Types of Waiting Periods in Health Insurance
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The waiting period is when a health insurance policyholder must wait before claiming the policy for certain health conditions. A waiting period is mandatory for every health insurance policy per the rules and regulations of India's Insurance Regulatory and Development Authority. A waiting period is a sanity check enforced to prevent the misuse of health insurance plans. Health insurance is intended to provide coverage in case of an unfortunate and unforeseen event that is uncertain in nature. Without a waiting period, people would purchase a health insurance plan only when needed, thereby driving the claim ratios up north. To prevent such situations, there is the concept of a waiting period in health insurance plans, and various types of waiting periods are discussed below:
The pre-existing waiting period, as the name suggests, is the waiting period for those diseases that exist before the inception of the health insurance policy. IRDAI defines a pre-existing condition as “Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and were diagnosed, and for which medical advice/ treatment was received within 48 months before the first policy issued by the insurer and renewed continuously after that.” So, any condition or ailment of which the insured is aware or had taken treatment or displayed symptoms before the policy's inception would be considered a pre-existing disease, and such conditions would require a waiting period of up to 4 years from the policy inception date. A pre-existing condition waiting period is not applicable at the time of renewal, subject to the condition that the renewal is done before the expiry date or within the grace period.
In general, if a health insurance policy is lapsed, the new policy would require you to satisfy the waiting periods mentioned in the policy. Customers should renew their health insurance plans within the grace period to avoid such cases. Certain diseases, such as Cancer, Heart problems, Kidney ailments, Diabetes, Hypertension, thyroid, etc., come under pre-existing illnesses.
Some specific diseases, such as knee replacement, hernia, tumor, ligament tear, cataract, etc., require customers to wait up to 2 years before claiming the health insurance policy. Specific disease waiting period covers certain diseases only after a certain period of time, subject to the condition that these are not pre-existing diseases. For example, if you develop knee issues requiring replacement after taking the policy, such a claim would be considered under a specific disease list. It would not be admissible before a specific waiting period expires under a health insurance policy. In the same example, if the knee issue were developed before the commencement of the policy period, then it would be classified as a pre-existing disease, and you may be required to wait up to 4 years from the policy commencement date. Specific disease waiting periods could be reduced by opting for an add-on, which reduces the period from 2 years to 1 year or less.
An initial waiting period is the time period one has to wait to claim after taking the health insurance policy. The initial waiting period usually exists for up to 30 days from the policy inception date. It is also referred to as the “Cooling period” by some insurance companies, where the insured cannot make claims for any disease except for accidental related injuries. For instance, if you had developed diabetes and required hospitalization within 30 days of taking a health insurance policy, that particular claim would not be covered under the policy as it comes under the initial waiting period. But, if you had met with an accident immediately after taking the policy, the policy would cover the claim, even though the claim happened within 30 days. This is due to the exception of accident-related claims from the initial waiting period clause.
A maternity waiting period is the time one has to wait before claiming any maternity-related issues such as childbirth or termination of pregnancy. The maternity waiting period usually starts at 9 months and may go up to 4 years, depending on the type of insurance policy and the insurer. A maternity waiting period is context-specific, meaning it would apply only to those who opt for the maternity benefit.
The critical illness waiting period is the time period the insured customer has to wait before claiming any of the critical illnesses suffered by the insured. The critical illness waiting period could go up to 90 days from the policy's purchase date. The main intention of this waiting period is that if there is a critical illness before taking the policy, it will come under a pre-existing waiting period. If a critical illness arises after taking the policy, it would be covered under this waiting period. The main idea of having 90 days is that one might not be able to survive for 90 days after contracting the critical illness, and it would discard customers who take the policy immediately after developing any critical illness.
A newborn waiting period is when the parents of the newborn have to wait before including the baby in the health insurance policy. It is to be noted that newborns are not automatically covered in a health insurance policy as there is a baby waiting period of up to 90 days from the date of childbirth. After the newborn baby's waiting period, the baby would be added to the health insurance policy and can claim for any health-related conditions.
The COVID-19 waiting period is when one has to wait before making a COVID-19-related hospitalization claim after taking the policy. The COVID-19 waiting period is 15 days, after which the claim would be admissible.
All the waiting periods are meant to discourage customers from taking undue advantage of health insurance plans. Health insurance plans are meant to help customers in case of uncertainties and not in case of planned hospitalizations. For more details on the waiting periods, please contact our health insurance experts at Ethika Insurance Broking.
