What are Waiting Periods in Health Insurance Policies?

A few days ago, we had an interesting interaction with one of our customers, Shashank. He booked a call with an advisor after his uncle's health insurance claim was denied because the hospitalisation was related to a pre-existing disease. And the waiting period was not over yet. It turns out that, unfortunately, the waiting periods were not mentioned to his uncle while purchasing the health insurance policy.

This experience left him worried about purchasing good health insurance with adequate coverage for him and his family. He wanted an honest understanding of how waiting periods work in health insurance policies, and our advisors were ready to help.

In this article, we provide you with the same insights about waiting periods in health insurance, their importance, and how they can impact your claims process.

Also, if you need personalised, spam-free insurance advice, you can always consult Ditto Insurance’s IRDAI-certified insurance experts at a convenient time.

Best Health Insurance Policies with Low Waiting Periods

Heads Up: It takes an average person up to 5 hours to read & analyze a term life policy, and 10 hours or more to compare different plans and make a decision.

This is why we propose a better alternative - taking a 30-minute FREE consultation with Ditto’s certified advisors. We have a spam-free guarantee, and we’ll never push you to buy a plan. Don’t delay this - we have limited slots every day, so book a quick call here before they run out.

What are Waiting Periods in Health Insurance Policies?

A waiting period in health insurance policies is the initial timeframe during which you cannot claim insurance for certain treatments. This begins from the date your policy starts and usually varies depending on the insurer and the type of waiting period the insurer imposes.

It is a buffer set by insurers to prevent immediate high-risk claims. This ensures that policyholders do not buy insurance just to claim benefits for pre-existing conditions or scheduled treatments right away. This safeguards not only the insurer but also the entire insurance pool so that people who need health insurance will get it when they need it the most.

Let’s understand this with an example:

Let’s say you buy a health insurance policy today. It has a 3-year waiting period for pre-existing diseases and a 2-year waiting period for specific illnesses.

Unfortunately, you have a road accident just 2 weeks later and need hospitalisation. Your policy will cover these expenses because accidents are unexpected. You don’t plan for one, which is why there is no waiting period for accidents.

However, let’s say you need treatment for a medical condition. The same disease can have different waiting periods depending on when it was diagnosed.

Take cataracts, for instance. If you were diagnosed with it before purchasing the policy, you would have to wait 3 years under the pre-existing disease waiting period before making any claims related to cataracts. However, if it were diagnosed after purchasing the policy, it would be considered a specific illness and be subject to the 2-year specific illness waiting period.

However, keep in mind that these are not the only two types. There are 5 types of waiting periods. Let’s explore them in detail now.

What are the Different Types of Waiting Periods in Health Insurance Policies?

Here are the different types of waiting periods in health insurance policies:

1. Initial Waiting Period:

The initial waiting period is usually 30 days from the start date of your policy. During this time, you cannot file any claims except for accidental hospitalisations. This waiting period is standard in most health insurance policies to mitigate the risk of covering illnesses that may already be developing when you buy the policy.

2. Pre-Existing Diseases (PED) Waiting Period:

Pre-existing diseases are medical conditions you already have before purchasing the health insurance policy. The waiting period for PEDs usually ranges from 1 to 4 years, depending on the insurer, the policy, and the add-on you pick. This means that any claims related to these conditions will not be covered until the waiting period ends. Some policies allow you to reduce this waiting period with add-ons for an additional premium.

3. Specific Diseases Waiting Period:

Some health insurance policies have a separate waiting period for certain specific ailments, such as hernia, diabetes, or joint replacement. This waiting period generally lasts 1 to 2 years, depending on the insurer and the policy. Sometimes, the insurer may also impose a loading charge based on the severity of the condition.

4. Maternity Waiting Period:

If you are planning to use your health insurance for maternity-related expenses, you need to be aware of the maternity waiting period. This usually ranges from 9 months to 4 years or more, depending on the policy. During this time, any claims for maternity expenses will not be covered. This waiting period ensures that people do not buy the insurance just to cover imminent childbirth expenses. It is also important to keep in mind that most insurance policies do not cover maternity expenses, and even if they do, the premiums skyrocket compared to health insurance plans without maternity coverage. Feel free to go through this article for more information on maternity coverage.

5. Critical Illness Waiting Period:

Some health insurance policies also have a separate waiting period for critical illnesses like cancer, heart attack, and stroke. This period usually ranges from 90 days to 2 years. During this time, any claims related to these critical illnesses will not be covered. This waiting period allows insurers to manage the high risk associated with critical illness claims.

How Do Health Insurance Providers Decide On the Waiting Period for a Policyholder?

Even though waiting periods are more or less standard in health insurance policies, insurers consider a few factors when determining your waiting period.

The number one factor is probably your medical history. This includes any chronic illnesses or frequent medical issues which play a significant role. If you have pre-existing conditions like diabetes or hypertension, insurers might impose longer waiting periods.

Age is another crucial factor. Naturally, as people age, the likelihood of health complications increases. This leads insurers to extend waiting periods to manage their risk.

