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Waiting Period In Health Insurance- An In-Depth Compendium

With the progress of time, the human body develops an affinity towards particular diseases. This usually takes place because of this fast track life and junk food consumption. Due to this, there is a major increase in the health insurance policy to sort things out immediately. Therefore, making a sound health insurance plan should be your topmost priority.

In this regard, Waiting Period comes into play. It is basically a short time gap before the chosen lust of ailments starts getting effective under the realm of the granted policy. In almost all the major insurance policies, for pre-existing or chronic diseases Waiting Period is generally taken as 4 years.

This is beneficial for the policyholder since the concerned agency will not claim after 4 years. So let’s begin this write-up with the concept of the waiting period.

Different Types of Waiting Period in Health Insurance

There are various sorts of the waiting period under the health insurance plans

Initial Waiting Period

During the time of health insurance policy, if an individual declares about some chronic hazards like diabetes, high BP, etc then these are considered as pre-existing diseases. The majority of the insurance agencies provide an initial period ranging from 30-60 days.

This is owing to the fact that any disease which pops up during that time frame is not eligible for payment except the inevitable circumstances like an accident. The restriction is imposed to make people refrain from endorsing such policies after the diagnosis of the disease.

Pre-Existing Condition Exclusion Waiting Period

A pre-existing condition exclusion period is a particular time gap which includes those individuals who already have a problem for six months before enlisting the name under such a scheme.

This kind of waiting period implies that the insurance coverage is restricted or excluded from the earlier conditions. The span of this waiting period will vary from 1 to 2 years. As a result, the pre-existing waiting period becomes only effective after the time-frame.

Maternity Waiting Period or Waiting Period for Pregnancy

You can avail of maternity benefits if you get yourself covered under health insurance policies. But the majority of them come with a waiting period varying from 9 to 48 months. This implies that health insurance plans should be framed well in advance before you start making the family plan. It will cover all the costs under the schemes and are not liable for return after conceiving.

Disease-specific Waiting Period

There are particular diseases along with ailments such as a tumor, ENT, disorder, etc which generally provides a waiting period varying from one to two years. However, you will get to know the waiting period of each of these ailments if you go through the policy details. Moreover, the different health problems or ailments that account for such waiting period varies from person to person.

Therefore, the disease-oriented full proof plan can cover all such diseases comprising of diabetes, cancer, kidney problems, cardiac ailments, and many more.

Waiting Period in Health Insurance

The clause of the waiting period executed in health insurance with the sole purpose of negating the wrong motive of the person to extract money available under the insurance plan. There are certain cases where the person has no health insurance after being diagnosed with a disease claimed for medical benefits without revealing the ailment to the insurer.

This practice of taking unfair means and showing fake documents in order to avail such benefits is in vogue. In order to avoid such discrepancies, this idea of a waiting period is introduced in a health insurance scheme.

The Requirement of The Waiting Period in Health Insurance Policy

There are manifold scenarios when the customers look for a health insurance policy to avail of such medical benefits and necessary reimbursements. To prevent fraudulent activities in the name of medical insurance, this waiting period concept is implemented.

Suppose there is a scenario when the patient is diagnosed with a critical disease but he has not done the insurance. The doctor asked him to go for surgery which is quite costly and if he wants to spend his savings, it will create a big gap. Under such situations, a patient always seeks for health insurance schemes by showing fake documents.

It might happen he/she gone through the surgery just after buying the policy. Therefore, to negate such illegal activities, this concept of waiting period came into existence.

Important Points About Waiting Period Covered Under Health Insurance

  • The waiting period is not effective under a group health insurance scheme.
  • The clause for the particular waiting period must be read properly before you go ahead and take the decision of buying.
  • If you are diagnosed with a particular disease for the first time during that particular period, then it comes under pre-existing disease.
  • Go through the fine print thoroughly in regards to the waiting period clause to negate any sort of surprises during the claim stage.

The waiting period covered under the health insurance scheme is governed by certain parameters such as type of health insurance, individual health insurance, medical benefits of the person, buyer’s age, etc.

Henceforth, we suggest you go through the exact clauses which come under such policy at least once and select the less waiting period. This will help you to enjoy such a health insurance policy instead of availing such medical influences from your hard-earned money.

Is it Possible to Minimize the Waiting Period?

  • Certain organizations come with an option to minimize the waiting period by purchasing a surplus premium.
  • Generally, in group health schemes provided by the employer to the employees, insurance organizations don’t put an extra burden on waiting periods for getting medical benefits.
  • On the basis of the IRDA norms, employees who are a part of the group health plan as provided by the employers can easily change the group cover into individual retail health policy. They will be benefited from a policy without a waiting period since they have spent enough waiting time in the group health which comes from the respective employers.

Why Does Waiting Period Exist?

There are several reasons due to which the waiting period exists. They are here to safeguard the insurance company so that they perform a proper investigation of the information given. It permits the company to take part in a claim that takes place during this period. Meanwhile, it provides a small payout as compared to the total benefit made from the policy.

It is noted as a suicide when it comes to providing benefits in most of the situations. This waiting period mostly diverts those who examine suicide to endorse his/her name under the health insurance policy.

Moreover, it gives you time for a thorough investigation if there is strife in regards to the policy holder’s death. There are certain situations when it comes very difficult to figure if the actual case is a suicide or an accident based on certain circumstances.

Apart from this, it also safeguards the insurance company if adequate information is not put forward during the application process.

Suppose, if they don’t ask you about the past record of any chronic disease, then you are not supposed to provide the relevant information while applying for the policy.

This is far better than providing wrong information when the concerned agency comes for the dispute before paying out the benefits.

Therefore, if there is a demise of the policyholder within the two-year limit then the insurance company is liable to provide the premium along with interest if applicable. This is just a token of money that the insurance agency provides and it takes care of the sudden illness that a policyholder possesses.

Graded Benefit Life Coverage and Guaranteed Issued

Both sorts of policies are applicable to those who are not eligible for life insurance owing to the present medical instability. However, for both these aforementioned policies benefits are not applicable if there is a sudden demise of the policyholder within the first two years.

But the premium that is included in the policy which covers any building interest will surely be repaid in due course.

If there is a waiting period, it protects the insurance agency from providing benefits to someone who is not eligible for such a policy. Please ensure that your agent or the organization knows the details beforehand.

Other Factors Pertaining to the Health Insurance Waiting Period

  1. During the waiting period, if the insurance holder is diagnosed with a specific disease, then it will not come under the purview of pre-existing disease. The policy will take care of such problems.
  2. With the progress of time, the insurance agencies come up with exclusive plans for senior citizens of the country where the health insurance waiting period is removed with a co-pay clause. Co Play Clause signifies that the policyholder will have to pay a certain percentage of the amount claimed. This can be explained with a simple example. Suppose there is a co-pay of 50%, in a policy of 1 lakh, then the holder is liable to pay Rs 30,000.

Final Remark

We are now quite sure that you have a clear idea about the features of the waiting period in health insurance. Under the realm of health insurance schemes, the waiting period is also referred to as the cooling period. It is the particular time gap before the insurance becomes effective under the concerned health plan.

Therefore, if you are willing to invest in the best health insurance plan then always opt for those plans which come with the shortest waiting period. This is all about this informative blog. Hopefully, you like this article.

And if you like this article, please provide your useful feedback in the comment box.

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