Types of Waiting Periods in Health Insurance

Posted on: Feb 23, 2023 | 3 mins | Written by: HDFC ERGO Team

Types of Waiting Periods in Health Insurance

Buying the best health insurance plans is important, but that doesn’t mean they come without terms and conditions. One of the terms that can get your claim request rejected is waiting periods. It refers to the time between when you purchase a Mediclaim policy and when you can actually use it to receive benefits. This is put in place to prevent individuals from only buying health insurance coverage when they need it most, for instance, when they are already sick. It also helps insurance companies manage their financial risk and keep premiums affordable for policyholders.

What is a Waiting Period in Health Insurance?

The waiting period in health insurance is the time that you, as a policyholder, must wait before you can avail of the benefits of the policy. During the waiting period, you cannot raise any claims. The waiting period starts from the day the policy commences, and the duration can vary from insurer to insurer. Let us try to comprehend it betterby using an example. Ayushi buys a health insurance plan with a sum insured of Rs 5 lakh. Within 10 days of taking the policy, she suffers a heart stroke and gets hospitalised. But when she makes a claim, she is shocked to know that the insurer will not cover the treatment expenses because the policy’s waiting period of 30 days is not yet over. Her claim is not accepted, and she needs to pay everything from her pocket.

Similarly, pre-existing diseases have a waiting period of 2-4 years, and you need to complete the waiting period to avail of the coverage benefits.

Types of Waiting Periods in Health Insurance

There are various types of waiting periods in health insurance, such as:

1. Initial Waiting Period:

Also known as the cooling period, the initial waiting period is typically 30 days from the day the policy starts. This applies to both planned and emergency hospitalisations. However, there can be exceptions like accidental claims wherein the policyholder needs immediate hospitalisation after an accident.

2. Pre-Existing Diseases Waiting Period (PED):

As per the IRDAI, any medical condition, illness, or injury diagnosed 48 months before buying the health insurance policy is considered a pre-existing disease. Some examples of PEDs are hypertension, diabetes, thyroid, etc. Usually, the waiting period is from 1 to 4 years, depending on your healthcare plan and insurer. At the time of purchasing the best health insurance plans, you must inform the insurance company if you have any pre-existing diseases.

3. Waiting Period for Specific Diseases:

For specific diseases and procedures like hernia, osteoporosis, ENT disorders, cataract, joint replacement surgery, and neurodegenerative disorders like Alzheimer’s and Parkinson’s disease, the waiting period ranges from one to two years.

4. Maternity Benefit Waiting Period:

Maternity benefit covers all expenses related to delivery and childbirth but after a waiting period of 1-4 years. This means if you plan to start a family in the near future and want to avail of maternity benefits, you should consider buying this plan now. The newborn will be covered for the first 90 days, including vaccinations.

5. Critical Illness Waiting Period:

The waiting period to cover critical illnesses is 90 days. There is also a survival period of 30 days, which means the insured has to survive for at least 30 days after being diagnosed with a critical illness. Those aged 60 years and above are at high risk of critical illnesses, so having senior citizen health insurance along with critical illness coverage comes in handy.

6. Waiting Period for Accidental Hospitalisation:

If an unfortunate accident requires emergency hospitalisation, the initial waiting period will be waived. Zero waiting period health insurance is applicable only in case of immediate accidental hospitalisation.

7. Waiting Period for Annual Health Check-ups:

Most health insurance policies offer complimentary annual health check-ups to policyholders. However, you have to wait for one year to avail of this benefit.

8. Waiting period for Bariatric Surgery and Psychiatric Illness:

The waiting period is usually 1 to 2 years, before which you cannot raise any claims.

Conclusion

Having the best health insurance plans or senior citizen health insurance doesn’t mean you can avail of the coverage benefits from the first day of purchasing the policy. There’s a waiting period in health insurance for specific diseases and an initial waiting period which you have to complete before raising any claims. Any claim filed within the waiting period will get rejected. However, if you want zero waiting period health insurance, some insurance providers offer the option of a'waiting period waiver' or 'reduce the waiting period' but charge a higher premium for it. It is, therefore, advised to buy health insurance when you are young for two reasons – one, the premium will be less and second, the waiting periods will, most probably, be over by the time you need to use the benefits. Remember, just buying a Mediclaim policy is not enough; you should be aware of all the terms and conditions of the policy, including thewaiting period in health insurance.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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