Understanding Waiting Periods in Health Insurance Policies

However, every health plan has certain exclusive rules and regulations that explain the coverage's working strategy. You must know all these facts beforehand to avoid any misunderstandings.  

One such technical jargon is the waiting period. You must understand it well to make an informed decision while purchasing.  

Meaning of Waiting Period in Health Insurance 

The waiting period refers to the specific tenure during which the insured individual cannot raise any claim for certain typical issues as per the terms of the plan chosen. To fulfil those claims, you need to wait for a predetermined period. This period begins from the date of policy commencement.  

How Does the Waiting Period in Health Insurance Work? 

The waiting period refers to the tenure during which the policyholder cannot file any claim depending on the terms and conditions of the plan chosen. This tenure begins right after policy commencement. 

Most insurers maintain an initial cooldown period of 30 days, during which no claim is entertained. Apart from this, there are specific waiting periods for specific ailments.  

So, you must read the policy document well before finalising your choice after knowing all the terms and conditions well, and analysing if it fits your requirements.  

Types of Waiting Periods in Health Insurance 

While dealing with waiting periods in health insurance policies, you must note that these are classified into multiple variants based on various circumstances: 

1. Initial Waiting Period 

Health insurance providers often refer to this as the cooling or cooldown period. Most insurers usually maintain a cooling period of 30 days, within which they will not accept any claim. This is applicable for both emergency and planned hospitalisation. However, exceptions happen depending on the gravity of the situation.  

2. PED Waiting Period 

While buying a health plan, you have to disclose whether you currently have any ailment and your general health status. If you have issues like thyroid, hypertension, diabetes, high cholesterol, etc., before purchasing a health plan, you need to disclose them correctly as PEDs/Pre-existing diseases. 

Each health policy maintains specific waiting periods for each type of illness and this tenure varies with every insurer.  

Pro tip: Try to seek plans with minimal waiting periods for every PED to enjoy optimum protection. This implies that you will enjoy coverage for those ailments without waiting for a long span. 

3. Specific Disease Waiting Period 

Certain health issues, like osteoporosis and hernias, require long-term care. Most insurance providers allow coverage for these sorts of issues only after a stipulated waiting period, as per the terms of the plan.  

Pro tip: Read the policy fine print to know the specific details of waiting periods for every ailment to get accustomed to the policy terms and avoid misunderstandings during claim settlement.  

4. Maternity Waiting Period 

Depending on the terms of your chosen health policy, you can get built-in maternity coverage or through an add-on rider. Childbirth and maternity costs are quite high, about which you need not have to worry if you have this coverage.  

Depending on the terms of your chosen policy, this waiting period usually ranges between 9 months and 4 years. If you are concerned about this coverage, you must clarify it with your insurer. 

Pro tip: Depending on your circumstances, try to opt for a plan with minimal maternity waiting period. However, if you are purchasing too early and have a few years at hand before a family extension, then you can opt for a longer span.  

5. Health Check-Up Waiting Period

Certain health insurance companies offer their customers the exclusive benefit of complimentary health check-ups. However, to avail of this facility, the policyholders often need to observe a waiting period, usually 1 year.  

Pro tip: It is best that you complete the health check-up at the beginning of your second-year coverage.  

6. Accidental Hospitalisation Waiting Period 

An unforeseen accident can severely jeopardise both financial and emotional state. Considering the circumstances, the policyholder must be immediately hospitalised to continue with the treatment process without worrying about any waiting period.  

Pro tip: Considering the gravity of the situation, insurers often waive the accidental waiting period.  

Why Do Health Policies Maintain Waiting Periods? 

Health insurance providers observe this waiting period clause to prevent misusage of the policy coverage. People may purchase a health policy after getting diagnosed with any ailment involving expensive treatment procedures.  

Some people even tend to hide any diagnostic report and then buy a policy to receive PED coverage.  

By maintaining these waiting period clauses, the insurance providers try to minimise such unethical behaviours.