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After How Many Days Can We Claim Health Insurance – Waiting Periods Explained

What is the purpose of purchasing healthcare insurance? A health insurance policy provides much-needed financial support when you get hospitalized. Whether individual or group healthcare policy, the objective is similar. The waiting period is also valid for employer-sponsored group medical insurance plans. But the waiting period varies with different companies and policies depending on the structuring of the program. 

The waiting period in health insurance

Waiting period is the  period of time that an insured member must wait to become eligible for insurance coverage and claims to be paid. Some Policies will not pay maternity benefits, for example, until nine months after the policy has been in force. Another common waiting period occurs in group insurance that is offered through a place of employment, whereby coverage may not start until an employee has been with a firm for more than 30 days. During this waiting period, an employee cannot claim the listed benefits of health insurance.

Different types of waiting periods:

Most people are aware of the initial waiting term for health insurance. When an employer purchases a group healthcare coverage for the employees, they can get coverage for medical expenses from the insurer during their service term. But the insurance coverage begins after the initial waiting term of thirty days. All employees are aware of this exception. Do you know that there are other waiting periods in a health insurance policy? Read along and know about the different types. It will help you get a clear overview of the policy features.

  • For pre-existing diseases: Most insurance companies have a compulsory waiting term before covering pre-existing ailments. Pre-existing condition refers to any ailment, injury, disease or health condition that is diagnosed up before you purchased the health insurance policy. 

As per the circular from IRDAI on 10th February 2020, a pre-existing condition is any illness or a medical condition, sickness, disease, or injury, that has been diagnosed prior to the purchase of a medical insurance plan. Any such medical condition diagnosed by a physician 48 months prior to the date of the issuance of the policy or its reinstatement is considered a pre-existing condition.

According to the new terms, only those diseases that are prevalent and have been diagnosed before buying the insurance are considered PEDs. Therefore, if you have an illness that you were unaware of or was not diagnosed before the insurance came into effect, it would not be considered under PED.

Some of the most common pre-existing conditions include thyroid, high blood pressure, diabetes, asthma, cholesterol, etc. 

  •  For specific diseases: The waiting period for specific diseases is a customizable feature and is applicable for certain specific diseases. There are some listed diseases and medical treatment procedures like – ENT disorders, osteoporosis, cataract, joint replacement operation, etc. In such ailments, you need to serve a waiting term of one or two years (depending on the insurance company). However, you can waive off the waiting span by adding features to the healthcare policy or add-on benefits and enjoy a cashless treatment/reimbursement for expenses. 
  • Initial waiting term: The initial period is constant with every insurance provider in the country. For most insurance companies, the initial waiting course is for thirty days. 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. During this period the insurer cannot avail of insurance benefits and coverage for planned medical treatment. If you are covered under an employer-sponsored group healthcare policy, you can get coverage for accidental treatment expenditure during the waiting period. 
  • For critical illness: Most health insurance policies have a waiting period regulation for critical illnesses. It may be up to ninety days. The policy covers the medical expenses only if the insured person gets diagnosed with the disease after passing the waiting period, as regulated by the insurance company. The critical illness may be related to multiple organs in the body like – the kidney, heart, liver, etc. 
  • Maternity waiting term: Maternity benefit and newborn coverage also requires a waiting period for most insurance companies. For group health insurance, the waiting period for maternity coverage is valid for female employees or family members of male employees. The period ranges from nine months to three years, depending on the insurance company coverage rules. 

A waiting period avoids any fraudulent claims coming into the health insurance policy. 

Can you reduce it?

Yes, the insurance company can waive the waiting period. But it is possible only if you pay additional premiums. Waiting period clauses differ from one insurance provider to another. 

Moreover, if you have an employer-sponsored health insurance policy, the waiting period clause does not exist as group policies can offer customisation to waive off the waiting periods to provide day 1 cover. 

Connect to PlanCover

PlanCover, brings you all the essential information for group healthcare insurance. You can connect to their team and resolve the queries about the waiting period. 

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