PEDs & PED Waiting Period In Health Insurance

Your friend is selling his laptop, and you would like to buy it. Before doing so, you ask him about the purpose he used it for, how often the laptop was repaired, and the problems he encountered in the past. By knowing these details, you can figure out whether the investment is worthwhile.

Similarly, when buying health insurance, your insurer will want to know about all of your past medical treatments or surgeries as well any existing health conditions. If you have any pre-existing diseases, your insurance company will need to figure out how much money they can afford to pay for hospitalisation if such a need arises in the future.

What are pre-existing conditions? What will happen if you purchase health insurance without stating them? How will the insurance company deal with it?

Let’s discuss in detail.

What Is A Pre-Existing Waiting Period?

Let’s start with an example. Rohit is diagnosed with liver cirrhosis. A year from now, he will have to spend over 15 lakhs for surgery and treatment. So. he immediately buys a health insurance plan from an insurer's website for a three-year period without disclosing his diagnosis. Upon receiving the policy, he consulted a different doctor in his city and generated a new report to show his insurer with which he hopes to get his medical bills covered.

As a way of preventing such false acts, insurance companies have devised a strategy called the ‘waiting period’.

You need to wait a certain amount of time from the start of the policy before you can start using its benefits. This period is called the Waiting Period, during which you will not be compensated for a claim related to pre-existing conditions, maternity, and other specific conditions mentioned in the policy. All health insurance plans impose a waiting period of 24-48 months (2-4 years) for pre-existing diseases.

During the waiting period, your health insurance will not pay for any treatment taken, and you will have to foot the bill yourself.

So, in Rohit’s case, his treatment will not be covered by his health insurance plan because of the waiting period.

What Kind Of Diseases Are Considered Pre-Existing Diseases?

Here are two scenarios showing how insurers impose waiting periods based on medical history and conditions:

What Happens If You Provide Incorrect/False Declarations?

All pre-existing conditions should be honestly disclosed to your insurance company. If you have lied or provided incorrect information on the insurance form or hidden your medical condition, the insurer has complete discretion to make any decision.

You may have to face the following consequences if your policy contains false information:

What Are The Additional Conditions Besides The Waiting Period?

When you submit a health insurance proposal form, the insurer shall verify the provided details. The insurer will decide on the next step based on the extent of your medical condition and the declaration statements.

Sometimes, additional conditions shall be placed on your policy if you have -

A pre-existing condition like diabetes, etc.

Health conditions (obesity, etc.)

Unhealthy habits (alcohol consumption, excessive smoking, etc.).

These are the conditions that may be added to your policy -

Summing Up!

A Waiting Period is a certain period of time after the date of policy issuance wherein you cannot avail the benefits of your health insurance. For Pre-Existing Diseases, the waiting period ranges from 2 to 4 years. Insurance companies use this concept to prevent people from buying policies immediately after they develop a condition or disease. To avoid any kind of trouble in the future, it is always imperative that you disclose any existing health conditions in your health insurance proposal.