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What is the Waiting Period in Health Insurance?

The waiting period in health insurance is a timeframe during which you must wait before certain benefits become accessible, serving to prevent misuse and ensure the sustainability of coverage.

  • 2,556 Views | Updated on: Jan 11, 2024

​Health insurance plays a vital role in providing financial security and access to medical care. When you enroll in a health insurance plan, you often encounter terms and conditions that influence your coverage. One such element is the waiting period, a concept that can significantly impact when you can access certain benefits.

What is the Waiting Period in Health Insurance?

The waiting period in health insurance refers to the specific duration during which you must wait before certain benefits or coverage options become available. This provision is typically implemented to prevent you from purchasing insurance coverage solely to address existing health issues or to obtain expensive medical treatments immediately after acquiring the policy.

Why Do Health Policies Have Waiting Periods?

Waiting periods in health insurance policies were instituted to curb certain situations from exploiting coverage opportunities. Some might acquire insurance plans after being diagnosed with an illness, strategically aiming to offset the expenses of costly treatments or surgeries. Concealing a pre-existing condition and subsequently obtaining insurance coverage is another practice that insurers seek to deter. The implementation of waiting periods serves as a preventive measure by insurance companies to discourage unethical behaviors of this nature.

Types of Waiting Periods in Health Insurance

Health insurance policies come with various waiting periods, each serving a distinct purpose in ensuring fair and sustainable coverage.

Initial Waiting Period

The initial waiting period, often termed the cooling-off period in health insurance, is the span during which you must wait before actively utilizing your health insurance benefits. Across the industry, the standard for this waiting period is typically up to 30 days from the date of policy issue.

Pre-Existing Diseases Waiting Period (PED)

When purchasing a health insurance policy, you are questioned about pre-existing diseases, and medical tests may be required. According to IRDAI, pre-existing diseases encompass conditions diagnosed up to 48 months before obtaining the policy. Waiting periods for pre-existing diseases typically range from one to four years, depending on the health insurer and the chosen plan.

Waiting Period for Specific Diseases

Some health insurance plans include waiting periods for specific diseases. You must wait for a prescribed duration before making claims related to a list of diseases. Generally, this waiting period falls between one to four years. The list of applicable diseases includes conditions such as arthritis, gastrointestinal disorders, urogenital issues, eye disorders, and various other specified ailments.

Maternity Benefit & Newborn Baby Cover Waiting Period

If you plan to include maternity benefits and newborn baby cover in your health insurance, there is a waiting period ranging from one to four years. This waiting period ensures that you can only claim for maternity-related expenses once you have completed the stipulated waiting period, which typically lasts two years. The maternity benefit add-on covers delivery expenses and provides coverage for the newborn for the first 90 days, including necessary vaccinations and other medical care.

Can the Waiting Period be Shortened?

The limitations on waiting periods can be adjusted through certain optional covers, often available at an extra cost. For instance, some insurers offer a Pre-Existing Disease (PED) waiting period waiver, which reduces the waiting period for pre-existing conditions from 4 years to 2 years. Nevertheless, the availability of such modifications primarily relies on the insurance provider. Therefore, it is advisable to consult with your insurer to obtain comprehensive details on this matter.

Final Thoughts

Understanding the waiting period in health insurance is crucial for you seeking comprehensive coverage. While it may seem like a temporary inconvenience, waiting periods are essential for maintaining the integrity of the insurance system and ensuring that coverage is provided in a fair and sustainable manner. You should carefully review the terms of your health insurance plans, including waiting periods, to make informed decisions about your healthcare needs and financial well-being.

Key takeaways

  • The waiting period in health insurance is a specified duration during which you cannot access certain benefits after enrolling in a new insurance policy.
  • Common waiting periods include the initial waiting period, pre-existing conditions, and specific diseases or treatments.
  • Waiting periods can vary from a few days to several years, depending on the type of coverage and the insurer’s policies.
  • Despite waiting periods, most health insurance plans cover emergency medical situations during the initial waiting period.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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