Insurers may also impose a loading charge on top of the base premium. A loading charge is an additional cost that we pay to the insurer to mitigate the higher risk. This charge is usually applied if you have an undesirable BMI, health condition(s), or lifestyle habits such as smoking or excessive alcohol consumption. The insurer considers all these conditions and adds an amount to the base premium.

3 Things To Know About Waiting Periods in Health Insurance Policies

1. Accidents are covered from day 1: All health insurance policies cover accidents from the first day of the policy, with no waiting period imposed.
2. Waiting periods can be reduced with add-ons in some policies: Certain health insurance policies offer add-ons that allow you to reduce the waiting period for pre-existing conditions or specific diseases. For instance, Care offers an add-on that reduces your pre-existing disease waiting period from 4 years to just 30 days!
3. Read the fine print: You need to thoroughly go through the policy documents to understand the specific terms and conditions related to waiting periods and avoid unpleasant surprises when making a claim. However, we understand that this can be a daunting task. You can feel free to use our Understand Your Policy tool to get a simplified, in-depth understanding of popular health insurance plans in India.

What are the Best Health Insurance Policies with Low Waiting Periods?

Several health insurance plans offer low waiting periods, making them attractive options for immediate coverage needs. Here are some of the top choices:

1. HDFC ERGO Optima Secure

HDFC ERGO Optima Secure plan offers comprehensive coverage with a 30-day initial waiting period, a 3-year waiting period for pre-existing conditions, and a 2-year waiting period for specific diseases. It boasts a vast network of over 13,000 hospitals, allowing you to pick any room you want. It covers pre- and post-hospitalisation expenses for 60 and 180 days, respectively. The policy also includes a unique 2X coverage from day 1 and covers AYUSH treatments, consumables, and offers a good no-claim bonus of 50% per annum up to 100%, whether you make a claim or not.

Drawbacks: HDFC ERGO charges a significantly higher premium for a health insurance policy similar to that of its peers in the market.

 2. Care Supreme

Care Supreme is designed for flexibility and affordability. It offers a 4-year waiting period for pre-existing conditions, which can be reduced with add-ons. It also has a 2-year waiting period for specific diseases, making it a flexible and affordable option. This policy can be purchased by individuals up to 99 years old, covers benign pre-existing diseases, and includes day-care procedures, AYUSH treatments, domiciliary treatments, and air ambulance cover up to ₹5 lakhs per year. It also offers an excellent no-claim bonus of 100% per annum, up to 500% of the sum insured, and a wellness discount of up to 30% of the premium for regular exercise.

Drawbacks: Care Insurance has a higher-than-average complaint ratio than its peers. It also does not include some basic features in the base policy, and we need to purchase it as an add-on.

 3. Niva Bupa ReAssure 2.0

With a 30-day initial waiting period and a 3-year pre-existing disease waiting period in the Titanium+ variant, Niva Bupa ReAssure 2.0 is a solid choice. It includes a 2-year waiting period for specific diseases and covers various medical expenses. The policy has no co-payment, disease-wise sub-limits, or room rent restrictions and includes daycare, AYUSH, and domiciliary treatments.

ReAssure 2.0 is a plan that stands out with its unique features. It features several add-ons, such as Booster Plus (no-claim bonus), ReAssure Forever (Restoration), and Lock the Clock. Lock the Clock is a stand-out feature where your premiums will only increase based on age once you make a claim. If you’re purely looking for a health insurance policy with solid features, ReAssure 2.0 by Niva Bupa is for you. However, this is not without drawbacks.

Drawbacks: Niva Bupa has a lower CSR than its competitors and a significantly higher complaint volume.

 4. Aditya Birla Activ One Max

Aditya Birla Activ One Max offers a 3-year waiting period for pre-existing conditions and a 2-year waiting period for specific diseases. The waiting period can also be reduced by purchasing an add-on. Aditya Birla offers an extensive network of over 11,000 hospitals and robust coverage options, extending base coverage of up to ₹ 6 crore! Activ One also offers add-ons that can reduce your premium, to wit, the per-claim deductible add-on and the room rent restriction add-on. The base policy does not have these restrictions. However, if you want to restrict yourself to a single private room or a shared dorm, you are welcome to do so. The base policy also does not have a per-claim deductible – you can add this to reduce your premium.

Drawbacks: Aditya Birla imposes a 10% co-payment at non-network hospitals (non-PPN hospitals). Apart from this, we feel that the company's operational metrics can be improved, and we are hopeful they can achieve this in the near future.

Why Talk to Ditto for Your Health Insurance?
At Ditto, we’ve assisted over 3,00,000 customers with choosing the right insurance policy. Why customers like Srinivas below love us:

✅No-Spam & No Salesmen

✅Rated 4.9/5 on Google Reviews by 5,000+ happy customers

✅Backed by Zerodha

✅100% Free Consultation

You can book a FREE consultation here. Slots are running out, so make sure you book a call now!

Conclusion

Understanding how waiting periods work in health insurance is one of the most important factors when selecting the best plan for your needs. Choosing a good policy with low waiting periods ensures you can access necessary medical treatments without prolonged delays. This will particularly come in handy if you have elderly parents approaching senility.

For personalised, spam-free advice, consult Ditto Insurance’s IRDAI-certified insurance experts to find the best health insurance plan tailored to your needs.