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What is Waiting Period in Health Insurance?

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The waiting period in health insurance is the time you require to wait before the diseases listed under your health plan are covered. Your insurance provider will not settle your claims made during this span of time. Many insurance companies have a waiting period of few year for health insurance plans, which cover the pre-existing conditions.

Mr Mehta was very happy thinking that he had secured his finances from a medical contingency by buying health insurance. The catch came when Mr Mehta’s claim was rejected by the insurer on grounds that it didn’t fulfil the terms. Feeling cheated, he inquired about every possible way to know the reason for rejection. He was then told that as Mr Mehta was a diabetic, he was supposed to serve a definite waiting period for the same. As Mehta had requested a claim without fully serving the waiting period, and hence, his claim was denied. Since then, he delved into the concept of the waiting period and below is everything he learned.

Medical contingencies can adversely affect your finances. The ever-growing cost of quality health care treatments and the rising incidents of illnesses is alarming for your finances. Health insurance is a necessary buy in this condition.

But, do you think your health insurer will cover you for every medical condition?

The answer is definitely “NO”!

You might be feeling cheated (if unaware), but waiting period is a part and parcel of every health insurance plan. It is nothing but a period when your insurer will not approve any claim. Thus, it is advisable to be wholly familiar with the various types of waiting period and clauses associated with them.

Now, you must be thinking why is there a waiting period in health insurance?

Let’s us clear your doubts…

Waiting Period in Health Insurance is Important Because:

A huge financial beating is on the insurer if the insured raises a claim during the initial period of the policy. In this context, it is quite obvious that insurance companies don’t want to reimburse for such probable damages. Similarly, it is sensible not to offer any coverage for the medical conditions that are declared as pre-existing ailments at the time of buying a plan. This might demand a probable course of treatment that may involve a huge amount within a short span of policy inception. Therefore, health insurance companies in India delay insurance coverage for such diseases.

Types of Waiting Period in Health Insurance are:

  • Initial Waiting Period (30 to 90 Days)

This is a 30-day waiting period (maximum to 90 days) from the date of policy initiation. If any claim arises within these days, the insurer will not entertain the request unless it is an accidental emergency. However, to cover the hospitalisation expenses, the patient needs to be hospitalised for a minimum of 24 hours.

  • Illness Specific Waiting Period

Every health insurance policy comes with a list of illnesses for which no claim can be made for a specific time. Usually, 1 or 2 years of waiting period is applicable, however, it entirely depends on the insurer or the plan you’ve opted for. That’s why it is important for you to read every clause mentioned in the policy wordings meticulously.

  • Waiting Period for Pre-existing Illness

Pre-existing illnesses are those illnesses that you have been suffering from before policy purchase or which existed at the time of purchasing a plan. Since the nature or condition of these illnesses is known, the insurer tries to avoid providing coverage for such illnesses in the initial years and sets a waiting period to serve. In most cases, 2 to 4 years of waiting period is applied.

  • Survival Period

If the insured person survives for a period of 28 days or so from the date of the detection of the disease or are undergoing any illness-related surgery, this period is called survival period. In such a case, a benefit will be released from the insurer to cover the treatment expenses. Below are the clauses related to survival period:

  • This waiting period is usually applicable in case of critical illnesses
  • The primary factors that decide the length of the waiting period include- the type of policy, type of illness and the insurer
  • It is an addition to the above-mentioned waiting period
  • A lump sum amount will be paid by the insurer in case you survive the waiting period. The benefit amount can be used for any purpose.

Can I Change the Waiting Period of  a Health Insurance Policy?

It can be, but it comes with a cost!

By paying a higher premium, you can reduce the waiting period. Moreover, some health insurers offer a co-payment option, especially in senior citizen plans, where you need to pay a certain percentage of the total expense and the insurer pay the balance amount.

However, insurance companies implement waiting period to reduce the probable risks. Pre-existing medical conditions or specific illnesses may require immediate medical attention. The treatments can be expensive as well, due to which, you might be looking for a plan with no waiting period. Though such policies are not available, opting for a plan with a comparatively less waiting period can be your best bet!

What Should I Do In Case of Existing Illnesses?

You might feel discouraged that your health insurance comes with so many terms regarding waiting period, there are ways to deal with this.

How? Let us explain…

Honesty is the Best Policy

We have been growing up listening to this. It is applicable to insurance as well. Be honest when it comes to declaring something important to your insurer such as any medical history. It is true that you will be restricted from claiming your insurance for a certain period or in extreme case that condition will be permanently excluded. But, if you don’t declare and the insurer gets to know later, the claim will be rejected or the policy will become null and void. Therefore, it is recommended to declare everything about your pre-existing illness as it is the only way to deal with this.

Explore, Explore and Explore

The waiting period may vary insurer to insurer or plan to plan. You should explore plans before zeroing on one. Always give preference to those with the lowest waiting period.

Buy Young Stay Covered

As we grow older, the chance of getting ill is higher. Therefore, you should buy a health plan at a young age. This way, you can easily serve the waiting period and get the complete coverage whenever you develop any such ailment and need to claim your policy.

Pre-existing ailments are not the end of the road, instead, they are the road-block. While health insurance plans come with exclusions for some pre-existing ailments, it would cover other illnesses. So, carefully understand your policy wording is a must.

Summing Up!

While you can’t evade the clause of waiting period in health insurance, it is important to know what ailments are covered by your policy and what is permanently excluded. To remain protected, it is important to opt for unceasing coverage. Here’s why, insurance experts advise to compare plans online before you make the final purchase. By the same token, read the policy wordings carefully and understand every hidden clause regarding waiting period of a health insurance policy to avoid any eleventh-hour hiccups.

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