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Understanding Waiting Period in Health Insurance

This article will define the waiting period and its different types. Let's shed light on frequently raised queries to gain a comprehensive understanding.

  • 03 May 2023
  • 2 min read
  • 2718 views

Health insurance is a vital safety net providing financial protection against unforeseen medical emergencies. However, it is essential to understand the waiting period associated with health insurance policies. The waiting period is when the insured person cannot claim insurance benefits after purchasing the policy. This article will define the waiting period and its different types. Let's shed light on frequently raised queries to gain a comprehensive understanding.

Waiting period definition

The popularly known term 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. For instance, maternity coverage usually has a waiting period of two to four years. Waiting periods help to 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 get provided to only those who genuinely need them.

Types of waiting periods in health insurance

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 one to two years, according to the insurer’s policy. This waiting period applies to illnesses that require long-term care.

● Maternity waiting period:

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. You can avail of this benefit from the second year of your policy.

● Waiting period for COVID-19 coverage:

The waiting period in health insurance plans that fully cover COVID-19 disease is 15 days.

Thoroughly reviewing the policy documents is crucial to comprehend the waiting periods embedded in health insurance policies. Some insurance service providers may provide health insurance without waiting periods too. Waiting period insurance protects the insurer from the risk of high claims immediately after the policy’s purchase.

Also read:

FAQs on health insurance waiting period

What is the longest waiting period for health insurance?

Typically, health insurance policies provide coverage for pre-existing conditions after a waiting period, which is generally between 1-2 years. This means you can claim any medical expenses arising from pre-existing ailments only after completing the waiting period with the insurer. Health insurance policies typically come with a countdown to coverage that can last for a maximum of ninety days. After the waiting period is up, you can breathe easy knowing that you can avail the benefits of the coverage. Nevertheless, if the insured experiences an accident requiring urgent hospitalisation, your insurer can make an exception to this waiting period requirement.

Is it possible to reduce or remove the waiting period?

If you want to reduce your waiting period in a health insurance policy, it is important to note that this option may not be available with every insurance provider. Therefore, you should check whether your insurer offers this provision. It’s crucial to read in detail the policy document attentively to ensure that you comprehend the ins and outs of health insurance with less waiting period, including any possible constraints that might come into play.

What happens if a claim gets filed in a waiting period?

If a policyholder files a claim with their health insurance provider before the waiting period ends, the insurer has the right to reject it. However, once the waiting period is over, the insurance service provider company cannot deny it. Knowledge about the waiting period and the associated terms and conditions is crucial as it can significantly impact the approval of a claim.  Thus, it is imperative to familiarise oneself with the waiting period of each policy and understand its specific provisions. This aids in avoiding unnecessary claim rejections and ensures you receive the necessary medical coverage.

What is 9 months waiting period in health insurance?

The 9-month waiting period in maternity coverage exists because insurance aims to cover unforeseen events. If a woman invests in purchasing maternity coverage while already pregnant, it gets deemed as a foreseen event, and the waiting period will still apply. The insurance company will check the date of the last menstrual period (LMP) to determine if the pregnancy was already underway before the policy's purchase. The claim will get denied if the LMP was before the policy's start date. However, the claim will be accepted if the LMP is after the plan's start date. To make sure the claim is payable, check the start date of the policy coverage and the LMP date with your doctor.

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