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Waiting Period in Health Insurance

​​Waiting period is the time span during which you cannot claim some or all benefits of the health insurance from your insurance provider i.e. you must wait for a specified amount of time before you make a claim. The duration of the waiting period and its terms and conditions vary from company to company. In most of the cases, you won't get any reimbursement or coverage from your health insurance policy during the waiting period.

Why is the need of waiting period in a health insurance policy?

There are several cases where a customer buys a health insurance policy to enjoy the claims and reimbursement. To avoid this moral hazard or wrong intention of getting hoax claim benefit, the concept of waiting period was introduced. Imagine an incidence where a person doesn't have a health insurance policy and is diagnosed with a disease. The doctor suggested him to go for a surgery which is quite expensive and could have put an enormous hole in his savings. Looking at the problematic situation, the person chose to buy a health insurance policy without disclosing the disease. He even got the surgery covered just after the purchase. Hence, to avoid such unethical practices, the waiting period clause was introduced in a health insurance plan.

What are the types of waiting periods?

Initial waiting period

If the person gets hospitalized in the first 30-90 days from the start of the policy, he/she won't receive any claim benefit from their health insurance policy if they fall sick or get hospitalized. There is an initial waiting period that needs to get over if you want to receive the benefits under your health insurance plan.

Pre-existing disease waiting period

There is a particular waiting period for some specific diseases which are declared by the policyholder at the time of policy purchase. These diseases are known as pre-existing diseases, and the waiting period for such conditions is known as a pre-existing disease waiting period. The pre-existing waiting period usually ranges from 1 year to 4 years of continuous policy coverage. The time for such waiting period depends on your medical status and the insurance company you select.

Maternity benefits waiting period

Some health insurance companies provide maternity benefits, but that cover comes with a waiting period varying from 9 months to 36 months.

Disease-specific waiting period

There is a specific waiting period varying between one year and two years for particular ailments like a tumour, ENT disorder, hernia, osteoporosis which are mentioned explicitly in the policy documents. These diseases vary from company to company.

The waiting period in your health insurance policy is influenced by various factors like the type of health insurance (individual health insurance, group health insurance, family floater health insurance, etc.), medical history of the insured and the age of the buyer. It is essential to read the fine print of the policy waiting periods of a health insurance policy and pick the plan with a lesser waiting period. It will allow you to avail the benefits of your health insurance policy as soon as possible instead of bearing medical expenses from your pocket due to a long waiting period clause.