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What is Waiting Period in Health Insurance & How it Works?

Team Digit

You’re probably here because you noticed there’s something called a waiting period in health insurance and like many others who are buying a health insurance policy for the first time, you aren’t sure what it means, and if there is something called a waiting period- how long is it and what does it include?

Well, keep your doubts at bay and read on for everything you need to know about waiting periods in your health insurance.

Waiting Period in Health Insurance
Types, Duration & Need
How Waiting Period Works?
Is it Possible to Reduce Waiting Period?
Survival Period in Health Insurance
Difference Between Survival & Waiting Period
Frequently Asked Questions

What is Waiting Period in Health Insurance?

As the name suggests, the waiting period is quite literally the amount of time you need to wait. In health insurance, it refers to the amount of time you need to wait, from the start of your policy, to be able to use the benefits.

For example: One of the most common types of waiting period is the time you need to wait to be able to use special benefits such as a Maternity Cover; in this case most health insurers will include a waiting period of 2-4 years i.e. before you can benefit from the maternity cover, you should have your policy for at least 2 years (the amount of time is dependent on the health insurance policy you buy).

Types of Waiting Periods in Health Insurance & Their Duration

There are various kinds of waiting periods present in every health insurance policy. Let’s have a look at what they imply, what the industry average is, and what is Digit’s Health Insurance waiting periods in context to them all.

1. Initial Waiting Period

An initial waiting period, also known as the cooling period in health insurance, refers to the amount of time you’ll have to wait from the date of issue to actively start using your health insurance policy and benefiting from it.Today, the industry standard for initial waiting periods is up to 30 days for all health insurance policies.

2. Pre-Existing Diseases Waiting Period (PED)

Typically, when you buy a health insurance policy, you will be asked about pre-existing diseases and/or will also be asked to take a few medical tests that may reveal the same.

According to the IRDAI, a pre-existing disease refers to any condition, ailment, injury, or disease that was diagnosed up to 36 months before buying a health insurance policy.

Some examples of pre-existing diseases include diabetes, hypertension, thyroid, etc. Therefore, if you do have a pre-existing disease, you will have to wait for the prescribed waiting period before you can claim any hospitalisation or treatment that is related to the disease.

Usually, the waiting period for pre-existing diseases health insurance is 1 to 3 years, depending on your health insurer and the type of health insurance plan chosen.

3. Waiting Period for Specific Diseases & Surgery

The title is perhaps self-explanatory, i.e., waiting periods for specific diseases and surgeries imply that you will need to wait for the prescribed amount of time when it comes to claiming treatment and hospitalization related to a list of specific diseases and surgeries.

Generally, the waiting period for these situations is 1 to 3 years.

Here’s the list of diseases:

Category	Diseases
Musculoskeletal Disorders	Non-infective Arthritis, Osteoarthritis, Osteoporosis (if age-related), Systemic Connective Tissue Disorders, Dorsopathies, Spondylopathies, Inflammatory Polyarthropathies, Arthrosis, and Intervertebral Disorders (unless due to accident)
Gastrointestinal Disorders	Pancreatitis, Calculus disease of gall bladder/biliary tract and urogenital system, Gastric & Duodenal Erosions/Ulcers, Varices of GI Tract, Cirrhosis of Liver, Rectal Prolapse
Ocular Disorders	Cataract, Glaucoma, Disorder of Retina
Urological Disorders	Hyperplasia of Prostate, Urethral Strictures, Hydrocele/Varicocele, Spermatocele
Gynecological Disorders	All abnormal Utero-vaginal bleeding, Female Genital Prolapse, Endometriosis/Adenomyosis, Fibroids, Ovarian Cyst, Pelvic Inflammatory Disease
Anal and Rectal Disorders	Hemorrhoids, Fissure, Fistula, Pilonidal Sinus/Cyst and Fistula
Hernias	Hernia of all sites
Vascular Disorders	Varicose veins of lower extremities
Ear, Nose, and Throat Disorders	Disease of middle ear and mastoid including otitis Media, Cholesteatoma, Perforation of Tympanic Membrane, Sinusitis, Tonsillitis, Adenoid Hypertrophy, Nasal Septum Deviation, Turbinate Hypertrophy, Nasal Polyp, Mastoiditis, Nasal Concha Bullosa
Neoplasms/Tumors	All internal and external benign or In Situ Neoplasms/Tumors, Cysts, Sinus, Polyps, Nodules, Swelling, Masses, or Lumps including breast lumps (each of any kind unless malignant)
Congenital Anomalies	Internal Congenital Anomaly
Psychiatric Disorders	Schizophrenia, Schizotypal and Delusional Disorders, Mood [Affective] Disorders, Neurotic, Stress-Related and Somatoform Disorders, Unspecified Mental Disorders
Neurodegenerative Disorders	Alzheimer’s Disease, Parkinson’s Disease

