Waiting period in health insurance - What, why and types

What's waiting period in health insurance & group health insurance? Why's there a waiting period and what are the types you should be aware of

Waiting period in health insurance

While buying insurance, you may come across the term waiting period. In this blog, we are going to look at what is waiting period is, the types of waiting periods and how they can impact you. It is essential to understand this and make an informed decision when buying health insurance.

What is the waiting period for health insurance?

The waiting period refers to the time between buying and exercising a health insurance policy. Or simply put, it is the duration of time one needs to ‘wait’ to start filing claims using their insurance policy. That is, the policyholder won’t be able to claim till the waiting period is over.  

Ideally, you should buy a policy with a minimum waiting period to start availing of benefits at the earliest. And the best thing you can do to get a less waiting period is to buy health insurance as soon as possible. Before we tell you how this helps with the waiting period, let’s understand the basics of it. 

Also read: Top General insurance companies in India

Why is there a waiting period for health insurance?

Sometimes, people would want to buy their insurance policy when they get to know they have huge health-related expenses coming up. Now, this is a huge loss to the insurers if they settle the expenses when claimed. To avoid this risk for the insurer, there exists a waiting period. During the waiting period, the insurer keeps collecting premiums but won’t settle claims. 

Types of waiting period 

Waiting periods tend to vary from insurer to insurer. They can be differentiated into some general categories - 

Initial waiting period 

It is the waiting period in the starting stage of your health insurance policy. The initial waiting period, also known as the cooling period, starts from day 1 of you buying the insurance. The most common initial waiting period is between 30-60 days but it can vary with different insurers. An initial waiting period is a common waiting period given to all insurance policy buyers.

Maternity waiting period

The maternity insurance generally covers delivery, delivery-related hospitalization and newborn (up to 90 days after birth). When you buy health insurance with maternity, there’s a waiting period of up to 2 years. Again, the waiting period depends on your insurer. If you or your spouse deliver a baby within the waiting period, it won’t be covered.

Also read: Know all about maternity insurance

Pre-existing diseases waiting period

Before providing health insurance, your insurer will ask you to go through some medical tests to disclose any current injury, ailment, or medical condition. If you have any disease or medical condition, it will be labelled as a pre-existing disease.

As per the IRDAI (Insurance Regulatory and Development Authority of India) norms, any disease, ailment, injury or condition, diagnosed up to 48 months prior to issuing health insurance, comes under the umbrella term, pre-existing diseases

Some chronic illnesses, for instance, thyroid, blood pressure, and diabetes are all examples of the same. An insurance provider will have a specified duration of the waiting period in such cases. On average, it can be 2 to 4 years.

For instance, Priya will be needed to provide her complete medical records to her insurer before buying a policy. Now let’s assume that Priya has diabetes and there’s a 3-year waiting period for that disease with her insurer. In this scenario, Priya will only be able to claim her expenses related to diabetes after the waiting period is over. Otherwise, her claim will get rejected by her insurance company. However, she can claim expenses for other treatments that she takes which don’t have a waiting period.

Specific disease waiting period

There are some diseases that are pre-decided to have a waiting period irrespective of the chosen policy. A few of these include hernia, cataract, endometriosis, some  neurodegenerative disorders, fissures, tumors, etc. The waiting period may vary from 1 to 4 years, depending on your insurer. 

Waiting period for mental illnesses

In health insurance, treatment for mental health has been welcomed and incorporated. In health insurance policies, a waiting period of 24 months is often given to claim the costs incurred in psychiatric illness cases. The IRDAI has also mandated that no insurance provider can reject policies for those who have taken antidepressants before the issuance of their policy. 

Waiting period for accidental hospitalization

As accidents are “accidental” in nature few insurers put zero waiting periods and some accept claims after the initial waiting period as specified by your insurer.  

Waiting period in Group Health Insurance

Group health insurance (GHI) has zero waiting period. A company provides group health insurance to its employees. GHI has zero waiting period because the risk is spread among all the employees. From an insurer's point, one person buying insurance and getting hospitalized is more likely than a company buying insurance for 150 employees and 5 people getting hospitalized. This is in fact one the major attraction for employers and HRs when they buy group medical insurance. They want to offer the best experience and the most value with group health insurance.

This means, if you have group medical insurance provided by your organization, you can claim for your treatment from day 1.

Also read: 5 steps to get group health insurance

Pazcare for group medical insurance

Pazcare provides all group insurance and business insurance for organizations. One can buy group medical insurance, group term life insurance, group personal accident insurance and much more. With Pazcare, HRs can make it wholesome by including corporate wellness programs, mental wellness, fitness, and healthcare into it. 

Frequently asked questions on Waiting period

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Is it possible to reduce waiting periods in health insurance?

  • By including a copay in your health insurance, the waiting period can easily be reduced. That is, the expenses paid are divided between you and the insurer.
  • Some insurers provide waiting-period waivers. Here, you pay some money to reduce or remove your waiting period.
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Is there a waiting period for all health insurance plans?

Yes, all health insurances come with a waiting period. There are multiple types of waiting periods. Commonly, all policies come with an initial waiting period of 30-60 days. This starts from the day you buy the policy.
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Is there a 2-year waiting period for whole life insurance?

No, generally term life insurance policies don’t have a two-year waiting period. Term life commonly doesn’t have a waiting period at all. However, if a person with an illness has taken life insurance, there may be a waiting period and this is specified by the insurer when a policy is bought.
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What is the waiting period for maternity and newborn benefits?

The waiting period varies from insurer to insurer. In some companies, the maternity and newborn waiting period are from 2 to 4 years.
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