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Waiting Period in Health Insurance: Here’s all you need to know before making an insurance claim

Waiting Period in Health Insurance: Here’s all you need to know before making an insurance claim

Recently, Mr. Rajat Sharma, a resident of Delhi, bought a health insurance cover worth Rs 5 lakh sum insured and was very happy with his decision. He was quite aware of his lifestyle habits and family medical history which made him prone to various illnesses. Considering the cost of treatment of those diseases, he was sure that buying health insurance cover is the best thing to do. However, little did he know that every health insurance policy comes with a defined ‘waiting period’.

Just two weeks after Rajat bought the health policy, he was diagnosed with a 7.8 centimetres bladder stone and was advised to go for a Lithotripsy (surgery for removing stone). Unaware about the waiting period in his health insurance policy, he got admitted in his choice of hospital and went for the surgery thinking his insurer will take care of all the medical expenses. However, he was totally shocked when he was informed that as he hasn’t completed the initial waiting period of the health insurance, his claim would not be accepted. Unfortunately, Rajat himself had to bear all the medical expenses which included hospitalisation and surgery charges amounting to Rs 1.5 lakh.

 

Waiting Period – What Does It Mean

Just like Rajat, there are numerous people who buy health insurance without knowing its numerous exclusions, one amongst which is waiting period. Buying a health insurance policy does not mean that the insurer will start covering you from the very first day of buying the policy. Rather, you need to wait for a few days before making specific claims. The time span after the purchase of the policy during which you cannot claim any benefit from the insurer is known as the waiting period in a health insurance policy. Different conditions and coverage have different waiting periods and have different rules for the same. Also, the terms and conditions of waiting period vary from company to company, though in all of the cases of medical attention, you will not get any benefit during the waiting period.

Different Types of Waiting Periods

# Initial Waiting Period

Within 30 to 90 days of purchase of health insurance, the customers do not receive any claim benefit from the insurer in case of any form of hospitalisation; planned and emergency. In order to make any claim, the customers need to wait till 30 to 90 days after purchase of the policy. The initial waiting period completely varies from insurer to insurer, however the minimum waiting period is at least 30 days. The only exception in initial waiting period is accidental claims wherein the claims are approved if the insured meets with an accident and requires immediate hospitalisation.

# Disease-specific Waiting Period

There are some numerous diseases and ailments like tumour, ENT disorder, hernia, osteoporosis which come with a specific waiting period usually ranging between one to two years. The waiting period for each of these ailments is clearly mentioned in the policy details of each insurer. Also, the various ailments that qualify for such waiting period vary from insurer to insurer. A disease-specific plan provides coverage for a specific disease including cancer, diabetes, kidney ailments, cardiac ailments, hypertension, stroke and most recently even dengue at all stages — early or advanced.

# Pre-existing Disease Waiting Period

There is a special waiting period for some specific diseases which are declared by the policyholder at the time of purchase of the policy. Such diseases are known as pre-existing diseases and waiting period for such diseases is known as pre-existing disease waiting period. The pre-existing waiting period usually varies from 1 year to 4 years of continuous policy coverage. The time span for such waiting period depends on your medical condition and the insurer you choose.

# Maternity Waiting Period

There are a few health insurance companies which provide maternity benefits under the policy, but with a waiting period ranging from 9 months to 36 months. Most of the maternity plans come with a 2-4 years of waiting period and it is always advised to the customers to purchase the policy early. However, there are some insurers that offer lower waiting period but in return charge additional premium. Maternity benefits can’t be claimed within the waiting period window.

# Need for Waiting Period in Health Insurance

The clause of waiting-period in health insurance is implemented to avoid wrong intention of a person to claim benefit under insurance plan. There had been instances where customers without any health insurance, after being diagnosed with a specific disease purchased a health insurance without disclosing the disease to the insurer. So, in order to avoid such unethical practices, the concept of waiting period is implemented in health insurance cover.

# IRDAI’s Notifications on Waiting Period

The working group recommends that insurers may be allowed to incorporate waiting periods for any specific disease, condition to a maximum of 4 years. Further, waiting period for conditions namely, hypertension, diabetes, cardiac conditions may not be allowed for more than 30 days. With many people suffering from conditions such as hypertension, diabetes, this move will be of great help.