4. Maternity Benefit & Newborn Baby Cover Waiting Period

As part of most health insurance policies for individuals and families, there is an option to also include a maternity benefit and newborn baby add-on for those planning a family soon, and apart from just planning for the baby, it is wise to also plan financially for the expenses that arise during and post labor.

Typically, the waiting period with most health insurance policies ranges from one year to four years.

This means you can only claim for maternity-related expenses once you’ve completed two years of your policy.

Therefore, if you’re planning on starting a family sometime soon and want to ensure your health insurance policy covers it, then take into consideration the 9 months of the pregnancy term, plus the rest 15 months to complete your two-year waiting period.

The maternity benefit add-on covers delivery expenses and the baby for its first 90 days; including its necessary vaccinations and any other medical care required otherwise.

Know more about:

5. Waiting Period for Accidental Hospitalization

Accidents can cause the most unexpected injuries and other medical concerns. Therefore, given the nature of accidents, all health insurers, including Digit, do not account for any waiting period when it comes to accidental hospitalizations. This means one can claim for accidental hospitalizations even just days into their new health insurance policy. The initial waiting period doesn’t apply here either.

Types	Other Insurers in the Industry	Waiting Period with Digit
Initial Waiting Period	Up to 30 days	30 days*
Pre-Existing Diseases Waiting Period (PED)	1 to 3 years	3 years
Waiting Period for Specific Diseases & Surgery	3 years	1-3 years
Maternity Benefit & Newborn Baby Cover Waiting Period	2 to 4 years	Currently Maternity Benefit & Newborn Baby Cover add-on is not available with Digit Health Plans.

*The 30-day waiting period is available through an add-on cover Initial Waiting Period Modification.

Note: These durations can vary slightly based on the insurer and the specific terms of the policy, so it is always advisable to review individual policy documents for precise details.

How Does Waiting Period in Health Insurance Work?

The waiting period is the time you need to wait before you can use your health insurance policy for specific treatments or conditions. For example, if your policy has a waiting period of 30 days, you can’t claim benefits for any illness or injury that occurs during this 30-day period. Waiting periods vary based on the insurance plan and the specific condition.

Let’s Explore How Waiting Periods in Health Insurance Work through a Practical Example

Initial Waiting Period

Pre-Existing Disease Waiting Period

According to his policy, the initial waiting period is 30 days. This means Kiran cannot make a claim for any illness or medical condition that occurs within the first 30 days after purchasing the policy.

On January 15th, Kiran develops a cold and needs to see a doctor. Since this illness occurred within the 30-day waiting period, it is not covered by his insurance policy.

He pays for the treatment out of his own pocket.

On February 1st, the 30-day waiting period ends. Kiran’s policy is now active for all covered illnesses and medical treatments.

If Kiran develops another illness or requires medical treatment after February 1st, he can make a claim under his policy, provided the treatment is covered and adheres to other policy conditions.

Suppose Kiran has diabetes, which he had before purchasing the policy. His policy has a 3-year pre-existing disease waiting period.

