People who are buying a health insurance policy for the first time aren't sure what the waiting period in group insurance means. Moreover, if there's something known as "waiting period," how long is it, and what does it include?
Well, keep your doubts at bay and keep reading to know everything about waiting periods in your health insurance.
What Is Waiting Period In Health Insurance?
Waiting period in health insurance is simply the amount of time you need to wait before you can avail any benefits.
For instance, one of the most common types of waiting periods is the time you need to wait to use special benefits like maternity cover. In that case, most health insurers will include a waiting period of 2 to 4 years. That means, before you can actually benefit from the maternity cover, you must have your policy for at least 2 years. [The amount of time depends on the health insurance policy you buy.]
4 Types of Waiting Periods In Health Insurance
There are several kinds of waiting periods present in every health insurance policy. Let's take a closer look at what they imply and what the industry average is:
- Initial Waiting Period
- Pre-Existing Disease Waiting Period
- Waiting Period for Specific Diseases
- Maternity Benefit and Newborn Baby Cover Waiting Period
1. Initial Waiting Period
The initial waiting period is also called as the cooling down period. It refers to the amount of time you will have to wait from the date of issue to actively start using your health insurance policy.
As a standard in the industry, all health insurance policies nowadays have at least a waiting period of one month.
2. Pre-Existing Disease Waiting Period
When you buy a health insurance policy, you will have to inform the company asked about pre-existing diseases and take a few tests.
As per the IRDAI [Insurance Regulatory and Development Authority of India], a pre-existing disease refers to any condition, injury, ailment, or disease that has been diagnosed up to 48 months prior to buying your health insurance policy.
Some types of pre-existing diseases include diabetes, thyroid, hypertension, etc. In such a case, you will have to wait for the prescribed time limit before claiming any treatment.
On average, the pre-existing disease waiting period is three to four years. It also depends on your health insurance provider and the type of health insurance plan you have chosen.
3. Waiting Period for Specific Diseases
The waiting period for specific diseases means that you will have to wait for the prescribed amount of time to claim for hospitalization.
On average, the waiting period for specific diseases is generally 2 to 4 years.
The list of applicable specific diseases are listed below:
- Non-infective arthritis, osteoarthritis, and osteoporosis (if age-related), systemic connective tissue disorders, dorsopathies, arthrosis, spondylopathies, inflammatory polyarthropathies, and intervertebral disorders (unless due to accident).
- Pancreatitis, gastric and duodenal erosions/ulcers, calculus disease of gall bladder/biliary tract and urogenital system, varices of GI tract, cirrhosis of the liver, rectal prolapse.
- Cataract, glaucoma, and retina disorder hyperplasia of prostate, hydrocele/Varicocele, urethral strictures, and Spermatocele.
- All abnormal uterovaginal bleeding, endometriosis/adenomyosis, female genital prolapse, fibroids, ovarian cyst, pelvic inflammatory disease.
- Hemorrhoids, fissures, fistula and pilonidal sinus/cyst, and fistula.
- Hernia of all sites.
- Varicose veins of lower extremities.
- Psychiatric illness and disorders such as schizotypal, schizophrenia, 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 and Newborn Baby Cover Waiting Period
As a part of most health insurance policies for individuals and families, there's an option to include a maternity benefit and newborn baby cover add-on.
Usually, the waiting period with most health insurance policies ranges from 1 year to 4 years.
The maternity benefit add-on covers delivery expenses and the baby for its first 90 days. Further, it includes all necessary vaccinations and other medical care required for the baby.
Waiting Period In Group Health Insurance
Group health insurance waiting period will usually be around 30 to 90 days after you purchase a group health insurance policy. Moreover, this depends on the terms and conditions of the insurance policy. However, in the case of group health policy, you can waive the waiting period.
For the pre-existing disease coverage, the waiting period is typically 4 years. The insurance company can't deny a claim to the holder once the waiting period is over.
The way this clause works is easy. Before buying the policy, the insured declares his/her pre-existing disease/ailments such as diabetes, hypertension, thyroid, etc. Based on the disease or ailments declared, the insurance company will decide whether the cover under the group health insurance can be granted or not.
When they accept to cover these diseases or ailments, the insurance company will force a waiting period of 4 years. This means that only after the waiting period of 4 years, the insurer can claim any medical expenses.
However, there are some specific diseases such as ENT disorders, osteoporosis, hernia, or others for which the waiting period is usually 1 to 2 years. Furthermore, the group policy-holder can waive off the waiting period.
As with the maternity waiting period, this is quite standard for most insurance companies. The waiting period usually ranges from 9 months to 36 months.
Just like other waiting periods, the maternity cover waiting period can also be removed in a group health insurance policy so that the person is covered from the first day of the policy.
Is It Possible To Reduce Waiting Period In Health Insurance?
If you are diagnosed with a particular disease during the waiting period for the first time, it is not a pre-existing disease. As a result, the policy will cover such diseases or ailments. Similarly, the addition of a co-pay can also help reduce the waiting period in health insurance.
For instance, insurance companies have devised plans for senior citizens. Here, you can remove the waiting period by adding a co-pay clause.
The co-pay clause proposes that policy-holders will have to bear a certain percentage of claim amounts. For instance, for a co-pay clause of 30% in a claim of Rs.1 lakh, the policy-holder will have to pay Rs.30,000 to reduce the waiting period in insurance.
We hope that you are clear with the concept of waiting period in health insurance. As to no doubt, there are many terms that you need to be familiar with before buying a health insurance. Click on this link to learn more about the waiting period and other insurance terms by downloading this free e-book.