All You Need to Know About Waiting Period in Health Insurance

To make sure your health insurance claim gets settled, it is best to read and understand all the terms and conditions of the policy and make an informed decision. This article elucidates all you need to know about the waiting period in health insurance.

What Is Waiting Period in Health Insurance?

As the name suggests, a waiting period in health insurance is the period or time for which you need to wait before getting the insurance benefits. The waiting period begins from the date of policy commencement, and until it is over, the policyholder cannot make the related claims to avail of the health insurance benefits. It can be applicable to certain health conditions or the entire coverage, depending upon the policy terms and conditions. The duration of the waiting period varies across health insurance benefits and insurance companies.

For example, the waiting period for maternity benefits is one of the common types of waiting periods. Most health insurance policies have 2 to 4 years of a waiting period to avail of the maternity benefit. So, the policyholder/insured cannot claim the maternity expenses until the maternity waiting period is over.

What Are the Different Types of Waiting Periods in Health Insurance?

Health insurance policies have different waiting periods, and each implies a different condition related to the insured:

1. Initial waiting period:

If an insured falls sick and gets hospitalised in the first 30 to 90 days from the commencement of the policy, they will not be able to claim the health insurance benefit. This is because every health insurance policy comes with an initial waiting period that you must serve to receive the benefits under your health insurance plan. Take note that this waiting period applies only to hospitalisation due to an illness. Most health insurance policies cover hospitalisation due to an accident from day one of the start of the policy.

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2. Waiting period for the pre-existing medical conditions:

You are required to provide details of any existing diseases or illnesses while filling up a health insurance application form. These ailments are called pre-existing medical conditions. Health insurance companies typically cover these ailments under your plan after 2 to 4 years of policy commencement. If a policyholder does not disclose his/her pre-existing health conditions and the insurance company finds out at the time of claim, your claim will be rejected, and your policy could be terminated. Hence, to avoid such situations, it is advisable to read the policy document carefully and provide the correct details without hiding or misleading any information.

3. Waiting period for the specific diseases and treatments:

Certain diseases/illnesses and medical procedures are listed in the health insurance policy as specific diseases/illnesses or treatments/medical procedures that can be claimed only after the related waiting period is over. Some of the common examples of such illnesses and treatments are cataracts, hernias, joint replacement surgery, ENT disorders, etc. Many regular health insurance policies apply the same waiting period to cover critical illnesses like cancer and stroke unless a specific critical illness health insurance rider or policy is purchased, which typically comes with a 90-day waiting period. An insured can claim for the expenses of medical treatments of these medical conditions after the waiting period for the specific diseases/treatments is over, which is generally 1 to 2 years.

4. Maternity waiting period:

Earlier health insurance plans did not provide maternity and newborn cover, but nowadays, most health insurance plans come with a maternity benefit. The waiting period to avail of the benefit of maternity coverage under your health insurance policy could be anywhere from 9 months to 48 months. Post this period, you can claim expenses pertaining to delivery and newborn care under your health insurance plan.

5. Waiting period for Covid-19:

After the spread of Covid-19, the Insurance Regulatory and Development Authority of India (IRDAI) has permitted health insurers to offer specific health insurance policies to cover medical expenses arising from covid-19 infection. While the spread of the deadly disease has reduced, most insurers still offer covid-19-specific health insurance plans with a 30-day waiting period.

6. Waiting period for mental health coverage:

With the increasing awareness of mental health, many health insurance companies have started providing mental health coverage, also known as psychiatric illness coverage. This cover generally comes with a waiting period of 1 to 2 years. So, after the completion of this period, an insured can claim for the medical expenses arising from their mental illness.

What Is Survival Period?

In the case of a critical illness cover, the claim benefit is offered to the insured only if he/she has survived for a minimum of 30 days after the diagnosis of the illness.

To conclude:

The waiting period for health insurance is impacted by several factors, such as the type of health insurance plan (individual health insurance plan, family floater health insurance plan, corporate health insurance plan, senior citizen health insurance plan, etc.), pre-existing medical conditions and medical history of the insured, age of the insured, insurer's terms and conditions, and many more. Therefore, it is advisable to read and understand the fine print of the health insurance policy. It is beneficial to choose the policy that comes with lower waiting periods but remember that it should not be the only criterion for choosing the best health insurance plan for you and your loved ones. You should also consider the policy coverage, convenience to buy and renew the policy, network hospitals, claim settlement process, customer support, claim settlement ratio, premium, company reputation, etc. and then make an informed decision.

Warm Regards,
Ketki Jadhav
Content Writer