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Waiting Period – Types of Waiting Periods in Health Insurance

Waiting Period - Types of Waiting Periods in Health Insurance

Health insurance is the key to financial well-being and peace of mind. Amid rising health concerns, pandemics, poor lifestyle choices, and increasing risks to health have made health plans an essential investment. However, when you purchase a health plan, it is important to understand various terms and conditions of the plan. Only when you understand the policy completely you will be able to make the most out of it.

One important aspect of a health insurance policy is the waiting period in health insurance. Read on as we discuss the waiting period and what you must be careful about.

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What is the waiting period in health insurance?

The waiting period, also known as the cooling period limit, is when an insured/policyholder cannot raise a health insurance claim. It is the cooling down period after you purchase a health insurance plan. For different diseases and under different conditions, the waiting period in health insurance may differ from plan to plan. Usually, there is a waiting period of 0-30 days for any health insurance plan offered by a health insurance company. However, for critical diseases and maternity plans, the waiting period may be longer.

Here is a table below that quickly explains PED waiting period, maternity waiting period, and so on:

Waiting periodHealth conditions
Coverage from day 1Accidental hospitalisation
30 daysInitial waiting periodCovid-19
1 to 2 yearsPsychiatric illnessesBariatric surgeryCertain diseases
9 months to 3 yearsMaternity coverNewborn cover
1 to 4 yearsPre-existing diseases (PED)

The table above explains the lump-sum waiting period for various health conditions. Depending on the health insurance policy and provider, the tenure may differ.

Different types of waiting periods in health insurance

The type of waiting period in health insurance depends on the type of treatment you are seeking. After the policy is purchased, the following are the cooling period limits for different health conditions:

1. Initial waiting period

An initial waiting period is the basic cooling period limit under which a claim cannot be raised for any disease. While some health insurance companies may offer zero waiting periods, typically in group health plan, others may request you to wait for up to 30 days. If you raise a claim within these 30 days, the claim has a high chance of being rejected.

2. Accidental hospitalisation waiting period

Accidents are unforeseen and quite overwhelming. The medical costs can further add to the stress. Hence, there is no waiting period for accidental hospitalisation. If an insured suffers an accident even on the 1st day of the policy inception, the medical expenses are covered under the health plan. Typically, the initial waiting period is not applied in case of accidental hospitalisation.

3. Pre-existing diseases waiting period

PED in health insurance or pre-existing diseases refers to the illnesses that an insured had/ has before purchasing the policy. The most common PEDs are diabetes, thyroid, hypertension, etc. Such pre-existing diseases usually have a waiting period that may range between 1 to 4 years.

This is one reason why it is highly recommended to invest in a health plan at an early age as people are usually healthy and do not have to go through a PED waiting period.

4. Certain diseases and ailments waiting period

Certain critical illnesses and diseases require a longer waiting period. These may include cancer, ENT problems, cataracts, osteoporosis, and so on. This is well specified in the policy documents and so, make sure to read all the terms properly. During the waiting period, if a claim is raised, it can be rejected.

Red More: Critical Illness Insurance Plans

5. Waiting period for maternity cover and newborn baby

Maternity cover and newborn baby cover refer to the pregnancy, delivery, and post-natal care of the mother and the baby. The medical expenses can be hefty, especially amid rising living costs.

It is advised that newlyweds invest in maternity cover soon so that they can easily serve the waiting period and get the needed financial aid. The waiting period for maternity and baby cover may range from 9 months to 4 years.

6. Bariatric surgery waiting period

Bariatric surgery is done for weight loss and digestive system alterations. Usually, the waiting period for bariatric surgery ranges from 1 to 2 years. So, if you have a plan for bariatric surgery, make sure to align investments accordingly so you do not feel burdened with medical expenses.

7. Psychiatric treatment waiting period

Psychiatric treatment can sometimes be expensive, including the counselling charges as well. Coping with such high costs can be daunting. Also, the waiting period in health insurance for psychiatric treatment can go up to 2 years. Until the waiting period is over, you cannot raise a claim.

Things to know about the waiting period in health insurance

Here are a few things you must know about waiting period

a). Cancellation of claims

A claim raised during the waiting period is usually rejected. Only accidental hospitalisation has zero waiting period and can be raised from day one after purchasing the policy.

b). Understanding a pre-existing disease

Any disease that is diagnosed after purchasing the policy or during the waiting period is typically not considered a pre-existing disease. It falls in the general disease category and is covered under the health plan.

c). Co-payment

Co-pay is a clause that may help reduce the health insurance waiting period. Co-payment is the percentage of the claim amount that is borne by the insured/policyholder.

Conclusion

A health insurance plan can be one of the most important investments in these times. On the one hand, it helps cope with the expensive medical costs, and on the other hand, it also offers tax benefits under the Income Tax Act of 1961. It is important to know all the terms and conditions of the policy, including the waiting period until which a claim cannot be raised.

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