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Difference Between Waiting Period & Survival Period in Health Insurance
Health insurance is a safety net, but did you know that not all benefits are immediately accessible? Yes! Insurers apply certain limitations and time frames to avoid fraud.
Two crucial timelines include the Waiting Period and the Survival Period, which determine when you can claim benefits. Many people get confused between these terms, but they have some major differences based on the policy type.
Read to understand these terms that can help you plan smarter and avoid claim surprises in future!
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What is a Waiting Period in Health Insurance?
A waiting period is the time period you (the policyholder) have to wait to claim from a health insurance policy. The length and terms & conditions of the waiting period can vary from one insurer to another. If you are admitted to the hospital during your waiting period, you will not be eligible to receive reimbursement for the medical expenses you incurred during that time.
Types of Waiting Periods in Health Insurance Policy
Regardless of your circumstances, you must wait for the waiting period in health insurance to end before attempting to get any benefits or filing any claims.
There are different types of waiting periods, including initial waiting periods, waiting periods for pre-existing conditions, waiting periods for specific diseases, and maternity waiting periods. Let’s discuss each one of them:
Disclaimer: The above-mentioned waiting periods are not Digit-specific. It is the standard duration provided by insurers across the industry.
What is a Survival Period in Health Insurance?
Unlike a waiting period, a survival period is only a part of critical illness plans. It refers to the period of time that you need to survive after the diagnosis of a critical illness (such as kidney or heart failure, cancer, etc.). This period can last anywhere between 14 to 90 days, based on the illness and the insurer.
Only after this period can you get the lump sum amount from your insurer as mentioned in the critical illness cover. This period is calculated based on the first diagnosis of the critical illness and is in addition to the regular waiting period.
However, if an insured individual dies due to a critical illness before the survival period ends, the insurance company will not have to make any payments.
Features of Survival Period in Health Insurance
We know the survival period seems horrifying because it means that you have to live for a specific amount of time after being diagnosed with a serious illness to get any kind of benefit from your insurer. However, it is important for the insurer to avoid false claims.
Here are some features related to the survival period in health insurance:
- It mostly pertains to policies regarding critical illnesses.
- The three main determinants of the survival period duration are the sickness, the insurer, and the policy.
- This survival period is in addition to the previously stated standard waiting period.
- If you survive the specified time period, the insurer will give out a lump sum of money, which you can use for treatment or for your personal use.
Understanding Waiting Period vs Survival Period with an Example
To understand the waiting period vs survival period, here is an example of two brothers Mr. Ajay and Mr. Vijay, who recently bought different types of insurance policies. While both are covered, their policies have different conditions, such as a Waiting and Survival Period.
The Waiting Period Example
Mr. Ajay purchased a health insurance policy that covers pre-existing diseases. However, he was surprised to learn that he couldn't claim for his diabetes treatment immediately. His policy has a waiting period of 3 years, meaning he must wait before the insurer covers expenses related to his condition.
However, once this period is over, his claims will be processed without issues.
The Survival Period Example
Mr. Vijay, on the other hand, bought a critical illness insurance policy. Unfortunately, he was diagnosed with a serious illness within his policy term. Unlike Mr. Ajay’s waiting period, his policy has a waiting period of 3 years as well as a survival period of 30 days, meaning he has to wait 3 years before the insurer covers the expenses of his treatment and he must survive for 30 days after diagnosis to be eligible for the claim.
His policy won't pay out if he passes away before this period. But if he survives beyond 30 days, he receives a lump sum amount to support his treatment.
In short, The Waiting Period applies before a policy covers specific treatments, while the Survival Period is the minimum time a person must survive after diagnosis to receive benefits.
Difference Between Waiting Period and Survival Period in Health Insurance
If you are still confused about the difference between a waiting period and a survival period, don’t worry! Here are the differences that you must understand before buying a policy.
*Note: The survival period and waiting period can differ from policy to policy. Read your policy document thoroughly to know about all the clauses.
In conclusion, while both the waiting period and survival period are there to keep an insurance company safe from unwanted risks, they are not the same.
While all health insurance plans will have a waiting period, the survival period is only applicable to those suffering from critical illnesses. Additionally, the waiting periods are usually longer than survival periods.
It is important to know what both of these are so that you can make the right choice when it comes to buying health insurance or a critical illness plan. This way, you can choose a plan with a shorter survival period or waiting periods so that you’ll get the policy’s coverage sooner.
FAQs about Waiting Period vs Survival Period
What should you know about survival periods and waiting periods before buying a health insurance policy?
In general, try to look for a health insurance policy that includes the shortest waiting and survival periods. Of course, there are other important factors to keep in mind as well, such as the premium and the correct amount of coverage.
Will your beneficiaries get a return of your premium if you don’t make it through the survival period?
Unfortunately, no. Most critical illness insurance plans don’t offer a return on your premium (or a refund of your premium amount) if you die during the survival period. Such a feature is available under life insurance or personal accident plans.
Do all health insurance policies have a survival period?
No, a survival period clause only applies to critical illness covers. You can check if it is there by going through the policy wordings.
Can you file a claim during the waiting period?
No, if you file a claim before the completion of the initial waiting period, except in the case of accidental hospitalization, it will be denied by the insurance company.
Why do health insurance policies have a Waiting Period?
Insurers implement a Waiting Period to prevent fraudulent claims and ensure that policyholders do not purchase insurance only when they anticipate needing medical treatment. It helps maintain the financial stability of the insurance pool.
How long is the typical Waiting Period for pre-existing conditions?
The Waiting Period for pre-existing conditions can range from 1 to 3 years, depending on the insurer and the specific condition. This period is designed to mitigate the risk of covering individuals who may require immediate and extensive medical care.
Can the Waiting Period be waived or reduced?
Some insurers offer policies with reduced or waived Waiting Periods for an additional premium. Additionally, group health insurance plans provided by employers may have shorter Waiting Periods compared to individual plans.
Can a policyholder claim benefits for different conditions during the Waiting Period?
Generally, policyholders cannot claim benefits for conditions specified under the Waiting Period. However, they can claim for other unrelated medical issues that are not subject to the Waiting Period.
How do insurers determine the length of the Survival Period?
The length of the Survival Period is determined based on the nature of the critical illness and the insurer's risk assessment. It is designed to balance the insurer's risk while providing adequate time for the policyholder to seek treatment and recover.
What is the difference between the waiting period and the survival period?
Waiting Period is the time frame during which the policyholder cannot claim any specified treatment expenses. During this period, no claims can be made. It's essentially a buffer period to prevent fraudulent claims. Whereas, a Survival Period is the minimum amount of time the insured must survive after being diagnosed with a critical illness to be eligible for the claim. If the insured does not survive this period, the claim is not payable.
Do You Get a Return on Premium if You Do Not Survive the Survival Period?
Typically, no. The critical illness benefit is not paid out if the insured does not survive the survival period. Some policies may offer a return of premium features, but this is not common and would depend on the specific terms and conditions of the policy.
Should You Consider Survival Period While Buying a Critical Illness Insurance Policy?
Yes, you should consider the survival period when buying a critical illness insurance policy. A shorter survival period is generally more favourable as it increases the likelihood of receiving the benefit.
What Happens if the Insured Dies Before the Survival Period in Insurance?
The critical illness benefit is not paid out if the insured dies before the survival period. The policy may have other benefits or riders that could provide some payout, such as a death benefit, but this would depend on the specific terms of the policy.