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 with an illness? It’s because of something called the ‘waiting period’ in health insurance. Find out everything there is to know about this incredibly crucial insurance clause.
What Is a Waiting Period in Health Insurance?
- The waiting period is the time during which you can’t file an insurance claim.
- If hospitalized during this period, you must bear the hospitalization costs yourself.
- The insurer won’t accept or approve your claim.
In health insurance, the 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 have an existing policy.
If you are hospitalized during this time, you have to bear the hospitalization costs from your own pocket. If you do file a claim during this time, the insurer is not liable to accept or approve it.
When Does the Waiting Period Start and End?
The waiting period starts from the day your health insurance policy becomes active, not from the day you first feel unwell or need medical care.
It ends only after you’ve completed the full duration mentioned in your policy document, whether that’s 30 days, 2 years, or longer. Once this period is over, claims related to that condition or benefit are processed normally, as long as all other policy terms are met.
This is why knowing exact dates matters just as much as knowing durations.
Why Does a Waiting Period Exist in Health Insurance?
As to why a waiting period exists in health insurance, the answer is simple. Health insurance companies offer policies at lower rates. In comparison, the coverage amount (also known as the 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 purchased the policy while you were in sound health and not after being diagnosed with an illness.
Risk Management for Insurers
Health insurance works on the principle of shared risk. When people buy policies early and stay covered over time, insurers can balance costs across many policyholders.
Waiting periods help insurers manage sudden, high-value claims and keep premiums stable. Without them, premiums would rise sharply for everyone, even those who rarely make claims.
Preventing Misuse of Health Insurance Policies
Waiting periods also act as a safeguard against misuse. Without them, people could wait until diagnosis, buy a policy, and claim immediately.
That would strain the system and make health insurance unsustainable in the long run. Waiting periods protect long-term policyholders and ensure fairness across the board.
Types of Waiting Period in Health Insurance
| Policy Type | Applicable Waiting Period |
| Initial waiting period | 30 days |
| Pre-existing diseases waiting period | 24-48 months depending on policy type and illnesses covered |
| Specific diseases/procedures waiting period | 24 months covering specific medical conditions/procedures |
| Critical illness waiting period | Up to 4 years + initial and survival period of 90 and 30 days, respectively. |
| Maternity cover + New born baby inclusion waiting period | 24-48 months, depending on policy type |
| Accidental hospitalization | Zero waiting period |
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.
Duration and Common Inclusions
For most health insurance plans, the initial waiting period is 30 days, though some insurers may extend it up to 90 days.
During this time, illness-related hospitalizations are not covered. Accidental hospitalizations, however, are usually excluded from this restriction and covered from day one.
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.
How Insurers Define Pre-existing Diseases
A pre-existing disease refers to any medical condition you were diagnosed with, treated for, or showed symptoms of before purchasing the policy.
This can include chronic illnesses, lifestyle conditions, past surgeries, or long-term treatments, even if they’re currently under control.
Typical PED Waiting Period Range
Most insurers apply a 24–48 month waiting period for pre-existing diseases.
The exact duration depends on your age, medical history, type of illness, and the policy you choose.
Specific Diseases or Procedures Waiting Period
Every insurance company usually has a list of specific medical conditions and procedures that come with specific waiting periods.
Examples of Commonly Excluded Treatments
Some commonly listed conditions include:
- Hernia
- Cataract
- Knee replacement
- ENT-related procedures
- Certain gynecological treatments
These are covered only after the specified waiting period is completed.
Waiting Period for Critical Illnesses
Critical illnesses are those ailments that are physically and financially draining.
Conditions Covered Under Critical Illness Plans
Critical illness plans typically cover severe conditions such as:
- Cancer
- Heart attack
- Stroke
- Kidney failure
- Major organ transplants
Because of the high payouts involved, these plans usually come with longer waiting and survival periods
Waiting Period for Maternity Benefits
There was a time when maternity costs were not covered under health insurance plans.
Factors Affecting Maternity Waiting Period
Maternity waiting periods depend on several factors, including:
- Whether maternity cover is part of the base policy or an add-on
- Coverage for newborn expenses
- Type of delivery
This is why early planning matters when maternity benefits are important to you.
Waiting Period for Accidental Hospitalization
In health insurance, there is one caveat in which the waiting period does not apply.
Is Accidental Coverage Exempt From the Waiting Period?
Yes. Most standard health insurance plans offer zero waiting period for accidental hospitalizations.
If an accident occurs soon after purchasing the policy, related hospitalization expenses are usually covered immediately.
Can You Reduce the Waiting Period in Health Insurance?
Yes, many insurance providers allow you to reduce the waiting period in Health Insurance.
Buying Health Insurance at a Young Age
Buying health insurance early helps you complete waiting periods before you’re likely to need coverage.
You also benefit from lower premiums and uninterrupted policy continuity.
Porting Health Insurance Policies
When you port your policy to another insurer, the waiting period you’ve already completed is often carried forward.
This allows you to switch without losing benefits you’ve already earned.
Choosing Plans With Shorter Waiting Periods
Some health insurance plans are designed with shorter waiting periods, especially for pre-existing conditions.
They may cost slightly more but provide faster access to coverage.
Important Points to Know About Health Insurance Waiting Period
- 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.
- In critical illness policies, the survival period is applicable in addition to the waiting period.
Waiting Period vs Policy Tenure
Waiting periods are completed once, but policy tenure continues as long as you renew on time. Missing a renewal can reset benefits you’ve already completed.
Impact of Waiting Period on Claim Eligibility
Even valid hospitalizations can be rejected if they fall within an applicable waiting period. Understanding this helps avoid unpleasant surprises during claims.
Importance of Reading Policy Wordings
Waiting periods vary across insurers and plans. Reading policy documents carefully helps you know exactly what’s covered, and when.
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. With transparent terms, flexible plans, and clearly defined waiting periods, Manipal Cigna helps you stay prepared, today and for the years ahead.
FAQs on Waiting Period in Health Insurance
What is the standard waiting period in health insurance?
Most plans have a 30-day initial waiting period, excluding accidental hospitalizations.
Is the waiting period applicable for renewals?
No. Once completed, the waiting period does not apply again if you renew on time.
Can the waiting period be waived off?
Some insurers offer waiting period reduction options at a higher premium, but complete waiver is rare.
Does the waiting period differ between insurers?
Yes. Waiting periods vary based on insurer, plan type, and medical condition.
Does the waiting period reset if I change my health insurance?
If you port correctly, completed waiting periods usually carry forward.
