All about ‘waiting period’

Read this clause carefully in the health policy before signing up

If you think you will get health cover from day 1 of your signing up a health insurance policy, you are mistaken. You need to wait for a certain time period called the ‘waiting period’ for the benefits to kick-in.

Waiting period is a standard clause in all health insurance policies. A look at the different types of waiting period and the conditions attached.

Why wait?

Waiting period is the time you will have to wait before you can start claiming your health insurance policy. Insurance companies will not reimburse any expenses you incur in this period. Anand Roy, CMO, Star Health and Allied Insurance, says “A waiting period ensures that insurance is not purchased with the intent of an impending hospitalisation. If this happens, the basic structure of the health insurance will be jeopardised.” Any insurance company would not want to pay for the claims that are certain and predictable, as that will lead to loss.

It is important that policyholders read the waiting period clause in their policy before signing up for it. The time frame under waiting period varies from one insurer to another.

Types of waiting period

Post signing-up for a health policy, every policyholder has to wait for the ‘initial waiting period’ to finish.

This is generally 30 days from the date of commencement of the policy. During this period, the insurance company will not admit claim for diseases or hospitalisation except for accidental injuries.

If you have any pre-existing health conditions, you will have to wait longer for the cover to kick-in. Insurers exclude all health complications arising out of ailments that the insured has already been suffering from for a few years. The ‘pre-existing waiting period’ is usually 48 months, but some have only 36/24 months waiting in a higher variant of the policy.

If you are willing to cough up more premium, the pre-existing disease waiting period will reduce.

Waiting period is disease-specific. Here too, it varies from insurer to insurer and is different for each ailment. It is usually two years.

While issuing the policy itself, the insurance company will provide you with a list of ailments and the respective waiting periods. But in some cases, depending on the individual’s heath status and declarations given, the waiting period may be higher, says Sandeep Patel, Managing Director and CEO of Cigna TTk Health Insurance. “It is called special waiting period (or personal waiting period) and may be for 48 months for claims on conditions such as asthma, epilepsy and ovarian cysts.

This waiting period will be specifically stated in the policy and will be applied only after receiving the consent of the policy holder.”

In addition to the above, health insurance companies have waiting period for maternity cover too. Though not all health insurers cover maternity expenses, the ones that do have a waiting period of three to four years from the commencement of the policy.

If, however, you want to avoid waiting period in a health policy, look for an employer offering a group health cover. In group covers, there is no waiting period for the health cover benefits.

The group health policies generally waive off not just the pre-existing disease waiting period, but also disease-specific waiting periods.

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