Kiran can’t claim benefits for diabetes-related treatments until 3 years have passed from the policy start date.

If he requires treatment for diabetes in the first 2 years, he will need to cover those expenses himself. After the 3-year waiting period, he can claim benefits for his diabetes treatment as long as it’s covered by the policy.

Why Do Health Insurance Plans Have Waiting Periods?

To Prevent Fraud

To Encourage Long-Term Coverage

To Manage Risk and Costs

Waiting periods help prevent people from purchasing health insurance only when they need immediate medical care. Without waiting periods, individuals could buy insurance just before a major medical event, knowing they would immediately claim expensive treatments. This would lead to financial losses for insurance companies and higher premiums for everyone.

Waiting periods promote continuous coverage and discourage short-term or temporary use of insurance. This means that the insurer collects premiums over time before paying out significant claims, which helps maintain financial stability and enables them to cover the costs of long-term medical care for their insured members.

Waiting periods help insurance companies manage the financial risks and costs associated with covering various medical conditions. Certain medical conditions or treatments can be very costly. Waiting periods allow insurance companies to spread out the risk of high claims over time. For pre-existing conditions or specific diseases, waiting periods give insurers time to better assess and manage the financial impact of these risks.

What is the Zero Waiting Period in Health Insurance?

A zero waiting period means that you can start using your health insurance benefits for the specified illnesses immediately after buying the policy without having to wait for a specified period. This is usually found in specific plans or for certain types of coverage, like accidents.

How Does Zero Waiting Period Work?

With a zero waiting period policy, you don’t have to wait any time at all to make a claim. As soon as your policy is active, you can use it for covered treatments or expenses. However, zero waiting periods are often applicable to only certain types of coverage, like emergency treatments, and may not cover pre-existing conditions or specific diseases immediately.

Let’s understand with an example:

Riya buys a health insurance policy on April 1st. Her policy includes a zero waiting period for accidental injuries.

On April 5th, Riya unfortunately has a minor accident and requires emergency medical treatment. Since her policy has a zero waiting period, she can immediately file a claim for the treatment expenses.

Riya submits her claim to the insurance company and receives reimbursement for her medical bills according to the policy terms.

This is how it works!

Is It a Good Idea to go with a Zero Waiting Period Health Insurance?

A zero waiting period health insurance plan is generally a good idea as it offers immediate coverage for pre-existing diseases, which is a significant advantage.

However, these plans often come with higher premiums, so it's essential to weigh the benefits against the cost. If you have pre-existing conditions or a family history of serious illnesses, a zero waiting period plan might be a worthwhile investment.

But, it might not be the most cost-effective choice if you buy it at an early age. Since you're young and likely have fewer health concerns, the chances of needing immediate coverage for pre-existing conditions are lower.

Reasons to Check Waiting Period in Health Insurance

Below are the reasons why you should check the waiting period before finalising a health insurance policy.

How to Reduce the Waiting Period in Health Insurance?

The restrictions on the waiting period can be modified with some covers that usually come with an additional cost. However, these modifications depend largely on the insurance provider. Hence, you must check with your insurer for complete details. Below are the ways you can reduce the waiting period for your health insurance policy.

What is the Survival Period in Health Insurance?

The survival period in health insurance is the minimum duration an insured must survive after being diagnosed with a covered critical illness to be eligible to receive insurance benefits. This period ensures that the insured survives a certain length of time post-diagnosis, which is essential for making a claim on critical illness policies.

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.

Example: If a health insurance policy for critical illnesses has a survival period of 30 days, the policyholder must live for at least 30 days after being diagnosed with a critical illness like cancer before they can claim the benefits.

