benefits. Remember, the waiting period in health insurance can differ by insurer, so scrutinize policy documents before buying. 

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 36 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, and 36 months, depending on the Health Insurance Policy opted for.

Beyond paying extra to shorten PED waiting periods, consider insurers with loyalty rewards. Some reduce waiting periods by 50% for renewing customers. For example, a 36-month waiting period for health insurance might drop to 18 months if you renew with the same insurer.

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. 

Disease-specific waits can be bypassed with critical illness riders. These paid add-ons cover conditions such as cancer immediately, even if the base policy imposes a waiting period in health insurance for such ailments.

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.

Some health plans offer maternity benefits. Waiting Periods for the same can range from 2 to 3 years. If you are somebody who is planning a family soon, opt for group insurance (employer/spouse plans) with shorter maternity waits. Some group policies have a waiting period of  9 to 12 months for health insurance, making them perfect for newlyweds or young parents.

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.

How Does the Waiting Period in Health Insurance Work?

A waiting period in health insurance is a particular duration following policy activation during which some benefits are not yet available. Basically, it's time you need to wait before you can claim for certain conditions or treatments. It's instituted to control risk for the insurance company, so people aren't making claims immediately for existing conditions or new disease.

What to Expect If You File a Claim Before the Waiting Period Ends?

Trying to file a claim during the waiting period for health insurance often leads to confusion or disappointment. Here's what usually happens:

• Most Claims are Denied: If the condition you’re claiming falls under the waiting clause, the insurer will reject the request, and no cashless treatment or reimbursement will be offered.
• Limited Exceptions Apply: Some other unrelated ailments can be covered to some extent. For example, if you are hospitalised from an accident within a maternity waiting period, then that treatment would still be allowed.
• Accidents are covered right from day one: Almost every health insurer covers accidents right from day one, even though you might be within the initial waiting period. Such cases are usually exempted from waiting provisions because they constitute emergencies.

Understanding your policy terms, and in particular, the duration of your health insurance waiting period, can prevent denied claims and help you better plan your coverage.

How Can You Minimise or Avoid Waiting Periods?

The waiting period in health insurance may appear to be an irritating obstacle, but there are smart ways to reduce or even avoid it in some cases:

1. Select Zero Waiting Period Health Insurance Plans: Certain insurance providers offer zero-waiting-period health insurance policies, under which certain conditions or pre-existing illnesses are covered right from the start. Although they are costlier, these policies are particularly helpful for individuals who require immediate coverage or senior citizens.
2. Buy Health Insurance Early: If you buy the plan when you are healthy and young, you will likely complete the full health insurance waiting period without claiming anything. Just keep renewing the policy timely to ensure that you get coverage when needed the most.
3. Port to a Better Plan: If your existing policy is one with a long waiting period, you can port to a new health insurer with more favourable terms. Insurers usually respect the time you have already served, particularly if you switch at renewal and follow the proper procedure.
4. Rely on Group Health Insurance: Employer-provided group health plans often come with no waiting period for health insurance. Such plans offer quick coverage, but they may not have the desired kind of protection that you will need when you retire or after your company tenure.
    

Knowing the health insurance waiting period is as critical as understanding your sum insured or policy details. Whether it is a blanket 30-day waiting period, a multi-year exclusion for pre-existing conditions, or maternity-related restrictions, waiting periods greatly influence how and when your policy can help you.

Having a good insurer also counts. Reputable insurance companies like Star Health Insurance provide diversified packages with easily discernible waiting periods and even add-ons to reduce the time period before one can get coverage for pre-existing diseases.

As always, carefully read your policy paper, ask questions, and consider your current health needs before deciding on a plan.
 

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.