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While buying health insurance, it is important to know all the terms and conditions present in the policy well. If you take health insurance thinking that you will be able to take advantage of it as soon as the policy is effective, then this is not entirely true. Generally, insurance companies do not cover the cost of treatment as soon as the health insurance policy becomes active; instead, they stipulate a time period after which coverage begins. Now, this waiting period may vary according to the type of policy and the insurance company. In this article, you’ll find everything you need to know about waiting periods in health insurance policies.

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  1. What is the waiting period in health insurance
  2. Types of waiting periods
  3. Need for waiting period in health insurance
  4. IRDAI's notification on waiting period
  5. Can the waiting period be reduced?
  6. Important points related to health insurance waiting period

As the name suggests, the waiting period refers to the amount of time one must wait. You can make a claim only after the stipulated number of days have passed since taking a health insurance policy. These fixed days are known as a waiting period in the insurance world. If you already have a pre-existing condition from before you bought the policy, the waiting period for it can be even longer. If a person is thinking about hospitalization, then they should first know about the waiting period mentioned in their policy. Usually, it falls between 15 days to 4 years. The treatment cost is covered by the insurance company only after this waiting period is over.

(Read more: What does health insurance cover)

Following are the types of waiting periods in health insurance:

  • Initial waiting period: The initial waiting period is also known as the cooling period in health insurance. Generally, all health insurance plans have an initial waiting period of at least one month and a maximum of 90 days. This means that to file any kind of claim customers will have to wait for 30 to 90 days after purchasing the policy. During the waiting period, a claim filed by you can be accepted only in case of an accident, as it requires immediate hospitalization and treatment. Note, the waiting period may differ from one insured to another. (Read more: First aid)
  • Waiting period for pre-existing disease: There is a special waiting period for certain diseases, known as the pre-existing disease waiting period. According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing condition can be any injury or illness that has been diagnosed up to 48 months prior to the purchase of the policy. Some examples of pre-existing diseases include thyroid disorders, high blood pressure, chronic obstructive pulmonary disease (COPD), depression, genetic disorders, kidney disease, hernia, hydrocele and diabetes. Generally, the waiting period for pre-existing illness in health insurance policies is 1-4 years, but it varies depending on the policyholder as well as the insured.
  • Waiting period for special diseases: There are many diseases like hernia, tumour, cancer, stroke, heart disease, for which there is a special waiting period. This waiting period of a health insurance policy can generally range between 2 to 4 years but may vary from one insurer to another.
  • Maternity waiting period: Under individual and family health insurance policies, the policyholder can avail maternity insurance and newborn baby insurance as an add-on cover. There are also many health insurance policies in which you do not have to worry about covering pregnancy separately, as they already have such a facility. But whatever the policy, it is usually required to complete the waiting period of 2 to 4 years. Some insurance companies may also offer a shorter waiting period but to avail of the same, policyholders may have to pay an extra premium.
  • Waiting period for bariatric surgery: Some health insurance policies also cover bariatric surgery. Bariatric surgery is surgery of the stomach and/or intestines to help reduce weight. There is usually a waiting period of 2 to 4 years for bariatric surgery in health insurance. This surgery is usually needed by people who have a BMI over 40 and who have to deal with health problems due to it.
  • Waiting period for COVID-19: In view of the COVID-19 pandemic, many people are taking health insurance plans that cover this infection to protect themselves and their families. But the insured may need to complete a waiting period of 30 days to avail coverage such as hospitalization and treatment under these policies. (Read more: COVID-19 test)
  • Waiting period in accidental hospitalization: Accidents can happen suddenly, anytime and anywhere and can cause serious injuries and other health problems. This is why the health insurance company does not fix a waiting period for cases where a person needs to be hospitalized suddenly due to an accident. Even the 'early waiting period' does not apply here. In such a situation, a person can get hospitalized and the insurance company bears the cost of treatment up to the sum insured.

Many people often question the need for a waiting period, but in reality, it is a very thought-out step. There have been many cases where people, despite knowing their illness, hid it from the insurance agent and bought a health insurance policy. Hence, to avoid such misconceptions, health insurance companies have adopted the concept of a waiting period.

It is suggested by IRDAI to insurance companies that a waiting period of up to 4 years can be fixed for a specific disease or condition. Also, the waiting period should not exceed 30 days for diabetes, high BP and heart disease. This step was taken so that those who are suffering from these conditions can get help soon.

(Read more: Difference between health insurance and life insurance)

Only some companies offer an option to reduce the waiting period but the insured has to pay an additional premium for this. Usually, this is not the case in group health plans given to employees, as there is no waiting period in them. But there is also a risk in such plans, as when you leave that company, you cannot take advantage of the group health plan anymore.

As per the IRDA guidelines, employees who are covered under a group health plan can convert their group health plan to an individual health plan at the time of leaving their employer and in doing so will be allowed to waive off the waiting period.

 

Over time, insurance companies have come up with schemes for senior citizens (senior citizen health insurance), where the waiting period can be eliminated through copayment. Copayment means payment of some percentage of the total amount claimed by the policyholder. For example, if the insured claims a medical bill of Rs 50,000 and the co-payment clause is 10%, then the insured will have to pay only Rs 5,000 out of their own pocket, while the remaining Rs 45,000 will be paid by the insurance company.

Other important things related to the health insurance waiting period:

  • While taking the policy, you should keep in mind the actual waiting period after which the cost of treatment will be covered.
  • Investing in a policy with the least waiting period can be a good move.
  • Some insurance companies offer an option in which the waiting period can be waived by paying an additional premium.
  • If during the waiting period, the insured is diagnosed with a disease for the first time, it will not be treated as a pre-existing disease. In this case, the policy will cover that disease.
  • The best way to deal with the waiting period is to buy health insurance early. Since you are less vulnerable to diseases at a younger age, you would be less likely to develop a disease. Chances are that the waiting period will be long over by the time you need to claim any of those diseases. 

If you are considering buying health insurance, then make sure that the insurance company or policy that you choose has the shortest waiting period.

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