Is There a Waiting Period for Family Health Insurance?

Waiting Period in Health Insurance: All You Need to Know

Health Insurance

A lot of individuals are first-time buyers of health insurance policy and don’t understand the concept of waiting periods properly. If you don’t quite know what the waiting period in a health insurance policy means, then you have landed at the right place. 

You might have plenty of questions about the same such as what it waiting period, why it is included, is it necessary, how it will impact your policy, and so on.  If you want to know the answers to such doubts, then read on to know everything about the waiting period in health insurance policies.

What is Waiting Period in Health Insurance?

Waiting Period refers to the period you need to wait after purchasing health insurance for being able to utilize its benefits. During this period, you cannot claim any benefits that fall under the insurance from the insurer. Now, the time span of the waiting period can vary from company to company and policy to policy. 

Why is Waiting Period in Health Insurance Important?

Health insurance companies have witnessed hundreds if not thousands of cases where the customers purchase the health policy to relish the claims and cover provided. Several incidents of hoax health insurance claims can impose a threat to the company. 

Take, for example, an individual who doesn’t have any health cover falls ill with a disease. Now, the doctor asks him to undergo a costly surgical procedure. This could create an enormous dent in their savings or worse, they might not have adequate funds to carry out the surgery. In this situation, the person could just buy health insurance without informing the insurer about his medical condition. Later, they might have the surgery covered by the health insurance policy.

So, to avoid these unethical hoaxes, the clause of the waiting period in health insurance was implemented. This avoids incidents of wrongly claiming the benefits under a health insurance policy.  

Types of Waiting Period

1. Initial Waiting Period

Initial Waiting is the time span you need to wait from the date of policy issuance to be able to use the benefits from your health insurance. This period is also referred to as the cooling period.

Generally, almost all medical insurance plans in India have a waiting period of a maximum of one month or 30 days. It could also range from 30 to 90 days from the policy starting date. 

2. Pre-Existing Disease Waiting Period

As the name suggests, certain diseases have a specific waiting period that is known as the Pre-Existing Disease waiting period. If the policyholder has any disease, then they need to declare that during policy purchase. Such diseases are called pre-existing diseases and the waiting period for the same could range from 1 to 4 years. 

Several ailments such as osteoporosis, ENT disorder, tumour, hernia, kidney problems, and critical illness like cancer, stroke, etc. come with disease-specific waiting periods. 

3. Maternity Benefit Waiting Period

Most health insurance plans for family and individuals provide you with an option to include a Maternity Benefit add-on. These are really beneficial for people who are planning a baby. 

So, the waiting period for maternity insurance plans usually lies in the range of 1 year to 4 years. This implies that you will be able to claim the cover for maternity-related spending after the waiting period. 

4. New Born Baby Waiting Period

This one is very much like the maternity benefit. In case, you plan to have a baby soon, then the newborn baby cover will provide for all the expenses of the baby for the first 90 days. The waiting period for this lies in the range of 9 months to 36 months.

5. Disease-Specific Waiting Period

This refers to the period you need to wait for being able to claim benefits for the coverage of certain diseases. Usually, the waiting period to claim for the treatment and hospitalization of a specific disease ranges from 2 to 4 years.

What Factors Influence the Waiting Period of a Health Insurance?

The waiting period of your health insurance can be effected by several factors such as medical insurance type, medical history of the applicant, age, etc. Please ensure that you go through the details of the health insurance policy before buying it. 

This will enable you to pick up insurance with a shorter waiting period. By doing so, you will be able to enjoy health insurance benefits as soon as possible.

Can the Waiting Period be Reduced?

Some of the best health insurance companies in India allow a lesser waiting period in exchange for a higher premium. Moreover, in the case of group health insurance policies, the insurer does not stress much on the waiting periods. 

The IRDA guidelines state that the employees who are included in a group health policy provided by their employer can convert this group plan into an individual health insurance plan. These employees will receive the individual health policy without any waiting period. The logic behind this is that they have spent the waiting period already when they were under the group health policy.

What Is Meant by Survival Period?

Survival Period is the time the insured needs to survive to be able to receive the claim benefits if he carries a critical illness. The policyholder needs to survive for at least 30 days in addition to the waiting period, to receive the lump-sum claim amount.

What Else Do You Need to Know About Waiting Period of Health Insurance?

Given below are some other points to keep in mind about the waiting period of health insurance:

  1. If the insured is diagnosed with an ailment during the waiting period, then this disease won’t be called a pre-existing disease.
  2. Some health insurance providers also offer a cooling waiting period of 1 month to register a claim for accidental hospitalization. 
  3. The waiting period in health insurance plans for senior citizens can be done away with by putting in a co-pay clause in the policy. The co-pay clause states that the insured will have to pay a specific part of the claim amount. 
  4. Since the cases of Coronavirus are rising in India, so the waiting period for COVID-19 related treatment has been kept at 30 days by most insurers.

Final Words

By now, the concept of waiting period must have become clear to you. A trick to escape the waiting period is buying your health plan early. Young individuals are less susceptible to ailments and have a lesser probability of having any pre-existing disease.

We have included everything there is to know about health insurance waiting period in this article. Let us know if it was beneficial to you in the comments below!