Imagine joining a gym and learning that access to certain facilities becomes available only after a few weeks. Health insurance operates in a similar way. When you buy a health insurance policy, it doesn’t cover all medical expenses from day one. For example, if you get admitted to a hospital for any illness just a week after purchasing the policy, your insurance won’t cover the treatment costs immediately. This is due to something called the ‘Waiting Period’.
So, what exactly is a waiting period in health insurance? What types are there, and how do they affect your coverage? Let’s explore these aspects in this article.
What Is A Waiting Period?
As mentioned earlier, when you buy a health insurance plan, there’s a specific time during which the insurer will not cover certain medical conditions or treatments. This time frame is called the waiting period. The main idea behind this is to keep the insurance plan affordable and manage claims effectively.
So, what does this mean for you? Well, let’s say you have a health insurance plan and there’s a waiting period for a particular surgery or treatment. You won’t be able to claim for that surgery or treatment until this period is over.
Take Reena, for example. She bought a health insurance plan that has a 2-year waiting period for a gallbladder surgery. If Reena needs to have this surgery within the first year of her policy, she’ll have to pay for it herself. Only after 2 years will her insurance cover the costs.
Now that we’ve got a handle on what waiting periods are, let’s dive into the different types of it in health insurance.
Types Of Waiting Periods In Health Insurance
- Initial Waiting Period
When you get a health insurance plan, it’s important to know that the insurer will only cover accidents from day one. For everything else, insurance companies typically enforce a 30-day waiting period. Meaning, if you need any treatment for a medical condition during the first 30 days after your policy starts, the insurer won’t cover it. But don’t worry, this period only applies when you first buy the policy, not when you renew or port it.
For example, let’s talk about Ravi. He buys a health insurance policy with a sum insured of Rs. 5 Lakhs on June 1, 2024. Just two weeks later, on June 14th, he starts having stomach pain and ends up in the hospital for three days. The hospital bill comes to Rs. 50,000. Unfortunately, because he’s still within the initial 30-day waiting period, he can’t claim this amount under his health insurance plan.
- Pre-Existing Diseases Waiting Period
A pre-existing disease is any condition, ailment, injury, or disease that was diagnosed or treated by a doctor within 48 months before the start date of your health insurance policy. It’s important to note that this is different from declaring existing conditions on your proposal form. When filling out the form, make sure your answers are as complete and accurate as possible.
Let’s look at some examples to understand this better:
✅ Rahul was diagnosed with diabetes last year, and he’s managing it well now. If he applies for a health insurance plan, the insurer will consider his previous diabetes diagnosis as a pre-existing disease.
✅ Anaya, had chickenpox during her childhood, about 12 years ago. She hasn’t had any treatment related to asthma in the last 48 months. If Anaya applies for a health insurance policy now, she will need to inform the insurer about her medical history. However, according to IRDAI guidelines, the insurer cannot consider this old asthma diagnosis as a pre-existing disease.
Depending on the policy conditions, the waiting period for pre-existing diseases can range from 2 to 4 years. So, the insurance company can apply a pre-existing disease waiting period for Diabetes under Rahul’s policy, but not under Anaya’s policy..
- Specified Disease/ Procedure Waiting Period
In addition to the aforementioned ones, there’s also a 2-year waiting period that insurers apply for certain specific medical conditions and treatments. This includes things like cataracts, varicose veins, arthritis, sinusitis. etc. Once this period is over, you can start making claims for these treatments. You’ll find the list of these illnesses in the product brochure or the policy wording. It is important to know what the policy doesn’t cover to avoid any surprises if a claim is rejected.
For example, let’s say Neha has a health insurance policy that includes a 2-year waiting period for cataract surgery. If Neha needs cataract surgery within the first two years after her policy starts, the insurance company won’t cover the costs. She’ll have to wait until the 2-year period is over to make a claim for cataract treatment.
Remember, this duration is different from the pre-existing disease waiting period. It’s not related to the medical declarations you make when you buy the policy. For any disease that the insurer considers a pre-existing condition, the pre-existing disease waiting period specified in your policy schedule will apply.
Summing Up!
Understanding waiting periods in health insurance is crucial for managing expectations and planning for medical expenses effectively. Whether it’s the initial, the pre-existing disease, or the specified disease/procedure waiting periods, knowing these timelines helps you avoid unexpected costs. By being informed about these aspects, you can make better decisions and be prepared for any financial responsibilities during the waiting periods.
