A lifesaver, a money-saver, and an invaluable asset – Health Insurance is a lot of things rolled into one neat package. It covers your costs when you are hospitalized due to an accident or an illness. The premium you pay, translates to extensive coverage, keeping your savings intact. But do you know why everyone insists that you get the policy before you are ever hospitalized? Why can’t you buy insurance after being diagnosed of an illness? It’s because of something called Waiting Period in Health Insurance. Find out everything there is to know about this incredibly crucial insurance clause.

What is Waiting Period in Health Insurance?

In Health Insurance, waiting period is that span of time during which, a policyholder, cannot access their insurance policy. Also referred to as a ‘cooling period’, it is that duration of a few months or years during which you cannot file a Health Insurance claim, even though you may an existing policy. If you are hospitalized during this time, you have to bear the hospitalization costs from your own pockets. If you do file a claim during this time, the insurer is not liable to accept or approve it.

The Logic Behind Waiting Period – Why It Exists?

As to, why waiting period exist in Health Insurance; the answer is simple. Health Insurance companies offer policies at lower rates. In comparison, the coverage amount (also known as sum insured) is significantly high.

Now, if you were to buy a policy today, for say ₹5,000, and file a claim worth ₹250,000 in a week’s time, would it be fair for your insurer to cover such a high amount? As such, the waiting period exists so that the insurer can ensure that you have purchased the policy while you were in sound health, and not after being diagnosed of an illness.

Types of Waiting Period in Health Insurance

TL;DR Points

Breaking Down Health Insurance Waiting Periods

Let us now decode each type of waiting period in Health Insurance one by one.

• The Initial Waiting Period

The initial waiting period is typically applicable to general Health Insurance policies that you may have purchased as an individual or for your family. It typically lasts up to 30-90 days, depending on your chosen insurer. Any claim you file during this initial waiting period, is subject to rejection. Your insurer is not liable to cover such claims.

If you do need hospitalization, you must bear all treatment costs on your own. However, you can stack the odds in your favour to ensure this doesn’t happen by purchasing Health Insurance when you are young and healthy. In such cases, the possibility of you having to file a claim so imminently after buying insurance is incredibly low. So, you can ride out the waiting period effortlessly.

• Pre-existing Diseases Waiting Period

Did you know that insurers provide health coverage even if you have an already existing illness? Yes, you can get insurance for several pre-existing ailments. However, you must declare the same to insurer while purchasing the policy.

Depending on your ailment, the insurer determines a waiting period that can last for 24-48 months. If you are hospitalized for these ailments during the waiting period, the insurer is not liable to cover the treatment costs associated with the pre-existing diseases. You must bear the costs yourself.

• Specific Diseases/Procedures Waiting Period

Every insurance company usually has a list of specific medical conditions and procedures that comes with specific waiting periods. Even if you contract the illness or need to undergo a procedure after purchasing your Health Insurance plan, you cannot file a claim for those specific diseases/procedures, until you ride out the waiting period.

In most cases, thewaiting period in Health Insurance for specific diseases and procedures lasts for approximately 24 months. Some of the treatments/procedures against which you can file a claim only after riding out the waiting period include vision-related disorders, hernia, knee replacement surgery, ENT procedures, etc.

• Waiting Periods for Critical Illnesses

Critical illnesses are those ailments that are physically and financially draining. The treatment of illnesses like cancers, kidney diseases, cardiovascular ailments, etc., often results in long-term care, not to mention, steep treatment costs. As such, these policies typically come with a significant sum insured attached to it, which, in turn, translates to longer waiting periods.

In most cases, the Health Insurance waiting period for critical illness policies lasts up to 4 years. You can only file a claim if you have been diagnosed of these critical ailments after four years of purchasing the policy. Some insurers also insist that you ride out a survival period, typically lasting up to 30 days, since the diagnosis of the critical ailment.

• Waiting Periods for Maternity Benefit

There was a time when maternity costs were not covered under Health Insurance plans. But thanks to the IRDAI, today you can get maternity coverage as a standalone policy or an add-on rider. However, like all insurance policies, you may claim maternity coverage after riding out a waiting period.

While some maternity policies cover the costs of the pregnant woman alone, others may extend coverage to the newborn baby as well. The waiting period in Health Insurance for these policies can last anywhere from 36 to 48 months. While it covers pregnancy costs, couples looking to start a family must assess the policy terms properly and accordingly plan pregnancies.

• Waiting Period for Accidental Hospitalization

In Health Insurance, there is one caveat in which waiting period does not apply, and that is accidental hospitalization. Yes, if you buy a policy today, are injured in an accident tomorrow, and need to seek treatment, you can file an accidental hospitalization claim.

In case of accidental hospitalization, the insurer waives off the waiting period, since the treatment you need is not technically for an illness or a disease, rather an unpredictable situation. However, this zero waiting period Health Insurance clause applies only to base or general Health Insurance policies like individual and family floater Health Insurance policies.

Can I Reduce My Health Insurance Waiting Period?

Yes, many insurance providers allow you to reduce the waiting period in Health Insurance. You may opt for a waiting period waiver on specific health plans. However, to get this benefit, you may need to pay a slightly higher premium.

For instance, if you have a pre-existing illness policy with a 48-months waiting period, you may be able to reduce the waiting period to 36 or 24 months. The premium for reducing the waiting period to 24 months may be slightly higher compared to that levied on reducing the waiting period to 36 months.

Important Points Related to Health Insurance Waiting Period

Let us now look at some incredibly crucial points surrounding Waiting Period in Health Insurance that you should not miss:

• Waiting periods differ from one insurer to another.
• Different waiting periods apply to different insurance policies and medical conditions.
• You can only reduce the waiting period by paying a premium; not remove it entirely.
• You can easily ride out a Health Insurance waiting period by purchasing a policy when you are young and less prone on illnesses, and by extension less likely to file claims.
• In critical illness policies, the survival period is applicable in addition to the waiting period.

Need Health Insurance? Let Manipal Cigna Guide The Way

Armed with your Health Insurance policy, you never have to worry about burning a hole in your pockets or depleting your savings. At Manipal Cigna Health Insurance, we offer an array of medical and Health Insurance policies, each with varying waiting periods. With our specially curated healthcare plans, you never have to worry about the ever-rising medical costs. Plus, you can enjoy extensive coverage against an array of medical conditions and situations.

Find a Health Insurance plan that suits your needs. Visit Manipal Cigna Health Insurance today.