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Waiting Period in Health Insurance

Considering present-day lifestyle habits and the vulnerability to developing health issues, having health insurance is mandatory to avoid financial stress during medical emergencies. However, it is essential to understand that health insurance benefits are not implemented immediately, owing to the waiting period. The waiting period in health insurance varies with the insurance company and ranges between 0 to 3 years. Read on for more information about the what is waiting period for health insurance and the types.

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Waiting Period in Health Insurance

What is the Waiting Period for Health Insurance?

Waiting Period in Health Insurance
March 04, 2025

Table of Content

 

Understanding what is waiting period in health insurance is crucial before buying one for an informed decision. It is the period for which coverage is not provided for a list of health conditions mentioned in the plan. The initial waiting period, however, varies with the insurance company.

For instance, the waiting period for pre-existing conditions ranges between 2 to 3 years from the date of commencement of the policy, which is a standard clause in most health insurance plans. Claims for such health conditions during the waiting period are not accepted. If the policyholder claims for such conditions after the waiting period, the insurance company is bound to accept the claim unless rejected for other reasons.

What is the Survival Period in Health Insurance?

Survival period and waiting period are two different clauses and are often misunderstood. The survival period is generally applicable to critical illnesses. Under this clause, the policyholder should be alive for a specific period after being diagnosed with a particular condition. The policyholder receives the lump sum payout after the completion of the survival period.

Different Types of Waiting Periods in Health Insurance

Awareness about what is waiting period in health insurance is important. For better clarity about the health insurance plan, being informed about the different types of waiting periods is crucial.

  • Initial Waiting Period

    • The initial waiting period or the cooling period refers to the period after the purchase of the policy during which claims for hospitalisation, whether planned or emergency, are not entertained. It is generally 30 days from the date of policy purchase. During this period only claims related to hospitalisation due to accidents are only accepted.

  • Pre-Existing Disease Waiting Period

    • When you fill out a form for a health insurance policy, you have to disclose pre-existing diseases to avoid complications during claim settlement in the future. Medical conditions diagnosed 36 months before the policy purchase are considered pre-existing, for instance, diabetes, thyroid, hypertension, etc.

    Pre-existing disease waiting period refers to the period from the policy commencement date during which the plan does not cover these diseases. You can claim benefits for such illnesses listed under the plan only after the completion of the waiting period.  Individuals should carefully review this type of waiting period while buying health insurance plans for parents to prevent a financial crisis in the future.

  • Specific Diseases Waiting Period

    • Some specific diseases require treatment for extended periods. Health insurance plans cover the treatment costs, but after a waiting period, referred to as specific diseases waiting period, that is different from the initial waiting period. The details of the diseases included in the plan and the waiting period for each disease are available in the policy document. The guidelines for specific diseases differ with the insurer.

  • Maternity Waiting Period

    • Some health insurance plans include maternity benefits under the base plan or provide it as an add-on*. These facility benefits individuals who are planning to start a family and are concerned about the maternity costs involved. However, there is a health insurance waiting period, i.e., a maternity waiting period that ranges between 1 to 3 years, during which the policyholder is not entitled to the benefit. While purchasing a plan with this specific benefit, ensure that the waiting period is not too long.

  • Health Check-Up Waiting Period

    • Reimbursement for health check-ups is an additional benefit provided in various health insurance plans. However, this facility can be utilised only after a waiting period, generally one year from the date of policy purchase. Such a waiting period is the health check-up waiting period. You can file a claim for the expenses incurred for annual health check-ups during the second policy year.

  • COVID-19 Waiting Period

    • The pandemic has shaken the entire world and the treatment expenses have disrupted the finances of many. Individuals opted to purchase COVID-19 health insurance plans to avoid such a financial crisis. However, if you purchase a plan without understanding the COVID-19 waiting period, you may end up losing the benefits.

  • Accidental Hospitalisation Waiting Period

    • Accidents are unpredictable and sometimes may cause grievous injuries that require immediate medical attention. An accidental hospitalisation waiting period may deprive the policyholder of immediate treatment that may at times, lead to loss of life. However, waiting periods, including initial waiting periods, do not apply to accidental hospitalisation. It is imperative to enquire specifically about such a waiting period in health insurance to avoid complications in the future.

How Does the Waiting Period in Health Insurance Work?

The waiting period in health insurance refers to the time you have to wait before you can derive the benefits covered under the plan. The period commences from the date of policy purchase. It differs with the insurer and the type of waiting period.

