What is the Waiting Period in a Health Insurance Policy?

Life is full of uncertainties and medical emergencies are one of them. With the increasing age, the human body becomes more prone to diseases. Moreover, considering the current pandemic situation, having a health insurance policy is imperative for every individual. However, while purchasing the health insurance policy, it is important to know about its various aspects. And, one of the important aspects is the waiting period in a health insurance policy. Read this article to know in detail all about it.

What is the Waiting Period in Health Insurance?

The waiting period is a specific time period before a certain list of ailments start getting covered under the intended health insurance policy. In almost all health insurance policies, a waiting period of 4 years for pre-existing illnesses is a standard clause. This is helpful for the policyholder because after completion of the waiting period the insurance company cannot deny the claim.

Let’s further understand the concept of the waiting period in detail.

Types of Waiting Period in Health Insurance

There are three different types of the waiting period in health insurance. Let’s take a look at them-

  • Pre-existing Diseases

At the time of purchasing a health insurance policy, if the policyholder declares that he/she has any specific diseases such as high blood pressure, diabetes, thyroid, etc., these are called pre-existing diseases. In such cases, the policy buyer needs to undergo a medical test to assess the level of impact of the diseases on the policy buyer. Based on the medical test report of the policy buyer, the insurance company decides whether they will accept the application or not. If the insurer accepts the proposal, then they prescribe a waiting period of 4 years to the policyholder. As per the underwriting of the policy, any hospitalization expenses related to the declared ailment can be claimed only after completion of the 4 years. Thus, an individual should take health insurance early in life to avoid any waiting period.

  • One/Two years Waiting Period for Particular Ailments

There are certain listed diseases like osteoporosis, hernia, ENT disorder, etc. for which the health insurance plans generally have one to two years of the waiting period. The waiting period of general health insurance is one month for every policy, except for accidental cases.

  • 90 Days Waiting Period for Infants

Some health insurance providers offer maternity benefits to the policy buyers. However, these benefits come with a waiting period ranging from 9 months to 36 months.

  • Initial Waiting Period

If an individual gets sick and hospitalized in the first 30-90 days from the date of policy initiation then he/she won’t get any benefits from their health insurance policy. To avail of the benefits under the health insurance policy, the insured must wait till the initial waiting period of the policy is over.

Is it possible to Reduce the Waiting Period?

Some insurance companies provide an option to decrease the waiting period by paying an extra premium. In group health insurance policies offered by the employer to the employees, the insurer does not insist on the waiting period for a health plan.

As per the guidelines of the Insurance Regulatory and Development Authority of India (IRDAI), the employees who are members of the group health insurance policy offered by their organization can convert their group cover to the individual retail health plan, at the time of leaving the organization. While converting the group cover to individual health cover. The policyholder will not have to undergo the waiting period.

If the life insured is diagnosed with a disease for the first time during the waiting period, then it will not be considered a pre-existing illness and the policy will cover such conditions. Nowadays, insurance companies offer policies for senior citizens where the waiting period of the policy can be excluded by adding the co-pay clause.

The co-pay clause is an agreement between the insurer and the insured where the insured agrees to bear a certain percentage of the claim amount from his/her own pocket. The rest of the claim amount is paid by the insurance company. For example, for a co-pay of 40% in a claim of Rs.1 lakh the life insured will have to bear Rs. 40,000.

The Bottom Point!

The health insurance plan waiting period is influenced by different factors such as the medical history of the insured, type of plan chosen i.e. (group health insurance, individual health insurance, family floater plan, etc.). It is very important to read the fine prints of the waiting period of the health insurance policy before making an informed decision. Make sure to choose the health insurance plan with a lesser waiting period to avail of the benefits of the policy in case of any medical emergencies.

FAQs
What happens if a claim is filed in a waiting period?
If the claim is filed before completion of the initial waiting period, it will be declined by the insurance company. Except, in case of accidental hospitalization.
What if I am diagnosed with a disease for the first time during the waiting period, will the claim be admissible or not?
If the life insured is diagnosed with a disease for the first time during the waiting period, then it will not be considered a pre-existing illness and the policy will cover such conditions.
Is it possible to reduce the waiting period?
Yes, it is possible to reduce the waiting period by paying an extra premium.
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