What is Waiting Period in Health Insurance?

As the word suggests, the waiting period is nothing but the time period under which your health insurance plan will not cover specific PEDs (Pre-Existing Diseases and conditions, except critical illness). Why is this so? Well, every healthcare policy comes with a waiting period; it is part of the terms and conditions you need to check before buying a health insurance scheme. 

This means that it is mandatory for you to wait for a specific time frame to avail of the medical coverage and benefits. This begins from the date of policy inception and is different for certain illnesses/sicknesses. Every insurance provider has a standard period of 24-48 months per policy. Post the waiting period is over, you can easily make a claim for treatment.

Example: Maternity cover is a type of rider option with a waiting period of 2 years. This means that you can only avail of maternity benefits after completing two years with your base mediclaim cover. Then again, this period (period is the time) varies from one policy to another. 

Let us get straight to the point. In this blog, we will check out the following topics - What is the waiting period for you? How long is it applicable? Does it affect health insurance premiums? and what is included?

Why is there a Waiting Period?

Insurance providers and companies, along with IRDAI (Insurance Regulatory and Development Authority of India), have designed the concept of a waiting period for preventing the misuse of healthcare cover. This practice also checks policy buyers who intentionally purchase a health plan and do not disclose PEDs and specific diseases to the insurance company. 

Types of Waiting Period

As mentioned above, the standard clause states that the period is between 2-4 years. Here is a detailed table for the same.

Type of ConditionApplicable Waiting PeriodAccidental emergency and hospitalizationNil -  accidental injury is  covered as soon as the policy comes into effectCooling period30 to 45 daysInitial waiting period30 to 60 to 90 daysHealth check-up1 yearMaternity benefit2 yearsNewborn baby cover2 years in some instances
90 days for infantsSpecific ailments2 yearsBariatric surgery2 yearsPre-Existing Diseases (PEDs)2 to 4 yearsCorona Rakshak15 daysCorona Kavach15 days
Dependent children are covered from day one of age to 25 yearsList of diseases/illness/sickness and conditionsHere is a list of specific conditions:

Neurodegenerative disorders
Psychiatric, neurotic, anxiety, mood, stress-related, and unspecified mental disorders
Internal congenital anomaly
Hernia 
Hemorrhoids and their types
Tumors, cysts, polyps, nodules, swellings, and their types
Cataract
Glaucoma
Pancreatitis
Liver disorders
Gastric Vs Duodenal Erosions/Ulcers
Infections of the GI tract 
Systemic Connective Tissue Disorders
Arthrosis

Note: The above table is based on general representation. Conditions and their respective waiting period depends on the type of health policy you have and the insurance company (limited).

Can I Reduce the Waiting Period?

• There is no specific method to reduce the waiting period completely. But you can avail of a waiver of pre-existing condition benefit. Under this cover, PEDs will be covered but only post the waiting period. 
• What if It's my first bout of serious illness? - If you are diagnosed with a disease for the first time during the waiting period, it will be covered under medical insurance.
• When you are looking to purchase a new health plan, select the one with the shortest waiting period.
• Many insurers provide the facility of co-pay to reduce the waiting period. If you have opted for co-pay, you will share the claim amount with your insurer. Co-pay usually ranges between 10% to 25% of the claim amount.
• On the other hand, group health insurance provides cover for you from day one. You can also include your parents, spouse, and children under a corporate health insurance coverage plan.

Looking for a change, explore comprehensive group health insurance schemes from Plum, and say goodbye to the waiting period!