For instance, the waiting period for pre-existing diseases can be between 2 years and 3 years, whereas the initial waiting period can be as low as 30 days. The insurance company will not bear any medical expenses incurred during this time. It is important to understand what is waiting period for health insurance to avoid surprises while filing a claim.

Can the Waiting Period in Health Insurance Be Reduced?

Yes. You can opt for a reduction in the waiting period in health insurance. However, it depends on the policy terms and the insurance company. Some insurers provide options for a waiting period waiver or reduction in the waiting period but for a higher premium. Add-ons* like waiver of premium to the base plan can facilitate such reduction. However, group health insurance or employer-provided insurance have a much shorter waiting period than individual health insurance plans.

Understanding the Difference Between Survival Period and the Waiting Period in Health Insurance

The difference between the survival period and the waiting period in health insurance is given below:

Features

Waiting Period

Survival Period

Definition

The period during which claims are not entertained for specific health conditions.

The period for which the policyholder should survive after being diagnosed with a critical illness.

Duration

Ranges between 30 days to 4 years depending on the type of waiting period and the specific guidelines of the insurance company.

It ranges between 15 to 90 days, depending on the insurance company.

Coverage

Can claim benefits under the specific waiting period after the completionof the waiting period

Can claim the benefits only after surviving the period stipulated for specific treatments and illness.

Applicable

All health insurance plans.

Only to critical illness insurance.

Important Things to Know About the Waiting Period in Health Insurance

The important things to know about the waiting period in health insurance are:

  • You should be aware of the waiting period stipulated in your health insurance plan.
  • Keep in mind to disclose your pre-existing health issues while purchasing a health insurance policy.
  • The waiting period for pre-existing health conditions can be up to 3 years.
  • Review the policy document for details regarding the waiting period.
  • Compare various health insurance plans and choose the one with a shorter or no waiting period.
  • Buy a health insurance plan that aligns with your health needs and fits your budget.
  • Choose a health insurance plan with a longer tenure to avoid frequent renewals.

To avoid the impact of the health insurance waiting period, purchase a health insurance plan early in life when you are not prone to major health issues and are less likely to claim benefits. The other option is to go for a plan with zero waiting period so that the benefits are implemented as soon as the policy is activated.

Summary

Health insurance plans offer peace of mind, ensuring timely treatment without financial strain during medical emergencies. Similarly, life insurance provides a safety net for your family, safeguarding their financial future in your absence. Just as you should understand the waiting periods in health insurance to know when benefits begin, consider the policy's terms and coverage details in life insurance. A waiting period in health insurance indicates when the benefits start after the policy purchase date. If you wish to avail yourself of the benefits immediately after the purchase, look for health plans with zero or shorter waiting periods. Likewise, for life insurance, understand when coverage becomes fully effective. Both health and life insurance are crucial for extensive financial protection, ensuring your well-being and your family's security.

FAQs on Waiting Periods in Health Insurance

Q. What is the purpose of a waiting period?

Individuals would buy health insurance only to get the benefit of coverage for immediate treatment. A waiting period was introduced to avoid fraud and for the insurance companies to manage risks. The waiting period in health insurance prevents individuals from taking advantage of shorter periods of coverage.

Q. What is the 'Zero Waiting Period' in health insurance?

A zero waiting period in health insurance is the availability of the benefits immediately after policy activation. The coverage is available without having to wait for a certain time, especially for pre-existing diseases. This is particularly beneficial for individuals who need immediate medical attention.

Q. Is a health insurance claim admissible if a disease is diagnosed during the plan term?

Yes. The health insurance claim is admissible if a disease is diagnosed during the plan term, provided the disease is covered under the plan. It also depends on the specific terms and conditions stipulated under the plan and the waiting period.

Q. How do I check if my health insurance policy covers my existing health conditions?

To check if your existing health conditions are covered under your health insurance policy, you should review the terms and conditions of the plan. You can also get the details by calling the customer care helpline of the insurance company or by contacting their representative. Some plans insist on underground medical tests to detect any pre-existing health conditions that may impact the policy coverage.

Q. How can I reduce my waiting period for health insurance?

You can reduce your waiting period for health insurance by opting for a waiver of premium rider1 to the base plan. However, you will have to pay an extra premium for the rider.

References:

1. https://economictimes.indiatimes.com/wealth/personal-finance-news/waiting-period-in-health-insurance/articleshow/9204675.cms?from=mdr

2. https://www.investopedia.com/terms/w/waiting-period.asp

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Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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Vishal Subharwal Vishal Subharwal

Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.

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