Waiting Periods Under Your Health Insurance Plans

A business deal is considered to be successful only if the buyer and the seller, both are the beneficiaries of that deal. There are different ‘types of Waiting Periods’ under health insurance plans.

A health insurance plan is no different where the buyer (insured) gets optimum health coverage and the seller (insurer) earns profits by providing the health cover. But, every insurance provider puts in certain clauses in the policy documents to keep a check so that no one misuses the health cover and also to ensure that the insurance company doesn’t incur losses owing to higher payouts compared to premiums received.

One of such important clauses is the WAITING PERIOD.

Definition of Waiting Period

This can simply be defined as a pre-specified period of time after the commencement of the policy that has to pass before the insurer becomes liable to entertain all or some of your claims. It means that you cannot start filing the claims immediately after buying the insurance; you’ll have to wait for some time at least. This time period varies from policy to policy and insurer to insurer based on certain pre-set parameters of the insurance company.

It also depends on the age and medical history of the policyholder.

There is no waiting period in the employer-based health insurance policy and you get the cover under a group health policy from the first day.

The waiting period in a health insurance policy is there to eliminate planned claims and moral hazards. If there will be no waiting period in a health insurance policy, then the misuse of the policy will grow as people will start buying the policy for planned claims and it will result in an unimaginable loss for the insurers.

Every detail about the waiting period of the policy is mentioned in the policy document and it is very much necessary to go through the waiting period clause and understand it well. There are different type of waiting periods in a health insurance plan which are as follow:-

Type of Waiting Periods 

1. Initial Waiting Period

This period begins after the commencement of the policy and lasts for 30 to 90 days depending upon the individual health insurance company. Any claim in regards to any illness or disease will not be entertained by the insurer during this period. The only exception to the rule is the accident cases, but that too, if it involves at least 24 hours of hospitalization.

2. Pre-existing Diseases Waiting Period

If you’re already suffering from chronic diseases like diabetes, or a heart ailment, at the time of buying the health policy, then the insurance company has the liberty to either include it under the health coverage or totally exclude it. Even if it includes such pre-existing diseases, they put a waiting period clause to them under which you cannot claim for the treatment of such diseases for a period of 12-48 months from the date when the policy gets executed. Any medical expenses on such diseases will be borne by you. However, you can definitely apply for the claim on any other ailments after the policy came into effect after crossing the initial waiting period. This specific waiting period is based on your age, insurance policy terms’, your health before buying a policy, etc.

3. Disease-Specific Waiting Period

This type is disease-specific and varies from insurer to insurer. During this period, a particular kind of ailment or disease will not be covered by your health plan. Some of the common ailments that are considered for this waiting period are ENT disorders, diabetes, osteoporosis, osteoarthritis, hypertension, hernia, and polycystic ovarian diseases. These are ideally covered at least after 2 years of the commencement of the policy. In some cases, even maternity claims are not included in the insurance claims.

4. Maternity Benefits Waiting Period

Some of the health insurance companies provide maternity benefits under their health insurance policy, but with a specific waiting period of 9 months to 36 months. This is to ensure that health insurance policy should be planned much before one’s decision to start a family.

Do go through this clause when you’re conducting your research to buy a health policy, and select the plan that offers the least possible waiting periods.

5. Bariatric Surgery Waiting Period 

Some of the health policy offers to cover this surgery, But before getting the coverage of this surgery you have to wait a fixed period of time, and after that, you will be able to claim to cover the surgery. For those who don’t know about Bariatric Surgery, it’s surgery on the stomach and/or the intestines that helps the patient with extreme obesity-related issues. Most of the time, having this problem is common in people who have a BMI of more than 40 and they are facing health problems regularly. Almost every insurance company takes a certain period of time to cover any kind of critical illness and the waiting period is just for checking you as a customer.

6. Coronavirus Waiting Period

Covid-19 pandemic was quite enough to know about that, this advanced world needs to improve them more. After the outbreak of Covid-19’s first wave, IRDAI comes with a new norm, that every health insurance company should introduce a new policy to prevent Covid-19. After this new norm, every company comes with a “Corona Kavach Policy”, under this policy insured person will have to wait 30 days after that he will be able to claim the coverage of the policy. An insurance company never wants to take any kind of risk, and the way Covid-19 affects our waiting period becomes an important part of the policy.

Benefits of having ‘Waiting Period’

The Waiting Period is quite a good option and plays various roles for Health Insurance Policy. The waiting Period gives a different perspective to know about the particular need of the customer, and it gives the proper time to cover the whole risk. The insurance company never deals in loss, being insurers they never take risks just because this is all about benefit.  The waiting period is basically a time difference in which the insurance company knows about the insured person whether his need is genuine or they come with the wrong intention. There are multiple types of waiting periods as per different plans.

Compare health plans to find the best one, not only based on waiting period criteria but also according to other parameters. However, knowing your waiting period can help you prepare for emergencies and you can arrange for your finances accordingly, keeping in consideration that the insurance provider may not come to your rescue.