When you purchase a health insurance policy, you may assume that the coverage starts immediately. However, this is not always the case. Most health insurance plans include a waiting period, which is the time you must wait before you can claim insurance benefits. Understanding how the waiting period works can help you make better decisions when choosing a plan and avoid surprises when you need to make a claim.
This article discusses what exactly the waiting period is, its common types and how it works.
What is a waiting period in health insurance?
The waiting period in health insurance refers to the duration an insured person must wait before being eligible for insurance benefits. This period begins from the policy commencement date and varies between insurance companies. During this period, the insurance company will not cover certain medical conditions, treatments or expenses. Only after the waiting period is over can you file claims for those services.
The purpose of a waiting period is to help avoid unethical practices by policyholders. This includes purchasing a policy after being diagnosed with an illness and immediately making a claim. The waiting period helps prevent deceptive behaviour and ensures that insurance benefits are provided to only those who genuinely need them.
Types of waiting periods in health insurance plans
Here are the key points regarding the different waiting periods in health insurance policies:
Initial waiting period in health insurance:
This is essentially the phase after purchasing your healthcare plan, during which you cannot claim any benefits for hospitalisation, planned or emergency. The minimum initial waiting period in health insurance is usually at least 30 days. Some insurance providers offer zero waiting period health insurance as well.
Waiting period for pre-existing diseases:
This is a waiting period for those diagnosed with a specific pre-existing disease listed in the policy document. The insurer can impose a waiting period of up to 2 years.
Waiting period related to specific diseases:
Health insurance plans may encompass separate waiting periods for diverse ailments, which can vary from 1-2 years, according to the insurer’s policy. This waiting period applies to illnesses that require long-term care.
Waiting period for maternity benefit:
The period during which you cannot claim maternity benefits typically varies from 9 months to 6 years. The health insurance no waiting period may not be applicable here.
Waiting period for accidental hospitalisation
No waiting period applies in the case of immediate hospitalisation resulting from an unfortunate accident.
Waiting period for health check-ups
Insurers who offer complimentary health check-ups keep the waiting period to at least one year. It essentially means you can actively avail of this benefit only after completing the one-year waiting period in health insurance.
How does the waiting period work in health insurance?
Let’s say you buy a health insurance policy on 1st January. If there is a 30-day initial waiting period, you can’t claim for any hospitalisation (except for accidents) until 31st January. If your policy includes a 2-year waiting period for cataract surgery, and you need the surgery within that time, the insurance will not pay for it. Once the 2-year mark passes, you can file a claim for it.
Does health insurance allow you to reduce the waiting period?
Some insurers offer the option to reduce waiting periods by paying an extra premium. For example, you might be able to shorten the waiting period for pre-existing conditions from 4 years to 2 years. However, not all policies offer this benefit, so it's best to check the terms carefully before buying.
Important things to know about health insurance waiting periods
Here are some things to keep in mind before buying health insurance:
- A new illness during the waiting period is not a pre-existing disease: If you are diagnosed with a disease for the first time during the waiting period, it will not be considered a pre-existing condition. Once the waiting period for that illness is over, the policy will cover it.
- Co-payment options can help reduce waiting periods: Some senior citizen health insurance plans allow you to skip certain waiting periods by agreeing to a co-payment clause. This means you agree to pay a fixed percentage of the claim amount.
- Waiting periods can carry over when switching insurers: As per the IRDAI (Insurance Regulatory and Development Authority of India) guidelines, if you switch to a new insurer, the waiting period you already completed with your old insurer may be carried forward to the new policy. This is subject to conditions and the new insurer's approval.
- Be honest about your health history: If you hide any health conditions while buying a policy, your claims may be denied later, even after the waiting period.
- Don't let your policy lapse: If your policy expires and is not renewed with the grace period, the waiting period may start all over again with a new policy.
Conclusion
A waiting period in health insurance can affect when you can start using your coverage. Knowing the different types of waiting periods and how they work can help you avoid delays in getting financial support when you need it most. To ensure smooth and timely healthcare access, choose an individual health insurance plan that offers shorter waiting periods or flexible options.
FAQs
Does the waiting period apply every year?
No, the waiting period applies only once at the start of the policy. Once you complete it (and keep renewing the policy without any gap), you don’t have to serve it again for the same condition.
Do all policies have the same waiting periods?
No, waiting periods vary from one insurance company to another and can also differ across plans. That’s why it’s important to compare policies and read the terms carefully before buying.
Can I claim for pre-existing diseases after the waiting period is over?
Yes, once the specified waiting period for pre-existing conditions is over (usually 1 to 4 years), you can make claims for treatments related to those illnesses.
What happens if I fall sick during the waiting period?
If you fall sick during the initial waiting period, your claim may not be accepted unless it is due to an accident. However, if you are diagnosed with a new illness during this time, it won’t be counted as a pre-existing condition in the future.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.