Waiting Period in Health Insurance
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.
What is Waiting Period in Health Insurance?
As the name suggests, waiting period is quite literally the amount of time you need to wait. And in a health insurance, it refers to the amount of time you need to wait for, from the start of your policy, to be able to use the benefits of it.
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 actually 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).
Waiting Period in Health Insurance – Simplified by Ouch Potato
Types of Waiting Periods in Health Insurance
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 are 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 standard in the industry, for initial waiting periods is up to 30 days with 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 conclude the same.
As per the IRDAI, a pre-existing disease refers to any condition, ailment, injury or disease that has been diagnosed up to 48 months before buying your health insurance policy.
Some examples of preexisting diseases include diabetes, hypertension, thyroid, etc. Thereby, if you do have a pre-existing disease, you will have to wait for the prescribed waiting period before you can claim for any hospitalization or treatment that is related to the disease.
Usually, the waiting period for the pre-existing disease is from one to four years, depending on your health insurer and type of health insurance plan chosen.
3. Waiting Period for Specific Diseases
The title is perhaps self-explanatory, i.e. waiting periods for specific diseases imply that you will need to wait for the prescribed amount of time when it comes to claiming for treatment and hospitalization related to a list of specific diseases.
Generally, the waiting period for these situations is one to four years.
The specific list of diseases this is applicable to are listed below.
- Non-infective Arthritis, Osteoarthritis and Osteoporosis (if age related), Systemic Connective Tissue Disorders, Dorsopathies, Spondylopathies, Inflammatory Polyarthropathies, Arthrosis and Intervertebral Disorders (unless due to accident).
- Pancreatitis, Calculus disease of gall bladder/biliary tract and urogenital system, Gastric &Duodenal Erosions/Ulcers, Varices of GI Tract, Cirrhosis of Liver, Rectal Prolapse.
- Cataract, Glaucoma and Disorder of Retina.
- Hyperplasia of Prostate, Urethral Strictures, Hydrocele/Varicocele and Spermatocele.
- All abnormal Utero-vaginal bleeding, female Genital Prolapse, Endometriosis / Adenomyosis, Fibroids, Ovarian Cyst, Pelvic Inflammatory Disease.
- Hemorrhoids, Fissure, Fistula and Pilonidal Sinus / Cyst and Fistula.
- Hernia of all sites.
- Varicose veins of lower extremities.
- 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.
- All internal and external benign or In Situ Neoplasms/Tumors, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump including breast lumps (each of any kind unless malignant).
- Internal Congenital Anomaly.
- Psychiatric illness and Disorders such as Schizophrenia, schizotypal and delusional disorders, Mood [affective] disorders, Neurotic, stress-related and somatoform disorders and Unspecified mental disorders.
- Neurodegenerative disorders including but not limited to Alzheimer’s disease and 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 would want to ensure your health insurance policy covers for it, then take in consideration the 9-months of the pregnancy term, plus the rest 15-months to complete your two- years waiting period.
The maternity benefit add-on covers for 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 Bariatric Surgery
A bariatric surgery is included in some health insurance policies today. It refers to a surgery on the stomach and/or the intestines to help someone with extreme obesity related issues.
It is usually only recommended for those with a BMI above 40, and who are going through other health issues because of the same.
6. 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.
7. Psychiatric Illness
These days we all know the importance of mental health, so insurers have included a mental health cover with health insurance policies. This covers expenses incurred for hospitalization or in-patient treatment due to any mental illness.
8. Annual Health Check-Up
You may have noticed that some health insurance policies, including Digit’s, also give you annual health checkups as part of your health insurance plan.
However, there is a sort of waiting period for this too.
With Digit’s health insurance, you can avail of this benefit during renewal. This means you can get it only after completing one year of your health insurance policy.
Is it Possible to Reduce the Waiting Period?
The restrictions on waiting period can be modified with some covers that usually come with an additional cost. For example, some insurers provide the PED waiting period waiver that reduces the waiting period of pre-existing diseases from 4 years to 2 years. However, these modifications depend largely on the insurance provider. Hence you must check with your insurer for complete details on the same.
Check Out This Video By Tanya Marwah (Head - Marketing and Corporate Communications, Digit Insurance) Talk About Waiting Period.
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FAQs about Health Insurance Waiting Period
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 only reduce your waiting period 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-, 3- or 4-years waiting period 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 expect 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 done; the premium is always a lot lesser. So, either ways, with a 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, it is a good idea to buy a health policy when you are young. Firstly, the premium for younger people is a lot less.
Secondly, by the time 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 a maternity cover so that you complete your waiting period by the time 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.
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 Day1.
Can Waiting Period 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 of time after buying the policy. A longer waiting period, for example in 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.