The sedentary lifestyle followed commonly by people in India makes them more prone to several diseases. We all are a part of the junk-food culture, which ultimately makes us fall ill. All this has made health insurance purchase an integral part of our lives. Hospitalization expenses, critical illnesses, and regular health checkups are mostly covered in a basic health insurance plan. However, not everyone knows about various facets of health insurance at the time of buying a plan, one of which is the waiting period.
Knowing about the waiting period in health insurance is a crucial step towards ensuring that you select the most suitable plan. You might want to know what waiting period is, what it includes, and how long it can be. Let’s cover it all in detail here.
What is WP in Health Insurance? – Definition
Waiting period in health insurance refers to the duration after which you will start getting the benefits of the purchased plan. In simpler words, it is the period for which you need to wait after buying the policy to become eligible to receive its insurance benefits.
You should also know that you cannot file a claim during the waiting period. Even if you do so, it will most likely be rejected by the insurer.
Types of Waiting Period in Health Insurance
There are different types of waiting period in health insurance, which means you need to wait for a certain period before you can benefit from your policy in several different ways.
Basically, there are six types of waiting period in health insurance, as given below:
Cooling Period or Initial Waiting Period
This type of waiting period in health insurance refers to the period starting from the date of issue of your policy, for which you need to wait to start using the policy actively and avail of its benefits.
As an insurance industry standard, most health insurance plans have an initial waiting period of up to one month. However, it is not applicable to accidental hospitalization cases in general (will be covered later here).
Waiting Period for Specific Diseases
As the name suggests, this waiting period means you will need to wait for a period before you can file a claim for hospitalization and treatment costs related to some specific diseases. It may vary from one insurance company to another.
However, it ranges from two to four years for different types of diseases like Arthritis, Osteoporosis, Osteoarthritis, Pancreatitis, Cataract, Hemorrhoids, and many others.
Waiting Period for Pre-existing Diseases
As per IRDAI, a pre-existing disease is a condition, injury, or ailment, or disease that is diagnosed up to 48 months prior to buying health insurance.
The pre-existing diseases waiting period in health insurance refers to the duration for which you need to wait before you can claim the insurance benefits related to a pre-existing disease.
In general, this type of waiting period ranges from three to four years and may vary depending on the type of plan and the insurer chosen.
Maternity Cover Waiting Period
You can buy an optional maternity benefit cover with most of the health insurance policies available in the market. It helps deal with the financial expenses during and post labor for the new parents. Typically, this cover comes with a waiting period of one to four years.
For example, if you buy a health insurance policy with maternity cover that has a waiting period of two years, you can only claim for the maternity benefit after two years.
Bariatric Surgery Waiting Period
Bariatric surgery refers to the stomach/intestine-related surgery needed by patients having obesity-related health issues. It is important to check if it is included in your health insurance plan.
The waiting period in health insurance related to this surgery is around two years.
Waiting Period for Accidental Hospitalization
No individual can afford to wait for a period on facing any accident which causes injuries and other health issues. Keeping that in mind, no health insurance company account for any waiting period to deal with accidental hospitalizations.
It means, in case of an unfortunate accident, you can file a claim under your health insurance plan without worrying about any waiting period even a few days after buying it.
Also Read: All About Incurred Ratio Meaning
Need for Waiting Period in Health Insurance
The need for a health insurance waiting period arises from the intentional misuse of insurance benefits. Some individuals who are recently diagnosed with a severe disease buy health insurance without disclosing the disease. They do this to get the benefits just after they have bought the policy.
The waiting periods help avoid the unethical practices followed by the individuals.
Waiting Period FAQs
Can I file a health insurance claim if a disease is diagnosed after the waiting period?
If you are diagnosed with a new ailment during the policy period after the waiting period has ended, your claim will be covered under the policy.
Are health insurance claims filed during the waiting period denied?
Most claims filed during the waiting period are denied, except those related to accidental hospitalization (its rules may vary from one plan to another)
Why you should buy a health insurance plan when you are young?
When you buy health insurance at a young age, you get the health cover at a premium you can easily afford, can select extended benefits easily, and need not worry about health insurance waiting period because of the lower risk of healthcare emergencies.
Can I eliminate waiting period in health insurance plans?
You can do this only when the chosen insurance company allows it subject to certain conditions and clauses.
How to check if my pre-existing diseases are covered in health insurance?
It is advisable to read the policy-specific terms and conditions before you buy any plan.
Is it possible to waiting period in health insurance?
Some health insurance companies provide the option to reduce health insurance waiting period in lieu of extra premium.
Do group health insurance plans have waiting periods?
In general, group health insurance plans do not insist on waiting period in health insurance. It means the insured members can get the insurance benefits from day one.
Also Read: All About Group Life Insurance
What happens if the claim is filed during the waiting period?
Most health insurance claims are denied if they are filed during the waiting period.