What is Waiting Period?

A waiting period is the length of time after which certain conditions are first covered by your health insurance plan. It starts when the policy is issued and is also referred to as the cooling-off period. For instance, the majority types of health insurance plans contain a very frequent clause requiring a 4-year waiting period for pre-existing conditions. *

The insurer has the right to deny a claim if the policyholder submits it to their health insurance provider before the waiting time has expired. But, the insurance provider cannot reject a claim that the policyholder makes after the waiting time has passed. For instance, the insurer would deny your claim if you submit it within 60 days of the end of the 90-day waiting period for diabetes. Yet, if you file a claim after 90 days, it won’t be rejected. *

Health insurance waiting period types

  • Existing Conditions (PED) Waiting Period: Pre-existing diseases are conditions that exist at the time of obtaining health insurance, such as diabetes, hypertension, thyroid issues, etc. Pre-existing conditions are covered by almost all health insurance plans after a waiting period of typically two to four years. This suggests that any hospitalisation costs associated with the listed illnesses can only be reimbursed after four successful years with the insurance company. *
  • Waiting Periods for Certain Conditions/Procedures: Health insurance policies typically contain a one- to the two-year waiting period for certain conditions and operations, such as ENT diseases, hernias, osteoporosis, joint replacement surgery, cataract, etc. Only when the one or two-year waiting period has passed will any medical costs associated with such diseases or procedures be paid.
  • Initial Waiting Period: Nearly all health insurance plans have a 30-day or one-month initial waiting period during which cumulative bonuses are accepted, with the exception of accidents. *
  • Crucial Conditions Waiting Period: Most health insurance policies have a 90-day waiting period before providing coverage for serious illnesses, and they deny any claims made during that time.
  • Waiting Time for Maternity Benefits: A number of health insurance plans only provide coverage for new babies and expectant mothers after waiting periods of between 9 and 36 months have passed.

Is a waiting period reduction possible?

The waiting period under health insurance coverage can, in fact, be shortened. By choosing a waiting period waiver, certain insurance companies provide customers with the option to shorten the waiting time. Such exemptions can, however, be acquired by paying an additional premium sum. For instance, a PED waiver is offered by a number of health insurance plans for families, which reduces the four-year waiting time for such disorders to two years.

Typically, insurance companies do not impose waiting periods on group health plans that employers provide to their employees. Also, if employees convert their group health plan to an individual plan, they are eligible for health coverage without a waiting period. In accordance with IRDA regulations, workers who are covered by a group health plan provided by their employers may change that coverage to an individual retail health policy when they leave that employment. Although they had previously used the waiting period for the group health insurance offered by their individual workplaces, they would then be awarded a policy without one. #

Crucial information regarding the waiting time for health insurance

Consider the following crucial details about the waiting period for health insurance:

  • It will not be referred to as a pre-existing disease if the insured receives a first-time diagnosis of a condition during the waiting period. In this scenario, the illness is covered by the coverage.
  • There are several senior health insurance plans available today that eliminate waiting periods by including a co-pay clause.

* Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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