Health Insurance

What Is Waiting Period In Health Insurance?


The waiting period in health insurance refers to a period you must pass to become eligible for specific benefits to treat diseases. Health insurance gets active from the starting date of your claiming policy. The waiting period for health insurance varies from company to company, from several months to several years. You must check the health insurance waiting period in an insurance policy before buying it.

Here is everything you need to know about the health insurance waiting period.

Why do companies put a waiting period for health insurance?

Companies have seen cases where people buy health insurance immediately before treating their diseases to encash the reimbursement for major procedures. To reduce false claims, insurance providers came up with a waiting period for health insurance policies to stay protected. It provides all the benefits to genuine people using health insurance for their purposes. Here’s an example:

Suppose Mr A was diagnosed with cancer, and the doctor suggested surgery. This would’ve made a big hole in Mr A’s pocket. Mr A had to avoid those expenses. So Mr A got his health insurance without disclosing the disease to the insurance provider.

He got his surgery done at the hospital. And he paid for the costs of the surgery right after the purchase. Now, the insurance company was at a loss. Insurance companies then developed the concept of a Waiting Period.

Types of Waiting Periods for Health Insurance Policyholders:

Initial Wait Period

​Pre-existing disease Wait Period

Maternity Wait Period

Disease-Specific Wait Period

Initial Wait Period:

It is the period for which you have to wait before a health insurance policy becomes active. Suppose you are hospitalized or fall sick, so before claiming insurance you must pass this initial period of 30-90 days before availing of your policy.

You cannot ask the health insurance company to provide you with coverage of a health insurance policy after 24 hr of hospitalization or before the waiting period in your health insurance is over.

Pre-Existing Disease Wait Period:

There is a particular waiting period in health insurance for specific pre-declared diseases. The policyholder should declare these conditions. For these Pre-Existing Diseases (PED), the waiting period ranges from 12 to 24 months. Any disease diagnosed at least 48 months prior can come under pre-existing conditions.

Maternity Wait Period:

Some health insurance companies provide maternity benefits. It is offered to expecting mothers and their children. The waiting period in health insurance for maternity benefits ranges from 9 months to 36 months, depending on your health insurance provider. Most companies cover the cost of pregnancy, delivery, and post-delivery expenses, but only after the waiting period passes. So it is better to plan accordingly before buying health insurance. In case your health insurance does not cover maternity benefits, you can choose a maternity add-on to cover the cost of pregnancy. You will be charged more. But it is better to bear it.

Disease-Specific Wait Period:

The waiting period for health insurance is fixed for a few diseases like kidney stones, ENT (Ear, Nose and Throat), osteoporosis and hernia ranging between 24 and 48 months in your policy documents. It would help if you talked to the company representative. Know the waiting period in health insurance for a few diseases. Suppose you suffer from any such condition. Then you can claim your benefits only after your waiting period has passed. Therefore, it is advised to read the documents thoroughly. Going for health insurance with a shorter waiting period is the best option. Then you don’t have to pay for the treatment from your pocket.

Points to be considered about the waiting period before buying Health Insurance Policy:

  • The waiting period for health insurance depends on your chosen health insurance plan.
  • Age and overall medical history may give you a custom waiting period.
  • You should disclose your existing medical conditions while purchasing the policy. The insurance company does not honor your policy if a PED is claimed without intimation.
  • Few insurance companies have started waiving senior citizens’ waiting periods by introducing a co-pay clause in plans. A co-pay clause states that the policyholder will bear a mentioned percentage of the total claim amount. For reference, if the entire claim is for Rs. 10,00,000. And you choose to co-pay 25%. Then you will bear the amount of Rs. 2,50,000. Your health insurance company will pay the remaining amount of Rs. 7,50,000.

Common questions regarding Health Insurance:

  • Can the insurance company waive the period?

Yes, some insurance companies give you the option to minimize the waiting period for health insurance. But only if you are ready to pay a higher premium amount. This process is called Premium loading. It is an excellent way to get health insurance benefits sooner. But it depends on the insurance company if they want to offer a reduced waiting period while keeping your medical condition in mind.

  • What happens to my policy if I do not disclose my pre-existing conditions?

You will breach your health insurance benefits. It is a severe concern if you hide your pre-existing medical condition from your health insurance company. You cannot get your health insurance benefits even after the waiting period.

Final Takeaway:

The waiting period is a procedure to give health insurance benefits to people who want to make the best use of it. You can choose the right plan before investing in health insurance. Choose according to your needs and keep in mind the waiting period for your health insurance policy.

Piramal Finance offers personal loans at a low-interest rate. Choose the best personal loan to finance your medical expenses. In case you did not take health insurance yet and have a medical condition already. Experts from Piramal will advise you on the best solution based on your financial needs. Contact them now for the best advice.