All about waiting period in health insurance

Learn About Waiting Period In Health Insurance

Most people buy health insurance without understanding the basics of health insurance. They often miss crucial aspects of a health insurance plan because of their ignorance. Such ignorance leads to claim rejection. One of the most common reasons for claim rejection is the waiting period in health insurance being ignored by the policyholder while requesting a claim. Hence it is essential to understand the basic terminology related to health insurance to clearly understand the inclusions and exclusions in a health insurance policy.

Keep reading as we explain what the waiting period in health insurance is, how it works, and what are the various types of waiting periods.

What is Waiting Period in Health Insurance?

The waiting period in health insurance is the duration the insured has to wait before making a claim. Every health insurer specifies a waiting period starting from the date of policy commencement or the beginning of the health insurance coverage period. A policyholder cannot claim any health insurance benefit during this period. The waiting period varies from insurer to insurer.

Let us understand how the waiting period in health insurance works with the help of an example.

Mr Kapoor had diabetes and recently bought a health insurance policy securing his savings against any medical emergency. Within a year of purchasing the policy, he was diagnosed with a kidney ailment leading to hospitalisation. He filed a claim for the same but his claim was rejected. He was shocked as he didn't know the reason for the rejection. When he inquired he was told that his kidney problem was a result of diabetes, which is a pre-existing disease and the waiting period for the same was still not over. Hence, the claim was rejected and he had to bear all the medical bills.

Mr Kapoor had no idea what is a waiting period in health insurance. It is important to note here that when you buy health insurance, you do not get coverage from the beginning of the health insurance coverage period. There is a period specified by the health insurance company, before which you cannot make a claim. For different conditions, there are different waiting periods applicable.

Different Types of Waiting Periods in Health Insurance

Every health insurer specifies different waiting periods for different conditions as per their terms and conditions. Here are different types of waiting periods in health insurance.

1. Initial Waiting Period

The initial waiting period is the first few days from the policy commencement when you cannot file a claim for anything except for emergency hospitalisation due to an accident. It is also known as the cooling period. Commonly, it is the first 30 days but it may be different for different insurers.

Aditya Birla health insurance plans have an initial waiting period of 30 days

2. Pre-Existing Disease Waiting Period

IRDAI defines pre-existing disease as a disease diagnosed 48 months before buying a health insurance plan. It includes diseases like diabetes, thyroid, hypertension, etc. If you have a pre-existing disease, you cannot claim any benefits for a prescribed period. This specified period is the pre-existing disease waiting period. The prescribed waiting period for a pre-existing disease depends on the type of health insurance coverage you opt for and also on your medical history.

Aditya Birla health insurance has pre-existing waiting periods depending upon the type of plan you choose and also offers customisation as given below.

• Activ Fit health insurance plan has a pre-existing disease waiting period of 48 months as it is a plan specially designed for young people and rewards the policyholder for being active.
• Activ Health Platinum Enhanced insurance plan from Aditya Birla is a plan for all age groups with no maximum limit on entry age and has a reduced pre-existing disease waiting period of 36 months.
• Activ Assure Diamond plan offers an optional benefit of reducing the pre-existing disease waiting period to 24 months on payment of an additional premium.

3. Specific Diseases Waiting Period

A specific disease waiting period is the prescribed waiting period for the list of specified diseases according to the terms and conditions of the policy. The waiting period can be for 1 to 4 years according to your health insurance policy. Some common specified diseases include cataracts, ENT disorders, joint replacement surgery, mental illness, etc. The terms and conditions for specific disease waiting periods vary from one insurer to another.

Aditya Birla health insurance plans come with a specific disease waiting period of 24 months.

4. Maternity Benefit Waiting period

The maternity benefit waiting period is the period during which you cannot claim maternity benefits. It ranges from 1 to 4 years. If you are planning to start a family in near future, select a health insurance plan with a suitable maternity benefit waiting period so that you can claim maternity benefits when you need them.

5. Mental Illness Waiting Period

Many health insurers provide coverage for mental illnesses these days. You can claim this benefit only after the waiting period is over. Normally, the mental illness waiting period ranges from 1 to 4 years.

Activ Assure Diamond + Super Topup Combi plan from Aditya Birla is one such plan which covers mental illness after a waiting period of 48 months.

Conclusion

There are various factors which influence the waiting period in health insurance. These factors include the type of health insurance (individual, family floater or group), your age, medical history and the terms and conditions of the health insurer. It is always recommended to buy health insurance with lower waiting periods or buy at a young age so that you don't have to worry about the waiting period.

Aditya Birla health insurance offers plans with waiting periods that suit your needs. You can also reduce your waiting periods at nominal charges. To know more about the features and health insurance products, visit the official website of Aditya Birla health insurance company.