Waiting Period in Health Insurance
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What is Waiting Period in Health Insurance?
The simple meaning of the waiting period is that the insurance company will not pay benefits or reimburse expenses during this period.
How Do the Waiting Periods Work in Health Insurance?
The duration of a waiting period and the applicable terms & conditions can vary across insurance companies. The waiting period also depends on the level of insurance coverage you need and the health condition(s) for which you seek insurance protection. A few insurance companies fix the waiting period based on the age and medical history of the policyholder.
The waiting period can range from a few days to a few years. Some health insurance plans may not have any waiting period at all.
Importance of Waiting Period in Medical Insurance
A health insurance company collects premiums from the policyholders and provides them coverage for specified medical conditions. The cost of medical treatment shall be compensated by the insurer to the insured.
But the annual premium paid by an individual policyholder is significantly less than the level of insurance coverage offered to that person. Excessive claims in a short time span can even bankrupt the insurer. So the concept of a waiting period in medical insurance helps to safeguard the interests of the health insurance companies.
Why is There a Waiting Period for Health Insurance?
Without a waiting period, anybody can purchase a health insurance policy and immediately make a medical claim for their pre-existing diseases. Many of these health conditions are not only expensive to treat but also require long-term care.
But specifying a waiting period helps the insurer to prevent any misuse and malpractices by the policyholders. Asking them to wait a while before claiming insurance benefits can prevent manipulation and undue risks to the insurance company.
Types of Waiting Periods in Health Insurance
1. Initial Waiting Period
The period between the date of policy commencement and the date from which you are entitled to use the policy benefits is known as the initial waiting period. This period typically ranges between one to three months. No insurance claims are admissible during this initial waiting period. But the only exception is an accidental claim. The claim is approved only if the policyholder meets with an accident during this period and requires hospitalization.
2. Waiting Period for Pre-Existing Diseases (PED)
The PED waiting period's meaning is simple. The policyholder may already be suffering from specific ailments at the time of buying a health insurance policy. These are called pre-existing diseases and should be declared by the insured at the time of purchase. The waiting period to cover such conditions is known as the pre-existing disease waiting period. This period can range between one to four years. It depends on the policyholder's health and other terms & conditions of the policy.
Certain health conditions, such as hernia, cataracts, osteoporosis, ENT disorders, joint replacement, etc., have specified waiting periods as mentioned in the policy document. It generally ranges between one to three years and depends on the policy's terms & conditions.
If you are planning for pregnancy, it pays to start early on. Most health insurance companies specify a maternity waiting period of three to four years. A maternity care policy covers all the delivery expenses. You can also buy a separate add-on cover for the newborn baby.
Some insurance providers have started reducing the waiting period to respond to market demand. But this benefit carries the cost of a higher premium amount.
Many insurance companies offer the benefit of free health checkups every year to their policyholders. But this is often subject to a caveat. The policyholders have to wait for at least one year to enjoy this benefit.
Tips for Managing Waiting Periods
Compare the policies to choose a suitable plan with the shortest waiting period.
Some health insurance policies provide zero PED waiting period coverage. The condition is that you must fully disclose your health condition. The insurer typically charges a higher premium to waive the waiting period.
Negotiate with the insurance provider to reduce the waiting period by paying a nominally higher premium.
Some health insurance plans may lower or waive the waiting period by inserting a co-payment clause.
Group health plans offered by employers generally do not insist on a waiting period. You can check and confirm this with your employer.
There is no waiting period for accidental hospitalization. The expenses will be covered from day one of your policy.
Are Waiting Periods Fixed in Health Insurance?
The waiting period depends on the insurance company and the terms & conditions of the health insurance plan. But the benefit of changing the waiting period to suit your convenience may affect the premium you pay.
Some insurers may offer to lower the premium by extending the waiting period. But you may have to forego the insurance coverage benefits for a more extended period. You also have the option to reduce the waiting period by paying a higher premium.
What is Survival Period in Health Insurance?
Critical illness insurance plans provide coverage for life-threatening diseases like cancer, heart attack, kidney failure, stroke, etc. This policy pays a fixed lump sum amount to the policyholder after the disease is diagnosed.
The survival period refers to the time duration for which the policyholder has to survive after being diagnosed with a critical illness. This period ranges between 15 days to 180 days. The lump sum amount is paid only if the policyholder survives this period. The survival period is in addition to the policy's waiting period.
Frequently Asked Questions on the Waiting Period
No. Unless the insurer waives the waiting period, you cannot raise any claims during this period. The only exception is hospitalization for accidents which is covered from day one.
The waiting period for health insurance depends entirely on the insurance provider. Some insurers may offer to reduce or waive the waiting period in lieu of a higher premium.
The most significant advantage of a lower waiting period is that you can quickly avail yourself of the policy’s benefits. The shorter the waiting period, the faster you can get health insurance coverage.
The only exception to the waiting period in health insurance is accidental hospitalization. Health insurance plans cover accidental hospitalization immediately after your policy commencement.
The waiting periods are not fixed and uniform in health insurance policies. It depends on the specific health condition and the terms & conditions of the policy. Please check the policy document or contact your insurance provider.
The waiting period in health insurance may have limitations, exclusions, and other terms and conditions that may affect coverage. It is important to carefully review the policy wording before making any decision.