What are waiting periods in health insurance policies? – Press Hub

What are waiting periods in health insurance policies?

What Is Waiting Period?

It is a period of time when your insurance company will not cover any of your medical expenses. So, even though you have purchased a plan, you will not receive any compensation if you make a claim in the waiting period.

Normally, the waiting periods are different for each disease/ailment/treatment and also depend on the specific benefits of the policy. To know the exact waiting period applicable on your policy, you must go through the policy wordings provided by the health insurer from whom you have purchased it.

The initial waiting period starts when your policy cover begins. It could last between 15 and 90 days, depending on your insurance coverage. During this period, your insurance plan will not cover any of your medical expenses, except accidental injuries that cause you to be hospitalised for more than 24 hours.

Waiting period in health insurance is essentially the period during which you may not use the benefits of your health policy. It is calculated from the date your health policy is issued for the first time.

Health insurance plans have a separate waiting period for conditions which are declared by the policyholder when purchasing the policy. These ailments are known as pre-existing conditions. These conditions include heart problems, high/low blood pressure, diabetes and so on. The policy holder will have to wait between one and three years, depending on the health insurance provider and the plan to get coverage for these conditions.

Health insurance policies usually have an ‘initial waiting period’ of about a month. What it means is that you cannot use any of your policy benefits for a month starting from the date your policy was issued. This is valid only for the first time you are buying a policy and doesn’t apply on policy renewals.

“Any hospitalization claims arising due to accidents do not apply to this clause and customers can avail the policy benefits for them,” said Parag Ved, head – consumer lines, Tata AIG General Insurance.

To completely understand what ‘waiting period for pre-existing diseases’ means, you need to understand what insurers mean when they mention ‘pre-existing diseases (PED)’ in the policy.

The Insurance Regulatory and Development Authority of India (Irdai) has standardized the definition of PED across health insurance policies. A pre-existing disease refers to any condition, ailment, injury or disease that has been diagnosed up to 48 months before buying your health policy.

Some examples of pre-existing diseases include diabetes, hypertension, thyroid, etc. If you are already suffering from a PED, it is usually not covered by your health insurance immediately. There is a waiting period from the date of policy issuance after which you can use the policy benefits.

Medical contingencies have a way of putting a strain on our finances. The rising cost of medical treatments and the rising incidence of diseases spell a warning for our finances. In these situations a health insurance plan becomes necessary. But does your health plan cover every medical contingency suffered by you?

No, it does not. Every health insurance plan has a list of exclusions. This list states the instances of medical contingencies which are not covered by the plan. Common exclusions include hospitalization due to suicide or self-inflicted injuries, HIV/AIDS, participation in hazardous sports and activities, acts of criminal nature, etc. One such exclusion, which is common to most health plans, is the coverage for pre-existing illnesses.

What is a waiting period for pre-existing diseases?

Health insurance plans exclude the coverage for pre-existing diseases for a specified period. This period is called the waiting period. If you suffer any complication due to any pre-existing disease and seek treatment within the waiting period, the costs of such treatments would not be paid. There are two types of waiting periods in your health plan:

  • Regular waiting period – This is a waiting period for pre-existing illnesses. Different health plans impose different waiting periods. Normally, such waiting periods range from 1 year to a maximum of 4 years.
  • Specific waiting period – certain treatments have a fixed waiting period of 2 years after which they are admissible. This waiting period is called a specific waiting period. These treatments might or might be related to your pre-existing diseases. A specific waiting period of 2 years is applicable in all health insurance plans in addition to the regular waiting period for pre-existing illnesses. Some common treatments for which the specific waiting period is applicable include sinusitis, tonsillitis, cataract, hernia, piles and fistulas, etc.

What to do if you have a pre-existing illness?

Though you might feel dejected that your health plan has terms and conditions in place for your pre-existing illnesses, there are ways to deal with such conditions. Here are things which you should do when buying a health plan with pre-existing diseases:

  • Be honest – the first and foremost thing to do is declare your illnesses. Though your plan would exclude coverage for your illnesses, temporarily or permanently, you would have the assurance of claim If you do not declare your pre-existing illness and later suffer from it, the insurer would investigate the cause of claim. If it is discovered that the claim is a result of a pre-existing illness which was not declared, the claim would be rejected and your policy might become null and void. So, declare your illness when you buy the plan. Though it might be covered after the waiting period, your policy would at least pay other medical expenses and would be valid.

Also read why your health claim was rejected

  • Explore plans – different health plans have a different tenure of waiting period. Explore various plans and find the one with the lowest waiting period.
  • Buy young – pre-existing diseases usually occur in older ages. So, buy a health plan when you are young and healthy. That way you could wait out the waiting period when you have no illnesses and get complete coverage when you age and develop such ailments. Also, don’t forget to renew your policy for a continued coverage.

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