Most salaried employees who are covered by their employer's group health insurance schemes put off buying personal health covers till they are close to retirement. Some may buy it only after retirement. But it makes sense to buy an individual policy, or at least a top-up even while you continue to enjoy your employer-provided schemes. This is because of the waiting periods which do not allow you to claim immediately after buying the policy. In group policies, there is typically no waiting period.
Most policies have a 30-90 days waiting period, during which you will not be able to claim any hospitalisation expense, except in case of accidents. This is to ensure that the buyer does not purchase the policy immediately after he or she is diagnosed with an illness and then try to claim the money for the treatment.
Then there is a waiting period for specific ailments like cataract, stones (kidney or urinary tract stones), arthritis, hysterectomy, hip or knee replacements and so on. The waiting period in these ailments vary from one to two years. Most companies have a list of 10-20 such ailments. Some companies may have a longer waiting period for those above 60 years.
There is also a personal waiting period which would include ailments like diabetes or high blood pressure, which are discovered at the time of the medical check-up while buying the policy. This waiting period, too, is typically for two years.
Then there is a waiting period for pre-existing diseases which may not get disclosed during the medical check-up. This can be up to four years, which is the maximum limit prescribed by IRDAI.
"Medical check-up is restricted and there could be conditions may not get detected. So, at the time of hospitalisation if the doctor says that the particular condition was pre-existing then it may not get covered," says Divya Gandhi, head-general insurance and principal officer, Emkay Insurance Brokers.
By an additional payment over the premium the waiting period could be reduced to from the standard 48 months to 24 months on payment of additional premium, says Sandeep Patel MD and CEO of Cigna TTK Health Insurance. This option is available even for reducing the waiting period for maternity covers. While porting insurance policies, getting the benefit of the waiting period may not be easy. In some cases you may get it only if you port to a plan within the same company, but not if you port to another company. The new company you want to move to can always say that the features of their product are not the same as your existing plan, and hence, your waiting period may not hold good," says Gandhi.
That is why buying an individual health when you are young helps, because then you won't have ailments like diabetes and blood pressure. By the time you contract these ailments you will have exhausted your waiting period, says Sanjay Datta Chief Underwriting and Claims, ICICI Lombard General Insurance.
If you are covered by your employer, you can opt for a top-up, where premiums are lower. This can be converted into an individual policy at the time of retirement. And since it will be from the same company, you would have already exhausted the waiting period and will be eligible for the claims, he adds.