Waiting period in health insurance policy is also known as cooling period in health insurance policy. What is “waiting period in health insurance policy”?
Mr. Sharma bought one health insurance policy from a reputed insurance company one week back and he was glad that he had made a right decision in buying such policy. Before taking such decision, he had discussed with his friends, colleagues and superiors in regard to the benefits of availing one health insurance policy. He was working in a steel unit as a supervisor and he was compelled to work in most uncomfortable atmosphere. After one week from the date of buying his health insurance policy, he suddenly felt sick and was admitted into a hospital where he was informed that he had been suffering from kidney disorders. It was a costly treatment and he was hopeful that his policy would definitely help him in meeting the cost of medical expenses.
However, he was informed that he would not be entitled to claim benefits since he had not completed the initial waiting period in health insurance policy as per the terms and conditions of the policy. Unfortunately, Mr. Sharma had to meet the entire expenditure from his pocket.
Like any other policy, health insurance policy contains many clauses and conditions and one among such clauses is the “waiting period”
It has to be borne in mind that the policyholder will not get coverage from day one of the policy and in order to make any claims over the policy the policy holder needs to wait for some time known as “waiting period”.
Like any other investments it is the responsibility of the individual to carefully study the terms and conditions of health insurance policy before taking a decision to have one in his name.
What is Waiting Period in Health Insurance Policy?
Waiting period in health insurance policy is the time limit after which the claim over the policy is considered by the insurer. The terms and conditions in regard to the waiting period differ from one insurer to another insurer. During the waiting period, no insurer undertakes to consider any claims over the policy.
The clause has been provided in order to prevent any false claims by the insured. A policyholder who has been declared as sick and has been suffering from a major disease can avail one health insurance policy without disclosing the facts to the insurer. Once the policy is issued, he can get an admission into a hospital and start claiming the medical expenses from the insurer. Waiting period prevents the insured in making such false claims.
Different types of waiting period in health insurance plans
- Initial waiting period:
The initial waiting period may be the first 30 to 90 days from the date of commencement of the policy and during such period the insured cannot make any claims through his policy in case he has been hospitalised. The insured has to wait till completion of the initial waiting period for getting the benefits from his policy. However, claims on account of accident are considered during this initial waiting period.
- Pre-existing disease waiting period:
There are certain situations, wherein the policy holder discloses the details of some specific diseases (as permitted by the terms and conditions of the policy) before purchasing the policy and such diseases are known as pre-existing diseases and the waiting period provided for such diseases is known as “Pre-existing disease waiting period” . It varies from one year to four years subject to the condition that the policy is covered continuously and the time limit for such waiting period depends upon the medical history of the insured and the insurer from whom the policy is purchased. Again, pre-existing disease waiting period differs from one company to another company.
- Disease-specific waiting period:
A specific waiting period known as “disease-specific waiting period” is available for some specific diseases namely; tumour, ENT disorders, hernia, osteoporosis etc., the details of which have been mentioned in the policy. Again the waiting period and the details of such diseases vary from one company to another company.
- Maternity benefits waiting period:
Some insurance companies provide maternity benefits under the policy wherein the waiting period ranges from nine months to 36 months. However, it has to be noted that the maternity benefits under the policy cannot be claimed under the waiting period window.
In the case of group insurance, there is no waiting period. In case, if it is diagnosed that the policy holder suffers from the disease for the first time during the waiting period, it will not be considered as “Pre-existing disease”.
There are various factors which affect the waiting period in health insurance policy depending upon the types of policies namely; the group health insurance, the individual health insurance, family floater health insurance etc., Apart from the above, the age of the insured and his medical history also play crucial role for consideration of the benefits under the policy.
The prudent buyer takes sufficient time in reading the terms and conditions of the policy before taking a decision to purchase the policy. Now you know, what is waiting period in health insurance policy. it is better that the policy is purchased from a company which provides lesser waiting period.