Waiting Period in Health Insurance

A health insurance policy can be defined as a contract that you and the insurance company sign. As per this contract, the insurer agrees to pay financial compensation to you in the event of a medical emergency in return for payment of premiums from your end. In an insurance policy document, various terms are listed that clarify the coverage provided under the health insurance plan. Under these, a clause related to the waiting period is also mentioned. What is the waiting period, and what is its significance in your health insurance policy experience? Let's take a deep dive into the same.

What is the Waiting Period in Health Insurance?

The waiting period refers to the duration during which the policyholder cannot raise a claim, despite the policy being active. Only after the specified time span has ended, can a claim be raised. During the waiting period, you may not be able to raise a claim against any disease, even if your insurance policy covers it. You need to pass the requisite waiting period, as per the insurer's guidelines, to be able to raise a claim. Therefore, when you're purchasing a health insurance plan, you must know the time you're supposed to wait before raising a claim. Waiting periods can be found in multiple kinds of insurance policies and are also present in different types as per the health insurance coverage you choose.

Different Types of Waiting Periods

Depending on the kind of coverage you choose, you may come across waiting periods of the following types:

1. Initial Waiting Period

This refers to the basic waiting period that every insurance policy has, which lasts for about 30 days. This means the policy shall cover no medical benefits for the first 30 days, except for accidental hospitalisation claims.

2. Waiting Period for Pre-existing Conditions

It is wise to purchase a health insurance policy when you're young as the chances of you falling sick or contracting a medical condition are less compared to older people. A medical condition, which is already afflicting a person at the time of buying the health insurance policy, is known as a pre-existing disease. Common pre-existing diseases for which waiting periods are common include diabetes, hypertension, thyroid, and so on. In this case, you will be asked by your insurer to wait for a specific period before you can raise a claim to avail of treatment.

3. Waiting Period for Maternity Benefits

Many health insurance companies have a waiting period before allowing a maternity benefit insurance claim. Depending on the terms and conditions of the company, this same period can range from a few months to a few years. Therefore, always purchase a health insurance plan with maternity coverage in advance. This waiting period may also be applicable for insurance coverage for newborns. *

4. Group Plan Waiting Period

Most companies offer health coverage to their employees. For the new employee to be able to make a claim, they must wait for a specific period before claiming against the group policy. The waiting period might apply to someone who's recently joined the company and is serving probation.

5. Waiting Period for Specific Illnesses

Some health insurance plans may also have specific waiting periods for certain ailments, such as cataracts, hernias, ENT disorders, etc. This waiting period may usually be one to two years long.

How Does the Waiting Period in Health Insurance Work?

The health insurance waiting period begins from the policy's start date and defines how soon you can use the benefits. Emergency hospitalisation from accidents is generally covered immediately, but planned treatments, pre-existing conditions, or maternity claims will have to wait until the specified time lapses.
Bajaj Allianz General Insurance Company, for example, offers different plans with variable waiting periods, depending on the coverage chosen. Understanding these nuances helps you better plan medical expenses and manage expectations around claims.

Why Do Health Insurance Plans Have Waiting Periods?

Waiting periods are built into health insurance plans to reduce the risk of misuse and ensure fair usage. They prevent individuals from buying insurance only after falling ill. Insurers, including Bajaj Allianz General Insurance Company, use this time to evaluate the risk associated with the policyholder, ensuring that premiums remain reasonable and the system stays sustainable.

Zero Waiting Period on BAGIC Plan

Bajaj Allianz General Insurance Company offers zero waiting period health insurance through select customised plans. These plans are ideal for those who require immediate coverage and want to avoid standard delays.

Key Benefits:

• Instant Coverage: Immediate claim eligibility for specified conditions from day one.
• No Waiting for Pre-existing Conditions: Subject to underwriting, some policies cover declared conditions without delay.
• Tailored for Urgent Needs: Best suited for individuals seeking health insurance with no waiting period due to immediate medical requirements.
• Hassle-free Claims: Skip the waiting and enjoy faster, smoother claim processing.
• Trusted Network: The company's reliability extends beyond health insurance, evident in its 18,400+ cashless hospitals under the Bajaj Allianz Health Insurance umbrella.

Is It Possible to Reduce the Waiting Period in Health Insurance?

Yes, some insurers provide the option to reduce waiting periods by paying an extra premium or opting for upgraded plans. It's worth checking with providers like Bajaj Allianz General Insurance Company for such flexible offerings.

Additional Points to Remember About Health Insurance Waiting Periods

• Different types of benefits come with different waiting periods.
• Minimum waiting period health insurance can vary significantly between insurers.
• Maternity and newborn covers usually have the longest delays.
• Group insurance may offer reduced waiting periods.
• Always review your policy documentation thoroughly.

What is Survival Period in Health Insurance?

The survival period refers to the duration a policyholder must live after being diagnosed with a critical illness to be eligible for a payout. Typically lasting 15 to 30 days, this clause applies only to critical illness policies. If the insured does not survive this period, the claim becomes void.

Difference Between the Waiting Period and Survival Period in Health Insurance

It can be quite natural to get the waiting period and survival period confused with each other. They are both components of health insurance and refer to a period before one can benefit from a claim. However, the similarities end there. The differences between both can be summarised in the following points:

Other Commonly Used Terms in Health Insurance

Now that you may be familiar with what a waiting period is, you should also get a strong understanding of other commonly used terms in health insurance:

1. Top-up Covers

Policyholders can purchase top-up covers to increase coverage as required. At times, the base plan may not have an adequate sum insured or the sum insured after a few years is starting to fall short considering the current treatment costs. This is when you require a top-up health insurance plan. These plans can also be opted for as a standalone cover. *

2. Coverage Provided

Coverage is the financial support that the insurance company provides you with upon purchase of the health plan. You can raise a claim in the case of emergencies and receive coverage for the sum insured. The amount of sum insured will then decide the premium amount. *

3. List of Inclusions & Exclusions

One must go through the policy documents carefully before buying the plan and peruse the list of inclusions and exclusions. If your insurance provider does not cover a certain disease and you file a claim for it, your claim will be rejected. *

4. Claim

In order to receive payment for treatment, you will need to notify the insurance company. This process is also known as raising a claim with your insurer. The compensation can be availed through the reimbursement process or via the hassle-free cashless option. Analyse your requirements and then go ahead with buying a health insurance policy that meets your needs. Know and understand all the above-mentioned basic terms to gain more knowledge about your policy and choose the best one. *

Also read: What is Maternity Cover in Health Insurance?

FAQs

1. Why should one choose a policy with a short waiting period?

A shorter waiting period helps you receive coverage within a short period of time after buying the policy. A long waiting period can be disadvantageous since you are uncovered against medical emergencies for that time despite having insurance coverage.

2. Do critical illness insurance plans have waiting periods too?

Yes, apart from the survival period aspect, a critical illness insurance plan has a waiting period, too. As with regular health plans, the waiting period of a CI insurance plan also refers to the time period before the coverage begins.

3. Can I raise a claim during the waiting period?

No, you cannot raise a claim for medical treatments during the waiting period, except in cases of accidental hospitalization, which may be covered immediately.

4. What happens if I don't meet the waiting period requirements?

If you attempt to file a claim before the waiting period ends, your insurer will likely reject the claim, and you will need to wait until the period expires to be eligible for coverage.

5. Can I switch health insurance policies without resetting my waiting period?

Some insurers may allow you to carry forward your waiting period if you switch plans, but this depends on the terms and conditions of both the new and old insurance providers. Always confirm this before making a change.

* Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.