Difference Between Survival Period and Waiting Period in Health Insurance

Parameter	Survival Period	Waiting Period
Definition	The minimum duration an insured must live after diagnosis of a critical illness before they can claim benefits.	The period is the time you must wait before certain benefits become available, often including pre-existing conditions and general illness coverage.
Purpose	To confirm that the insured survives a set period post-diagnosis before the insurer pays out the claim.	To prevent immediate claims and manage risk by excluding coverage for certain conditions or newly acquired illnesses during the waiting period.
Applicability	Specific to critical illness policies where a claim is made after surviving a diagnosed illness.	Applies broadly across various health insurance policies, including those for pre-existing conditions, general illnesses, and specific treatments.
Example	A policy might require the insured to survive 30 days after a diagnosis of cancer before making a claim.	A health insurance policy may have a 3-year waiting period for coverage of pre-existing conditions.
Impact on Claims	Determines when benefits for a critical illness can be claimed, based on survival after diagnosis.	Affects when you can claim benefits for covered conditions, as claims cannot be made until the waiting period is over.
Common Duration	Typically 14 to 90 days for critical illness policies.	Can vary from a few months to several years, depending on the condition and policy terms.

Important Points about the Waiting Period in Health Insurance

Health insurance policies typically include a waiting period for pre-existing conditions, which is usually 1 to 3 years.
Most health insurance policies have an initial waiting period of 30 days from the date of policy commencement.
If an individual is diagnosed with a disease for the first time during the waiting period, this condition will not be considered a pre-existing disease. Consequently, the policy will provide coverage for this ailment.
When transferring from one insurer to another (portability), the waiting period for pre-existing conditions may be carried over from the old policy.
Waiting periods are generally reset with new policies or renewals unless otherwise specified.
Insurers are required to clearly disclose waiting periods in the policy document and during the sales process.

Disclaimer: This information is based on general guidelines and standards set by the Insurance Regulatory and Development Authority of India (IRDAI). Always check the specific details of your health insurance plan to understand its waiting period, survival period, and coverage.

Understanding the waiting period in health insurance is crucial for every policyholder. It not only sets realistic expectations about claim eligibility but also emphasises the importance of early policy purchase. Whether it's the initial waiting period, disease-specific, or pre-existing disease, being informed helps avoid claim rejections and ensures better financial planning.

Overall, understanding the waiting period empowers you to plan wisely, anticipate coverage timelines, and avoid surprises when you need support the most. 🙂

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FAQs about the Waiting Period in Health Insurance

All

What is the purpose of a waiting period?

The primary purpose of a waiting period is to:

Prevent fraudulent claims: It helps insurers identify genuine policyholders from those who purchase insurance solely to cover pre-existing conditions.
Accurate risk assessment: The waiting period allows insurers to assess the policyholder's health status and determine appropriate premiums.

Can I claim health insurance after 1 month?

Yes, you can claim for accidents or injuries after a month of purchasing the policy.However, claims for illnesses will be subject to different waiting periods, which vary depending on the nature of the illness.

How does the waiting period in health insurance work?

The waiting period starts from the policy's inception date. During this period, specific conditions or procedures are excluded from coverage. Once the waiting period ends, the coverage for those specific conditions becomes effective.

Can I eliminate the waiting period in health insurance policies?

No, you cannot entirely eliminate the waiting period. It's a mandatory requirement by IRDAI to protect the insurance industry from fraudulent claims. However, some policies might offer shorter waiting periods for specific conditions or coverages.

Note: While this information provides a general overview, it's crucial to refer to your specific policy document for accurate and detailed information regarding waiting periods and exclusions.

What happens if a claim is filed in a waiting period?

The claim will be denied by the insurance company if it is filed before the completion of the relevant waiting period, except in the case of accidental hospitalization, which is covered from Day 1.

Is it possible to reduce or remove the waiting period?

Yes, it is possible to reduce your waiting period only if your respective insurer gives you the option to do so. For example, some health insurance companies give their customers the option to opt between 2 or 3 waiting periods and instead charge them a higher premium accordingly.

Why does a health policy have a waiting period?

Health insurance policies have waiting periods to reduce the risk from the side of the insurer. 

