Health Insurance Waiting Period Guide

Posted on: May 29, 2019 | 3 mins | Written by: HDFC ERGO Team

Health Insurance Waiting Period Guide

Imagine falling sick or needing a medical procedure and discovering that your health insurance policy will not cover it immediately. This is where waiting periods come into play. Understanding waiting periods is crucial because it affects when you can actually use your insurance benefits, how you plan your medical expenses, and even which policy is best for your needs. In this guide, we will break down what is waiting period in health insurance and show you what to expect so you can avoid surprises when you need your coverage the most.

What is waiting period?

As the name suggests it's a period of time, which has to pass for you to avail certain covers or benefits under a health insurance plan. It is the period during which certain claims are not payable. Waiting periods are waived only through continuous renewals without any break in the policy. Insurance companies may deny claims if intimated within the waiting period, however once the waiting period is over you are free to register claims.

Types of waiting period

Here are the different types of health insurance waiting period:

• Pre-existing Diseases (PED)

The policyholder, at the time of purchase, has to declare to the insurance company if they suffer from pre-existing diseases like diabetes, high blood pressure, thyroid, etc. Almost all health insurance plans cover pre-existing diseases, after usually between 2 years waiting period of can be claimed only after 4 successful years with the insurer.

• Specific diseases/procedures

cataract, etc., health insurance policies normally have a one or 2 years of waiting period.

• Initial Waiting Period

which no claims are accepted. This depends on the policy terms and conditions.

• Critical Illnesses Waiting Period

Critical illness insurance policies (or riders) typically have a waiting period of 90 days before coverage begins.

• Maternity Benefit Waiting Period

Many health insurance plans that offer maternity benefits and newborn baby cover only after a waiting period ranging from 9 months to 36 months is over.

Under what circumstances waiting period is implied?

Waiting periods for health insurance are not arbitrary; they are applied in specific situations to manage risk and ensure fair coverage. Here are the main circumstances where you can expect a waiting period under a health insurance policy:

• Maternity cover

expenses as soon as you buy the policy or when you are pregnant. Most of the health insurance companies imply a waiting period of 3-4 years, hence you can claim under maternity cover post on cover, while some make it a part of their basic health policy.

• Pre-existing diseases

had any sort of medical history such as diabetes, high blood pressure,thyroid, hypertension etc then you have to declare this to your health insurance company. Bases your medical reports, health insurer either accepts the case by implying an additional premium or rejects the case depending upon medical adversity. Once your waiting period is covered for the declared diseases you can make claim under it.

• Survival period

For critical illness insurance there is a survival period of usually 30 days. With HDFC ERGO critical illness insurance you have a survival phase of 30 days before receiving the lump sum payment.

• New born babies

Coverage for newborn babies varies by policy. Some plans cover from day one under maternity benefits, while others impose a waiting period of up to 90 days.

Is it possible to reduce waiting period?

Yes, it is possible to reduce the waiting period under a health insurance policy. There are health insurance companies that offer an option to reduce the waiting period by opting for a waiting period waiver. These waivers can be obtained by paying an extra premium amount.

Usually, in case of group health insurance plans offered by companies to employees, insurance companies do not insist on waiting periods. Employees may be able to carry forward waiting period credits when converting group health insurance to an individual plan, but underwriting conditions may still apply.

According to IRDA guidelines, employees who are a member of a group health plan offered by their employers can convert their group cover to an individual retail health policy at the time of quitting their jobs. In such scenarios, they will get a health insurance without waiting period as they have already spent the waiting time in the group health cover provided to them by their companies.

What more should you know about waiting periods?

Waiting period in health insurance can affect how and when you use your health insurance, so it is important to understand a few key points to avoid surprises when filing a claim:

• If any new ailment is detected during the policy period it will get covered and is not a part of pre existing waiting period.

• However, if an already existing ailment is not declared at the time of policy issuance and claim has been registered then claim will not get honored.

• Some insurance companies offer an option to reduce waiting period by paying additional premium.

• There is also a common cooling period of waiting period of 1 month for accidental hospitalisation or overall any claim to be registered. Hence you may not be able to immediately register a claim post buying a policy.

What is cooling-off period in health insurance?

The cooling-off period, also called the free-look period, is the 15–30 days after buying a policy during which you can cancel or modify it. It is different from a waiting period, which delays claims for specific treatments. Some insurers also use the term ‘cooling-off’ to indicate a short period after recovery from a recent illness during which a new policy may require additional checks before coverage is approved.

Things to keep in mind about waiting period in health insurance

Here are some important points about waiting periods in health insurance:

• Before buying a policy, it is important to understand what a waiting period is so you can choose the plan that suits you best.

• There is no waiting period for accidents, so coverage starts from day one.

• If a condition is diagnosed for the first time after the policy starts, it is not treated as a pre-existing condition, and the insurer will cover it.

• Thanks to IRDAI’s portability rules, the waiting period you have served under your old policy can be transferred to your new policy when you switch insurers.

• Waiting periods can differ from one plan to another, even for the same treatment. Always check your policy documents carefully.

Conclusion

Understanding waiting periods in health insurance is more than knowing when your coverage starts; it helps you plan for medical expenses, avoid claim denials, and select a policy that truly fits your needs. By being aware of waiting periods for pre-existing conditions, treatments, and maternity benefits, you can make informed decisions, manage your healthcare proactively, and ensure that your insurance serves you when you need it the most. Always review waiting periods before buying a policy.

FAQs

1. Is it possible to reduce the waiting period health insurance?

Yes, some insurers offer the option to reduce waiting periods by paying an additional premium or through portability credits from a previous policy. This can help you access coverage sooner for pre-existing conditions or specific treatments.

2. Does the waiting period affect maternity benefits?

Yes, most maternity benefits have a separate waiting period, typically ranging from 9 to 36 months. Understanding this helps you plan pregnancies and related expenses without surprises.

3. Are waiting periods the same across all policies?

No, waiting periods vary by insurer, policy type, and treatment. Always check the policy document to know exactly which conditions or procedures are covered and when.

4. What happens if I switch insurers?

Thanks to IRDAI’s portability rules, any waiting period already served under your old policy can be credited to your new policy, provided coverage has been continuous.

5. Do waiting periods apply to critical illnesses?

Yes, critical illness plans often have a waiting period, plus a survival period (usually 14-30 days) before the lump-sum payout is made.

6. Can newborns be covered immediately?

Coverage for newborns varies. Some policies cover from day one under maternity benefits, while others impose a waiting period of up to 90 days.

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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