Waiting periods in health insurance policies: What the policyholder needs to know

• The whole idea why waiting periods exist is that people should not abuse insurance.
• When there is a pre-existing disease declared in the proposal form, it will have usually a 24- 36 month waiting period
• A lot of health insurance policies provide options to the customer to reduce the waiting period for pre existing diseases by paying an extra premium

The purpose of health insurance is to cover us in case of any medical procedure or emergency. But the coverage does not start from day one of the policy being issued. There is a certain time, also known as the waiting period after which the policy coverage kicks in.

“A waiting period in health insurance policies refers to the duration that must pass after purchasing the policy before it covers specific diseases, specific surgeries, medical conditions, treatments or any add-ons. These typically range from 1-4 years and vary across insurers,” says Adarsh Agarwal, Chief Distribution Officer, Digit General Insurance.

Types of waiting period

Waiting periods are typically of three kinds.

The first is an initial 30 day waiting period. During this time, no claims or planned procedures are covered.

“Anything like an infection where there is a probability that one may have caught it before buying the policy, is not covered. However any hospitalisation due to accidental injury is covered,” says Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz, General Insurance.

The second type of waiting period is when there is a pre-existing disease (PED) declared in the proposal. Coverage for such diseases will have a 24- 36 month waiting period. Similarly, health insurance policies for maternity also have a waiting period ranging between 9-24 months or more, so as to discourage people from buying a health insurance policy to solely cover maternity costs.

The third type of waiting period is for some of the surgeries like hip replacement and knee replacement surgeries. “These types of surgeries can be postponed by a couple of years. So they have a waiting period as well,” says Nerukar.

“The whole idea why waiting periods exist is that people should not abuse insurance,” he adds.

How to reduce or do away waiting periods

“A lot of health insurance companies offer that flexibility to the customer where they can reduce the waiting periods for certain diseases like asthma, BP, cholesterol or diabetes. If you pay some extra premium, the waiting period can be reduced to day one also, which means after the initial waiting period,” says Siddharth Singhal, Business Head, Health Insurance, Policybazaar.com.

For other diseases, you can reduce the waiting period depending from plan to plan and from insurer to insurer. Apart from the diseases mentioned, the waiting period can be reduced to 90 days, in most cases.

In some policies, there is an inbuilt feature which lets you reduce your waiting period, while in others, it comes as a rider.

What to keep in mind

It is advisable to take health insurance as early as possible when one does not have any pre-existing disease.

“While one must look at opting for health insurance plans with reduced waiting periods, younger individuals, for example, who have no pre-existing diseases can opt for higher PED waiting periods in order to opt for a health plan that is affordable to them. This way one can finish all the prerequisite waiting periods when they are healthy and still keep their health insurance plan affordable,” says Agarwal.

Also, when taking a policy it is important that one makes a clear declaration of all pre-existing diseases. That may mean that there is a waiting period, but one can pay an extra premium and reduce the waiting period. However, not declaring an existing condon may mean that a claim may be rejected altogether.