A health insurance works on the concept of gradual premium collection and risk sharing, and therefore health insurers can only start paying out claims once those insured, pay out their respective health insurance premium.  

Additionally, it also prevents people from misusing their health insurance policy – for example by buying a policy just days before they make a claim and expecting their health insurer to pay for all their medical expenses from the next day.

Besides, when you calculate the premium you pay, and the claim payouts are made, the premium is always a lot less. So, either way, with health insurance in place, you are always bound to save, even with the waiting periods present. 😊

Is it a good idea to buy a health policy when you are young?

Yes, buying a health policy when you are young is a good idea. Firstly, the premium for younger people is a lot less. Secondly, when you want to seek benefits under your policy, the probability is that the waiting periods will all be over.

For example, if you plan to have kids one day, you can buy a health insurance policy early with maternity cover to complete your waiting period when you decide to have kids.

Do waiting periods apply to all medical conditions?

Waiting periods are of different kinds depending on medical conditions like specific diseases waiting period, pre-existing diseases waiting period, maternity benefit waiting period, annual health check-up waiting period and a few others.

The initial waiting period does not depend on any specific medical condition and is the minimum time period that you need to wait before you can use your health insurance policy. However, accidental cases are an exemption for the initial waiting period and are covered from Day 1.

Can waiting periods be different for different types of medical conditions?

Yes. The waiting period differs for different medical conditions. Not just that, it also depends on the insurance provider.

Why should one choose a policy with a short waiting period?

With a shorter waiting period, you receive coverage for certain medical conditions within a short period after buying the policy. A longer waiting period, for example, in the case of the pre-existing waiting period can be disadvantageous since you are uncovered against certain medical conditions for that time despite having insurance coverage.

Is a health insurance claim admissible if a disease is diagnosed during the plan term?

Yes, a health insurance claim can be admissible even if a disease is diagnosed during the plan term and it's not a pre-existing condition or excluded condition.

Are all claims filed during the waiting period in mediclaim policy denied?

Yes, claims filed during the waiting period of a mediclaim policy are denied. This waiting period is a stipulated time after which the policyholder can claim for certain illnesses or procedures.

Will the policy's beneficiaries receive a return of the premium if they do not survive during the survival period in health insurance?

No, typically, the policy's beneficiaries will not receive a return of the premium if the insured does not survive during the survival period. Health insurance is a risk management tool, and the premium is paid for the coverage provided during the policy term. It's designed to cover medical expenses, not as a savings or investment product.

What is the benefit of a lower waiting period in health insurance?

The major benefit of a lower waiting period in health insurance is that you can claim for certain illnesses or conditions sooner than with a longer waiting period.

Can we claim health insurance immediately?

No, you can’t claim health insurance immediately, as most policies have waiting periods for specific conditions.

Why should I consider a health insurance plan with zero waiting period?

A health insurance plan with zero waiting period offers the following advantages:

You can claim for any covered illness or accident from the start of the policy.
You're protected from high medical costs right from the beginning.

Are all health insurance plans eligible for a zero waiting period?

No, not all health insurance plans offer a zero waiting period.

Pre-existing diseases: Most plans have a waiting period for pre-existing diseases, even if they offer zero waiting periods for other conditions.
Specific conditions: Some plans might have waiting periods for specific diseases or treatments.

Is there health insurance with no waiting period for pre-existing diseases?

No, typically, there is no health insurance with a zero waiting period for pre-existing diseases. Most insurance companies have a mandatory waiting period for pre-existing conditions.

How soon after taking out health insurance can I claim?

After buying a health insurance policy, you must wait for an initial waiting period as per the policy terms before filing a claim. However, if your insurance plan has zero waiting period then you can claim immediately after taking out health insurance.

What is the PED waiting period in health insurance?

PED stands for Pre-Existing Disease. The PED waiting period is the time you must wait before your health insurance covers pre-existing diseases. The PED waiting period typically ranges from 1 to 3 years, depending on the insurer.