What is the waiting period in health insurance?

Let’s take one step at a time and start by understanding what the waiting period in health insurance is: A common term you would come across while purchasing a policy. 

What is the Waiting Period?

A waiting period is simply the duration during which the insurer does not offer coverage for certain diseases and ailments. It is only after the lapse of the waiting period that the insured can avail themselves of the advantages of the policy. 

The waiting period is not the same for every health insurance company, and it even changes depending on certain diseases and critical illnesses like cancer. Let’s take an example to understand the waiting period better: Suppose you purchase a health insurance plan that offers coverage for listed critical illnesses, but the waiting period is 30 days. Now, during these 90 days, you can not raise a claim for such critical illnesses. 

Note: The waiting period is calculated from the date of policy issuance. 

Different Types of Waiting Periods in Health Insurance

Typically, health insurance companies have five types of waiting periods that you must be aware of. Let’s take a look:

1. Initial Waiting Period: The initial waiting period is usually the first 30 days of policy issuance, under which the insurer does not cover claims for any of the coverages in the policy document. However, in most cases, coverage for claims raised for accidental cases is provided.
   
   Typically, most health insurance companies have a 30-day initial waiting period for treatments.
   
   Did You Know the Insurance Regulatory and Development Authority of India has made it mandatory for health insurance companies to not exceed the initial waiting period beyond 30 days? 
    
2. Pre-Existing Diseases Waiting Period: As the name suggests, a pre-existing disease waiting period is the duration during which your claims are not admitted for pre-existing diseases. Pre-existing diseases are those diseases that you were diagnosed with at the time of purchasing the policy itself. Some common examples of pre-existing diseases are diabetes, thyroid, asthma, etc. 
    
3. Critical Illness Waiting Period: A critical illness waiting period is the duration during which claims are not admitted by the insurer for listed specific critical illnesses. Some examples of critical illnesses are cancer, stroke, kidney ailment, etc. Usually, the waiting period for critical illnesses is 90 days from the date of policy issuance.
   
   Did you know that many insurance companies also have a survival period clause, which means that the insured has to survive at least 14 to 30 days from the date of policy issuance to raise any claims.
    
4. Specific Ailment Waiting Period: A specific ailment waiting period is the duration under which you cannot raise a claim for specific ailments, conditions, procedures or treatment. Typically, health insurance companies offer coverage for different types of treatment and procedures, but during the waiting period, the insured cannot raise a claim. 
    
5. Maternity Benefits Waiting Periods: If the health insurance policy offers maternity benefits, it typically comes with a waiting period of 9 to 36 months during which the insured cannot raise any claims for such benefits.

Why You Must Check the Waiting Period in Health Insurance?

Choosing the right health insurance policy requires you to evaluate different aspects of the policy, and the waiting period is an important one. Here’s why:

1. To Understand the Policy Coverage Better: Understanding coverage under the health insurance policy is not only about checking the list of services, health conditions and diseases that are covered under the policy. You must also understand when you are eligible to raise a claim for such coverage offered by the insurer. This also helps you choose the right policy depending on the waiting period and your medical needs.
2. To Avoid Claim Rejection: If you raise a claim during the waiting period, there is a high chance that your claim will be rejected. To avoid claim rejection, you must understand the waiting period clause carefully.
3. To Reduce Waiting Period: Many health insurance companies also offer an option to reduce the waiting period for certain diseases and health conditions. But to make an application for a reduction in the waiting period, you must first understand the different types of waiting periods.
4. Make the Right Choice: Choosing the right health insurance policy requires you to understand the waiting period carefully because claim benefits are applicable only once the waiting period under the policy is over. Additionally, if you are purchasing a health insurance policy for a senior citizen, comparing the waiting period for specific diseases of different health insurance companies is a step you must not ignore.