What is the waiting period in Health Insurance policies?

How often have you heard about waiting periods or cooling-off periods from your insurers or health insurance agents?

What exactly does it mean? What are its implications for policyholders? Can this be a deciding factor when choosing a health insurance policy that suits your financial & medical requirements?

Let’s decode!

What is the Waiting Period in Health Insurance?

The waiting period in a health insurance plan is the span for which a policyholder has to wait before he/she can access the sum insured (coverage). If the policyholder has to be hospitalized during the waiting period, the availed insurance doesn’t cover treatment costs. And if the policyholder raises a claim for these treatment charges, the claim is rejected.

However, there is 1 exception to this rule -

EXCEPTION: With most of the policies offered by the best health insurance providers across India, accidents & their treatments are covered from Day 1.

What are the different types of waiting periods in health insurance?

Based on the health insurance policy availed, the insurance provider approached, the pre-existing conditions of the policyholders, & multiple such factors, the waiting period varies. Based on these factors, the health insurance waiting period can be categorized into a few types -

1. Initial Waiting Period:

Once a health insurance plan has been availed, there is a 30-day waiting period from the day the plan commences (except in accident cases). This span is more or less the same for all health insurance plans across the industry. During this plan, any claims raised (apart from accidents) for treatment are rejected by the health insurance provider.

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

The name is self-explanatory in the case of Pre-Existing Diseases or PED and their subsequent waiting period. If a policyholder has certain ailments before availing of the plan, they are called PED. Insurers put a certain waiting period before the treatment of such conditions is covered under a health insurance plan.

The existing illness waiting period may be between 2 and 4 years. During this span, the insurer refuses to cover the cost of treatment of these diseases or any other complications arising from the same ailment.

3.   Waiting Periods for Specific Diseases/Procedures:

Each insurance provider has a list of specific ailments and/or procedures that come with a certain waiting period. Even if these ailments are contracted after the availing of the health insurance plan, policyholders have to wait for a specific span before their insurance kicks in & cover the treatment charges for these diseases and/or procedures.

For most health insurance plans, the waiting period for specific ailments/procedures extends to a maximum of 2 years. Of course, various conditions listed under this category have different waiting periods. With the specific diseases/procedures, you are most likely looking at cataract surgery, ENT surgeries & treatments, knee replacement surgeries, etc.

4.   Waiting Periods for Critical Illnesses:

For potential policyholders with critical ailments, getting a health insurance insurer who’d offer a policy is a huge deal. Considering that critical ailments indicate substantial payout over frequent hospitalization, the steep cost of treatment, and more, insurers are reluctant to offer any plan.

Thus, when individuals with critical ailments (for example, cancer) are offered a health insurance policy, it comes with a substantial waiting period. And despite this, individuals avail of such critical ailment health insurance plans because it mitigates the burdening cost of treatment that pushes a family into a financial abyss. Thus, the extensive waiting period is a compromise they are willing to make.

5.   Waiting Periods for Maternity Benefit:

Multiple policies come with an in-built maternity health insurance plan. While some offer coverage only for the mother, some insurers also extend the coverage to the newborns. However, such perks come at the cost of an extensive waiting period that usually ranges from 3 to 4 years.

[P.S. There are also health insurance plans in the market requiring a lower waiting period of 9 months. However, in such cases, the premiums are exorbitant, pushing the policyholder into a dire financial crunch.]

What factors decide the waiting period in a health insurance plan?

While there is a more or less standard waiting period on health insurance plans, a few factors may impact the waiting period, thereby extending it.

Age

With age, the chances of health complications are heightened. This suggests more chances of raising a claim over hospitalization, treatments, daycare treatments, etc. Hence in the case of senior citizen health insurance plans, both the waiting period & the premium are spiked compared to a standard plan.

Pre-existing medical conditions

In the case of policyholders with Pre-Existing Medical Conditions, the waiting period often gets extended. Insurers impose a certain period (varies based on the disease in question) before they are willing to cover the treatment of that disease and its subsequent complications.

Availed insurance policy

The waiting period varies substantially based on the insurance provider and the health insurance plan that one avail -

And hence, the waiting period has become a significant factor when determining a health insurance plan that best caters to your tailored medical requirements.

5 Must-Know Facts about Waiting Periods in Health Insurance Policies

1. Balance or remaining waiting period are transferable in the case of health insurance portability.
2. In the case of some health insurance providers and their plans, there is a waiting period for the perk of a free annual check-up that comes with their policies.
3. There are NO WAITING PERIODS or COOLING OFF PERIODS regarding coverage for accidents.
4. Waiting periods can be reduced by -

• Additional premium payment post-discussion with your health insurance provider.
• Availing of a health insurance add-on like Reduction in PED add-on, like in the Care Advantage plan from the stable of Care.

5.  Waiting periods are not applicable in most corporate health insurance policies. With the best Employee Health Insurance plan, the cost of treatment for all ailments is covered from Day 1.

Frequently Asked Questions