Waiting period in health insurance: All you need to know

June 7, 2022

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Waiting period in health insurance

When you buy health insurance, it is mandatory that you read the policy documents carefully as despite having a high coverage policy, you can still be denied coverage by your insurance company. Your claim can be rejected by the insurer owing to the concept of waiting period. Here’s all you need to know about the waiting period in health insurance.

What is waiting period in health insurance?

The waiting period simply refers to the time you must wait to start receiving certain benefits for specific conditions under your health insurance. This means that to receive coverage for specific diseases, you must wait for a certain period from the policy start date and only after completion of the waiting period, you can take the benefits. Prior to the waiting period, a benefit cannot be filed for excluded health conditions and diseases.

For instance, you buy a health insurance policy on January 25, 2022, and the policy has a waiting period of 2 years for coverage of diseases like hernia, hypertension, etc. In this case, you can claim only after January 25, 2025, for the above-mentioned diseases.

Types of waiting period in health insurance

Waiting periods are of various types which may vary from insurer to insurer. The period can vary depending on the coverage, policy and terms and conditions. Given below are different types of waiting periods in health insurance.

 Initial waiting period

Known as the cooling period, the initial waiting period is the time for which you must wait from the date of policy issuance before you actively start using the policy benefits. The initial waiting period under a standard individual health policy is 30 days.

Waiting period for pre-existing diseases

Pre-existing disease (PED) refers to the disease that the policyholder is suffering from at the time of policy purchase. This may include diseases like cholesterol, diabetes, thyroid, etc. Waiting period for PED is usually 2-4 years, which may vary depending on the type of disease and the coverage offered. Any claim for PED and any associated medical condition cannot be made during the waiting period.

Disease-related waiting period/ Waiting period for specific disease

The health insurance policy that you buy can come with a waiting period for specific medical conditions like diabetes, hypertension, dengue, cataract, etc. Waiting period for specific medical conditions is usually 2 years. This simply means that the policyholder will have to wait for a period of 2 years before making a claim for any of the mentioned diseases.

Maternity cover waiting period

Maternity cover provides coverage for pregnancy and new-born. Not all types of health insurance policies offer maternity coverage. Moreover, the policies that provide cover for maternity come with a waiting period of 2-4 years only after which the coverage is offered.

Waiting period in group health insurance

Waiting period in group health insurance policy is usually 30-90 days, which can be waived off depending on the policy terms and conditions. For pre-existing diseases, the waiting period under individual health insurance policy is usually 4 years which varies from insurer to insurer. In a few cases, PED is covered from day one in group health cover. For maternity, the group health insurance policy may come with a waiting period of 9-24 months.

Conclusion

Overall, insurance company will deny you coverage in case you make a claim during the waiting period. It is best to read the policy documents carefully before you decide to purchase the health policy.

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