Did you know that not every hospitalisation is covered under health insurance from day 1? A health insurance cover provides you a lifetime cover on hospitalisation, and hence opens up gradually over time. Suppose you buy health insurance today and get hospitalised in the next week for, say, treating pneumonia. In this case, your health insurance won't pay for the pneumonia treatment. Wondering why?
Because of something called the 'Waiting Period'.
What is a waiting period? What are the types of waiting periods in health insurance? How do these types work?
Let's find out!
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.
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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.