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Waiting Period
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  • Explore the types of waiting period
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waiting period in health insurance
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Waiting Period in Health Insurance

The waiting period is a predetermined time period wherein an insured individual has to wait before receiving all or part of the benefits of their health insurance coverage. It is important to be aware that during this waiting time, you typically cannot make any claims against your policy. This waiting time may be applicable to all of your coverage or just a few health issues, depending on the insurer.

What is Waiting Period in Health Insurance?

Waiting period in health insurance refers to the time that starts from the day of commencement of your insurance policy and during this time you can not file any health claims. Waiting period is pre-decided by the insurance policy and different health conditions are covered after different waiting periods. For example, some conditions like maternity are covered after 1 to 3 years after the starting of the policy whereas, some are covered just after 1 month. Each insurance provider has different waiting periods set by them, so, make sure to read the policy documents carefully to understand what is covered when by your policy.

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Types of Waiting Periods in Health Insurance

There are several types of waiting periods in health insurance plans. Read below to explore more about these.

  • Initial Waiting Period After receiving a health insurance policy, the policyholder is required to wait for a predetermined number of days before making any claims or receiving any benefits under the policy. In the context of health insurance, this time frame is known as the initial waiting period or cooling period. Mostly, health insurance policies have a waiting period of at least 30 days as a requirement in the business (may vary from insurer to insurer).
    Accidental claims are the only exception to the initial waiting time; these claims are only accepted when the insured is involved in an accident and needs to be hospitalised right away. Bear in mind that each insurer has a different initial waiting period.
  • Pre-Existing Diseases (PED) Waiting Period A unique waiting period for some pre-existing conditions that the policyholder disclosed at the time of insurance purchase. A pre-existing disease is defined by the Insurance Regulatory and Development Authority of India (IRDAI) as any condition, accident, illness, or disease that has been identified up to 48 months prior to the purchase of the insurance. Thyroid, hypertension, and diabetes are a few pre-existing conditions.
    Pre-existing waiting periods in health insurance plans typically range from one to four years. The pre-existing disease waiting period, however, varies depending on the insured's health status and the health insurance plan they select.
  • Waiting Period for Specific Diseases There are several diseases like tumors, ENT disorders, cancer, stroke, and cardiac ailments, that come with a specific waiting period. The waiting period for these plans usually ranges between 2 and 4 years. The ailments that qualify for this waiting period vary from insurer to insurer and can be found in the policy details provided by each insurer.
  • Maternity Benefit & Newborn Baby Cover Waiting Period Maternity and newborn baby coverage are available as an add-on benefit of individual and family health insurance plans. Maternity coverage is a common inclusion in health insurance plans. In each case, the coverage is available following a 2–4 year waiting period. However, some health insurance providers offer shorter waiting periods, however, the policyholders need to pay higher health insurance premiums to take advantage of that.

How does the waiting period in health insurance work?

Let us understand this with an example, Suppose Mr A, has a family history of diabetes. He bought health insurance to cover the cost of Diabetes if he happens to suffer from it in the future. The company offers him a waiting period of 2 years. This means that he will get the benefits from the coverage after two years from the date of purchase of the policy. Even if he is diagnosed with diabetes in these 2 years, he will not be able to avail the advantage related to the policy.

Importance of Waiting Period in Health Insurance

Waiting periods serve an important purpose in the overall management of healthcare costs and the provision of coverage for all insured individuals. Here are some of the reasons why waiting periods are important in health insurance:

  • Cost Control: Waiting periods can help control costs by preventing individuals from enrolling in a health insurance plan only when they need medical care. Without waiting periods, individuals could enrol in a plan, receive medical care, and then drop the plan once their treatment is complete, which would increase the cost of premiums for everyone.
  • Risk Management: Waiting periods help insurance companies manage their risk by ensuring that they have time to evaluate the health status of individuals before providing coverage. This helps insurance companies ensure that they are not providing coverage for pre-existing conditions or other health issues that were present before the policy became effective.
  • Plan Stability: Waiting periods help promote plan stability by ensuring that individuals who enrol in a plan are committed to maintaining coverage for a certain period of time. This helps ensure that insurance companies can provide coverage for all insured individuals, and helps prevent adverse selection.
  • Fairness: Waiting periods help ensure fairness by requiring all individuals to wait a certain period of time before receiving coverage, regardless of their health status. This helps ensure that everyone who enrols in a plan is subject to the same rules and requirements, and helps prevent discrimination against individuals with pre-existing conditions.
  • It Ensures Affordability: The waiting period in medical insurance helps to keep the premium affordable. Because without a waiting period, the chances of claims will be more , and this will increase the risk for the companies and ultimately they will charge the policyholder more for coving their part of the risk.

How to Decrease Waiting Periods in Health Insurance

There is no insurance company that provides plans without any waiting period. However, the policyholder still gets the option to decrease the waiting period duration. There are many plans with a waiver benefit or riders, that can reduce the time span of the initial waiting period in health insurance. Here are the names of the plan that have the waiting period waiver and riders:

Care classic with Instant Cover
Care Supreme With Instant Cover
Niva Bupa Reassure With Disease Management Rider
Star Health Comprehensive Plan With Buy Back Rider
Care With Reduction In PED
Aditya Birla With Chronic Management

Health Insurance Waiting Period: FAQs

1. What is the waiting period for health insurance?

The waiting period is a predetermined time period wherein an insured individual has to wait before receiving all or part of the benefits of their health insurance coverage. It is essential to be aware that during this waiting time, you typically cannot make any claims against your policy. The waiting period differs from one health insurance plan to another.

2. If an insurance holder is diagnosed with a disease will they be covered for the same?

If an insured individual is diagnosed with an ailment during the policy period, the claim will cover it, However, the condition will be applied wherein the initial waiting period has to end before they can file a claim.

3. Why does a health insurance policy have a waiting period?

There are multiple risks involved when an insurer designs health insurance for the benefit of the customer but they are misused by some. To avoid unethical practices by certain individuals waiting periods are implemented under various health insurance plans.

4. Is there a benefit if a health insurance plan has a lesser waiting period?

Yes, a lower waiting period translates to access to health insurance policy coverage in a lesser amount of time. For example, if policy A has a 48 months waiting period for pre-existing diseases and policy B has 24 month waiting period then the user can avail coverage against pre-existing diseases earlier through policy B than from Policy A.

5. How can I check if my health insurance covers my existing health conditions?

Every health insurance policy has a different waiting period for certain illnesses and conditions, insurance buyers must thoroughly understand the terms and conditions of a health insurance policy before purchasing one to understand if their existing conditions are covered or not.

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Naval Goel

Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.

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