With age, the human body becomes prone to diseases. Unhealthy lifestyle and junk-food consumption are some of the reasons why diseases are catching up so early. This is one of the root causes why health insurance policies have become increasingly important these days. Annual health check-ups and preventive services like screenings and counselling are covered under such policies and therefore it is a wise step to take health insurance early in life. A lot of people buy health insurance without knowing its numerous exclusions, one such is the waiting period. 

No diseases get covered during the first 30 days from the commencement of any policy. Only accidental hospitalization gets coverage from day one. Further, some diseases are covered only after the expiry of a specified period. There are 1-year, 2-year, 3-year and 4-year exclusions for certain diseases. Pre-existing illnesses are mostly covered after the expiry of four claim-free years. 

A waiting period is a certain period before a select list of ailments starts getting covered under your intended health policy. A waiting period of 4 years for pre-existing diseases is a standard clause in almost all health policies. This is helpful to the policyholder because an insurance company cannot deny a claim after 4 years, i.e., once the waiting period is over.

What is the Waiting Period?

When you undertake any surgery in the hospital, say a female taking labour pain goes through it for 12-18 hours. Before she delivers a baby, this is the crucial waiting period when both she and attendants wait for the baby. Similarly, under a health insurance policy, a particular span must pass before you get all the coverage. This is referred to as the “Waiting Period” under health insurance.

Types of Waiting Period

The waiting period in your health insurance policy is influenced by various factors like the type of health insurance (individual health insurance, group health insurance, family floater health insurance, etc.), medical history of the insured and the age of the buyer. It is essential to read the fine print of the policy waiting periods of a health insurance policy and pick the plan with a lesser waiting period. It will allow you to avail the benefits of your health insurance policy as soon as possible instead of bearing medical expenses from your pocket due to a long waiting period clause.

  • Initial waiting period - If the person gets hospitalized in the first 30-90 days from the start of the policy, he/she won't receive any claim benefit from their health insurance policy if they fall sick or get hospitalized. There is an initial waiting period that needs to get over if you want to receive the benefits under your health insurance plan.

  • Pre-existing disease waiting period - There is a particular waiting period for some specific diseases which are declared by the policyholder at the time of policy purchase. These diseases are known as pre-existing diseases, and the waiting period for such conditions is known as a pre-existing disease waiting period. The pre-existing waiting period usually ranges from 1 year to 4 years of continuous policy coverage. The time for such waiting periods depends on your medical status and the insurance company you select.

  • Maternity benefits waiting period - Some health insurance companies provide maternity benefits, but that cover comes with a waiting period varying from 9 months to 36 months.

  • Disease-specific waiting period - There is a specific waiting period varying between one year and two years for particular ailments like a tumour, ENT disorder, hernia, osteoporosis which are mentioned explicitly in the policy documents. These diseases vary from company to company.

Additional Reading: Arogya Sanjeevani Health Insurance

Need of Waiting Period in A Health Insurance Policy

There are several cases where a customer buys a health insurance policy to enjoy the claims and reimbursement. To avoid this moral hazard or wrong intention of getting a hoax claim benefit, the concept of the waiting period was introduced. Imagine an incidence where a person doesn't have a health insurance policy and is diagnosed with a disease. The doctor suggested him to undergo surgery which is quite expensive and could have put an enormous hole in his savings. Looking at the problematic situation, the person chose to buy a health insurance policy without disclosing the disease. He even got the surgery covered just after the purchase. Hence, to avoid such unethical practices, the waiting period clause was introduced in a health insurance plan.

Health Insurance Claims

Almost all the network hospitals have an insurance desk, that you will end up visiting during a hospitalisation. To avail of cashless service, you will have to fill out a pre-approval form at the desk for planned hospitalisation. For emergency hospitalisation, intimation can be done within 24 hours of admission. Only the insured's identity proof along with the health card is needed for admitting a cashless claim. All you need to do is fill the pre-approval forms given by the insurance desk at the hospital and the rest of the documentation would be taken care of by the third-party administrator (TPA) desk of the hospital. 

It is recommended that you speak with the hospital regarding your policy coverage details right from the beginning. This will avoid any sort of confusion and the hospital staff will get back to you if the policy coverage runs out. To ensure that your reimbursement claim goes on smoothly, you must cater to reimbursement-specific factors. There is a varied array of papers that you must provide for a hassle-free experience. Documents such as duly filled claim form signed by the policyholder, doctor's advice for admission, the complete breakup of the final bill provided by the hospital and original bills and receipt for pre- and post-hospitalisation expenses. 

Additional Reading: What Are the Different Types of Insurance?

End Note

If you get in need of a surgery, it is likely to elicit immediate worries such as, will the operation work? How much pain will I endure? How long will it take to recover? Concerns about costs are likely to follow close behind. If you have health insurance, you'll want to know how much of the surgery you can expect your plan to cover. You can heave a sigh of relief since most plans cover a major portion of surgical costs for procedures deemed medically necessary.