Personal v/s Group Health Insurance

Insurance is a commitment that spans a number of years, if not decades. Owning an insurance policy that caters to your needs is kind of a rainy day fund - it is a financial cushion that shields you against expenses that may seem to touch the skies. Especially health insurance. You don’t want to deal with the hefty bills that are a hand-in-glove companion to the mental stress of hospitalisation for a treatment.

There are a number of health insurance plans in the market and it’s up to you to choose the one that’s right for you. Your insurance should cater to your specific set of needs and requirements, so you can extract the most out of it when necessary.

In this article, we talk about two types of health insurance plans - personal health and group health insurance, so you can make an informed choice.

What Is A Waiting Period?

For the purpose of keeping claims under control, and hence keeping the health insurance plan affordable , health insurance plans do not cover certain medical conditions or treatments for a specific period when you buy the policy. This period is known as the ‘waiting period’. You will be able to claim for those medical conditions and treatments only after the waiting period is over.

For instance, Priya purchases a health plan under which the insurer has applied a 1-year waiting period for Appendectomy (surgical operation for removing the appendix). Now, if Priya gets hospitalised for an Appendectomy or a treatment that is related to it, she’ll have to bear the hospitalisation expenses out of her pocket until the waiting period for Appendectomy is completed under her policy, i.e., until 1 year.

Now that we’ve understood what waiting periods are, let’s take a look at the types of waiting periods in health insurance.

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3 Types of Waiting Periods In Health Insurance You Should Be Aware Of

  • Initial Waiting Period

    Only accidents are covered from day one under health insurance. Insurance companies apply a 30-day waiting period for all other treatments that are carried out during this period. This means health insurance does not cover any treatment for or related to any medical condition during the initial 30 days after the policy is issued.

    This waiting period is applicable only when you first buy the policy - it is not applicable at the time of renewal or when you port the policy.

    Example - Aisha buys a health insurance policy for a sum insured of Rs. 10 Lakhs on 1st May 2022. Two weeks later, i.e., on 14th May she starts experiencing pain in her chest - and hence, is admitted to the hospital.

    She is hospitalised for 3 days and the hospital bill amounts to Rs. 75,000. Because the 30 days waiting period under her policy isn’t over, she can’t apply for a claim under her health insurance plan.

  • Pre-existing Diseases Waiting Period

    A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor 48 months prior to the date of issue of your health insurance policy.

    Note, a pre-existing disease included in the waiting period is very different from the declaration of existing diseases in the proposal form. Your answers to questions on the proposal form should be complete and accurate, as far as possible.

    Example 1 - Gaurav was diagnosed with cancer last year, which is now cured. If he applies for a health insurance plan now, cancer will be considered as a pre-existing disease.

    Example 2 - Gaurav’s friend Sana had cancer in childhood, 10-12 years back. She did not undergo any treatment related to cancer in the last 48 months. If Sana applies for a health insurance policy now, while she will have to inform the insurer of such a history, as per IRDAI guidelines, the insurer cannot consider this cancer as a pre-existing disease.

    Depending on the policy conditions, for pre-existing disease, they will apply a waiting period of 2 to 4 years for pre-existing conditions.

    So, in the above examples, the insurance company can apply a pre-existing disease waiting period for Cancer under Gaurav’s policy, but not under Sana’s policy.

  • Specified Disease/ Procedure Waiting Period

    In addition to the above two waiting periods, the insurer also applies a 2-year waiting period for specific medical conditions and treatments - like hernia, hemorrhoids, chronic kidney disease, spinal disorders, etc. Once the waiting period is complete, you can start making claims for such treatments.

    The list of such illnesses is mentioned in the product brochure or policy wording. You must know about the broad diseases excluded, so there are no surprises if the claim is rejected.

    Example - A 2-year waiting period for hernia is applicable under Harsh’s health insurance policy. So, if Harsh is admitted to the hospital for hernia treatment within the first two years after the policy is issued, the insurance company will not cover the treatment costs.

    Please keep in mind that the specific disease/ procedure waiting period is different from pre-existing diseases, and not related to the medical declarations you make at the time of purchase. For any disease included by the insurer under pre-existing disease, the waiting period of pre-existing disease mentioned in the policy schedule will apply

exclusion of health insurance plans
Not Covered In Health Insurance
  1. Pre-existing Deceases for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

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Summing Up!

A waiting period is a specific period during which health insurance will not provide coverage. There are 3 types of waiting periods in health insurance. After the policy is issued, insurers apply a 30-day waiting period for all medical conditions except accidents. For pre-existing diseases, insurers apply a pre-existing disease waiting period that may range from 2 to 4 years. And for specific diseases/ treatments, like hernia, spinal disorder, kidney disease, etc., insurers apply a 2-year waiting period.

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Sameer-Yadav
Sameer Yadav

I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More

Dheeraj-Bhatia
Dheeraj Bhatia

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Jyoti-Sharma
Jyoti Sharma

We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More

Sumit-Khanna
Sumit Khanna

Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More

Kishor-Kumar-Bijlani
Kishor Kumar Bijlani

My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More

Megha-Singhal
Megha Singhal

I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More