What is the Waiting Period in Health Insurance?

Waiting period is the amount of time you need to wait (from the beginning of your insurance policy) until you can claim your insurance benefits for specific illnesses or treatments. This period applies right from the start date of your policy, and its duration varies depending on the type of coverage.

This means that a claim made during the waiting period is likely to be declined, and you will be advised to wait until it is over. However, claims for accidents do not have a waiting period and are available from the day your policy starts.

For example, most medical insurance plans have a waiting period of four years before covering 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.

Applying waiting periods is a standard practice to prevent the misuse of health insurance benefits and ensure that those who need them can receive the support they require. These terms are specified in your policy, and understanding them beforehand helps you avoid claim rejections and last-minute financial hassles.

Also Read: How does Health Insurance with a Waiting Period work?

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

Initial Waiting Period in Health Insurance

The initial waiting period refers to the time during which you have to wait before your health insurance policy becomes active. You have to wait until the expiry of this initial waiting period to receive the benefits from your medical insurance. For TATA AIG plans, the initial waiting period is 30 days long and does not apply to accidental claims.

PED Waiting Period

When you buy a health insurance plan, you have to disclose any pre-existing diseases (PED) or health conditions that are diagnosed up to 48 months before the purchase. Some of these illnesses include diabetes, thyroid, hypertension, etc. We have a specified waiting period of 3 years with our health insurance plans. This means that before the waiting period ends, you cannot claim any hospitalisation or treatment expenses incurred for pre-existing conditions.

Specific Illness Waiting Period

This waiting period applies to specific illnesses before your health insurance plan acknowledges your claim for their treatment and hospitalisation. Some of these include osteoporosis, hernia, ENT (Ear, Nose and Throat) disorders.

At TATA AIG, the average waiting period in such cases is two years. However, you must verify your policy documents for accurate details specific to your disease.

Waiting Period for Maternity Expenses

Not all medical insurance plans cover maternity insurance in their policies. However, comprehensive health policies also provide benefits for maternity expenses too. Insurance companies apply a waiting period before you can make a claim for maternity expenses under your health insurance plan.

Generally, the waiting period in maternity insurance 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.

Waiting Period for Accidental Hospitalisation

If you need to claim your health insurance plan for treating any injury caused by an accident, you can get the benefits without serving any waiting period. According to IRDAI, accidental claims do not have a waiting period, and benefits are available from day 1.

Additionally, for benefits such as annual check-ups and other wellness benefits, waiting periods may vary depending on your policy terms. Hence, it is wise to review the documents and contact the agent or the insurance company directly if you have any queries.

Also Read: Is Maternity Insurance Available for Already Pregnant Women?

A waiting period is applied to prevent false claims and discourage policyholders from making claims with the wrong intentions.

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.

Waiting period clauses differ based on the plan and coverage options. While we have different waiting periods for different types of conditions, we also offer ways to help you reduce your waiting period.

• Opting for Add-Ons: We offer add-ons, such as Modification in Pre-Existing Disease Waiting Period, which allows you to reduce your waiting period of 3 years of PEDs to 1 - 2 years.

• Choose Policies With Low Waiting Periods: As mentioned, different policies may offer different waiting periods. For example, under our Elder Care plan, the waiting period for PEDs is 24 months. So, compare and choose the right type of plan for your needs.

• Employer-Sponsored Plans: 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.

• Convert Employer-Provided Plans: According to the IRDAI (Insurance Regulatory and 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. This is because you would have covered the waiting period clause in the group health cover.

• Buy Early: If you do not want to buy an add-on or have time until you need your specific health insurance benefits, the ideal approach is to plan ahead and buy early. By doing so, you can complete the waiting period by the time you need your insurance claim to support your treatment expenses.

Also Read Are There Health Insurance Plans With No Waiting Period?

The survival period refers to the number of days a policyholder must live after being diagnosed with a critical illness for a claim to be valid. In the TATA AIG critical illness plan, this typically ranges from 0 to 15 days, depending on the variant chosen. This period is applicable only to critical illness policies and not to regular health insurance plans.

The cooling-off period, also called the free-look period, is the initial time frame after purchasing a health insurance policy when you can review the terms and cancel it without penalty. It gives buyers a chance to thoroughly understand the inclusions, exclusions and terms.

TATA AIG offers a 30-day free-look period for online or distance marketing purchases.

If you cancel during this period, you receive a refund after deducting nominal charges for the time covered. It differs from the waiting period, which relates to claiming eligibility. While the waiting period delays claim benefits, the cooling-off period safeguards your right to exit a plan if you're unsatisfied.

For instance, if you find a plan does not cover maternity as expected and you're still within the free-look period, you can exit without major losses. Always read your policy documents during this window to make informed decisions.

The waiting period is the time before insurance benefits are available to cover the expense of certain illnesses. 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. To avoid claim rejections and select the right plan, it is important to carefully read the health insurance policy documents and choose a minimum waiting period in health insurance.

Moreover, it is advisable to buy health insurance early. This is because if you buy health cover early, you can easily pass the waiting period without needing to use insurance coverage benefits.

With TATA AIG, you can choose from our wide range of health insurance plans depending on your healthcare needs. With access to diverse add-ons, you can enhance the best health insurance policy and reduce the waiting time to ensure you are well-protected during emergencies.

With our 24/7 accessible expert support, digital claims processing and transparent processes, you can rest assured that you and your family can get access to the top-quality healthcare services when you need them the most.