Waiting Period in Health Insurance

Generally, the waiting period is the time you have to wait. In terms of health insurance, it implies the amount of time you need to wait (from the beginning of your insurance policy) for specific diseases or health conditions to be included in your health insurance plan. Before the expiry of the waiting period, you cannot make a claim for the excluded health conditions and diseases.

Each insurance company specifies the waiting period, if any, and explicitly lists down all the health conditions and diseases that will be eligible for the claim only after the waiting period ends. The waiting period and the exclusions vary per different insurance providers. Moreover, varied health conditions and coverage have different waiting periods and rules for the same.

For instance, most health insurance plans have a waiting period of four years before the inclusion of diabetes. This means that you have to wait for at least four years before you can claim any benefits for diabetes-related health expenses offered by your health insurance policy.

A waiting period is levied to avoid false claims and the wrong intention of the policyholder to claim the health insurance plan.

During the initial years when health insurance plans were introduced, several customers purchased a health insurance plan after being diagnosed with a medical condition or requiring surgery for a specific disease. This was because people realised that paying for the treatment of their existing diseases would be expensive. Hence, they purchased a health insurance plan without disclosing their pre-existing health conditions to the insurance company.

To avoid such unethical practices, the concept of a waiting period was introduced.

Tata AIG Medicare Health Insurance Plans – Medicare, Medicare Protect and Medicare Premier offer the following types of waiting periods:

1.Initial waiting period
Also known as the cooling period, the initial waiting period refers to the period for which you have to wait before the health insurance policy becomes active. You have to wait until the expiry of this initial waiting period to receive the benefits from your health insurance policy.

In most cases, the initial waiting period is about one month long and applies to some insurance benefits like non-accidental claims.

2.Pre-existing diseases waiting period
When you buy a health insurance plan, you have to disclose any pre-existing diseases or health conditions. Pre-existing condition refers to any ailment, injury, disease or health condition that is diagnosed up to 48 months before you purchased the health insurance policy. Some of these illnesses include diabetes, blood pressure, thyroid, hypertension, anxiety, heart issues, knee injury, kidney ailment, etc.

Each insurance company specifies a waiting period before these pre-existing diseases or conditions will be covered by the health insurance plan. This means that before the waiting period ends, you cannot claim any hospitalisation or treatment expenses incurred for pre-existing conditions.

On average, the waiting period, in this case, is between three and four years. That said, if during the waiting period in a health insurance policy, you are diagnosed with a disease for the first time, it will not be considered a pre-existing disease. The insurance policy will provide coverage for the ailment as per the terms.

3.Waiting period for specific diseases
This means that you need to wait for a specific time before your health insurance plan acknowledges your claim for treatment and hospitalisation for defined illnesses and diseases.

Some of these include osteoporosis, hernia, ENT (Ear, Nose and Throat) disorders. On average, the waiting period in such cases is two years. However, you should check your health insurance policy for details.

4.Waiting period for maternity expenses
Not all health insurance plans cover maternity expenses in their policies. But comprehensive health policies allow you to get benefits for maternity expenses too. However, insurance companies levy a waiting period before you can make a claim for maternity expenses under your health insurance plan.

Generally, the waiting period for maternity expenses is four years. This means that after the elapse of four years from the purchase of your health insurance plan, you can claim for maternity-related expenses.

For instance, if you plan to start a family in another five years, you should ideally consider the nine months of pregnancy plus the 39-months required to complete the four-year waiting period for maternity expenses. Some insurance companies might restrict the number of pregnancies covered in the plan. However, sound health insurance plans do not levy such restrictions and happily take care of your maternity expenses.

Apart from these, some insurance companies can levy a waiting period for additional aspects of the health insurance policy, such as free annual check-ups, accidental hospitalisation, etc. Hence, it is wise to check the documents and ask the agent or the insurance company directly in case of queries.

Waiting period clauses differ from one insurance provider to another. You can get in touch with us to understand the details of the waiting period in your Tata AIG health insurance policy.

Moreover, if you have an employer-sponsored health insurance policy, the waiting period clause does not exist. Even if it exists, the waiting period is relatively shorter than individual health insurance policies.

Further, as per the IRDAI (Insurance Regulatory Development Authority of India), if you convert your employer group health insurance plan into an individual retail health policy, you will not have any waiting period because you would have covered the waiting period clause in the group health cover.

Overall, the waiting period in a health insurance policy depends on the type of health cover (individual, group or family floater health Insurance plan) as well as on your medical history and age. It is important to read the health insurance policy documents carefully and choose a minimum waiting period in health insurance.

Moreover, it is advisable to invest in a health insurance plan early. This is because if you buy a health cover early, you are at the peak of good health. This means you can easily pass the waiting period without requiring insurance coverage benefits. When you near your old age, you would have already crossed the waiting period and would be eligible to get all the policy benefits.