Introduction
A health insurance plan acts as a solid financial shield, protecting you against the onslaught of medical expenses, both planned and sudden. But, before you can find comfort in its protective embrace, you’ll have to face something known as waiting periods.
Which quite literally mean periods of time you need to wait for before your health insurance coverage begins.
Let’s understand what waiting periods are, why insurers impose them, and their various types - in this article. 👇
What Are Waiting Periods?
A waiting period is, in the simplest sense, a span of time you need to wait for before your health insurance coverage commences. During this time, you will not be able to make a claim under your plan. Once the waiting period is over, you can unlock the full potential of your health coverage.
Why Are Waiting Periods Imposed In Health Insurance?
Insurance companies levy waiting periods (also called ‘temporary exclusions’) for specific health conditions or medical treatments to keep health insurance claims under control. This, in turn, keeps health insurance affordable.
Types of Waiting Periods In Health Insurance
There are 3 main kinds of waiting periods in health insurance –
1️⃣Initial Waiting Period
Health insurance policies come with an initial waiting period of 30 days, during which no treatments or medical conditions will be covered, except for those related to accidents. In other words, any medical expenses for illnesses, injuries, or conditions (except for accidents) cannot be claimed for the first 30 days after the policy is issued. After the initial waiting period, all treatments are covered as per the policy’s terms and conditions.
2️⃣Pre-Existing Diseases Waiting Period
Pre-existing diseases are health conditions that you have been diagnosed with or received treatment for within 3 years before applying for health insurance. The waiting period for pre-existing conditions may range from up to 3 years, depending on the policy. During the waiting period, any treatment or complication arising from the pre-existing condition will not be covered by the policy.
With the advent of new features and benefits, the PED waiting period may be different in some health insurance products -
👉Some plans give you the option to lower the PED waiting period by option for an add-on and paying an extra premium. Like, the Care Supreme Plan provides an add-on by which the PED waiting period can be reduced from 48 months to 12 months.
👉Some plans come with a shorter waiting period for a few PEDs, like asthma, hypertension, etc. You can read about this in more detail in the article we have written on Shorter Waiting Periods for PEDs.
Keep in mind that a pre-existing condition listed under the relevant waiting period is different from declaring any existing diseases in the health insurance proposal form. To ensure that you receive the right coverage, it is crucial to provide complete and honest information while filling out the proposal form.
3️⃣Waiting Period for Specific Diseases/Procedures
Apart from the initial waiting period and the pre-existing disease waiting period, health insurance policies can also have a waiting period for specific medical conditions and treatments like hernia, haemorrhoids, chronic kidney disease, spinal disorders, etc. This waiting period typically lasts for up to 3 years. The complete list of such illnesses is usually available in the product brochure or policy wording.
Once this waiting period is fulfilled, you can begin making claims for the specified treatments or procedures. It is essential to familiarise yourself with the list of specific diseases excluded during the waiting period to help you avoid unexpected rejections if you need to make a claim.
This waiting period is different from the one imposed for pre-existing diseases and is also unrelated to the medical declarations you make at the time of purchasing the policy.
4️⃣Other Waiting Periods
Waiting periods may also apply to some benefits under your health insurance plan. For example, coverage for bariatric surgery costs or maternity expenses may have their own waiting periods.
When Are Waiting Periods Applied To Your Plan?
Waiting periods only apply when you initially purchase the policy. Once the waiting period is completed, you don't have to serve it again, whether it’s when you renew the policy or port it to a new insurance company.
However, suppose you decide to enhance your existing sum insured during policy renewal or when porting your policy. In that case, the insurance company will impose a fresh waiting period specifically for the increased sum insured.
Let’s understand this better with the help of an example.
Daksh purchases a health insurance plan with a sum insured of Rs 15 lakhs in January 2023. He was diagnosed with diabetes in 2021, and the insurance company imposes a 3-year waiting period for this pre-existing condition.
This implies that Daksh will not be able to claim any medical expenses for diabetes-related treatments until January 2026.
In January 2024, Daksh decides to enhance his sum insured by Rs. 5 lakhs. This increases the total sum insured to Rs. 20 lakhs. Due to this modification, a fresh 3-year waiting period for diabetes will be applicable for this increased sum insured.
Therefore, Daksh will need to wait until January 2027 to make any claims specifically related to diabetes for the increased amount of Rs. 5 lakhs.
Waiting periods are just one aspect of health insurance. Want to dig deeper? Post your questions on the buzzing MyInsureBuddy Forum, and insurance experts will answer them all! :)
Note: Earlier, a pre-existing disease was any disease or condition that was diagnosed, treated, or sought medical advice in the last 48 months. This has been changed to 36 months, from 1 April 2024. The maximum waiting period for pre-existing and specific diseases has also been reduced to 36 months from 48 months.