Waiting period claims are very important in many health insurance terms. So we are talking about it separately. What is the waiting period in health insurance? As the name implies, the waiting period for receiving a policy benefit is called the waiting period. This period is calculated from the date of commencement of the policy.
Which disease or hospitalization will be covered after how many times is already decided. E.g. Maternity benefit. In case the policyholder himself or the woman covered under the policy has to be taken to the hospital for delivery, he has to wait for the benefit of the policy. This waiting period is very common. Under normal circumstances there is a waiting period of two to seven years. Thus, those who want to expand the family should take out a health insurance policy at least two years before the planned procreation. What is the reason for having a waiting period in a health insurance policy?
This is to ensure that the policyholder does not deceive the health insurance company. This rule has been enacted to prevent fraud by those who try to claim it after taking a policy by hiding it even though they are already ill. E.g. Someone already has a heart problem and has been told by a doctor to have bypass surgery. Such a patient may try to pass a claim for bypass after a few days by hiding his heart problem. Companies keep a waiting period to prevent this from happening.
Each policy has different types of waiting periods, let’s take a look at:
Early waiting period
Almost all policies have an initial waiting period of at least one month. This means that if any claim is received within one month from the date of receipt of the policy, it will not be accepted. However, if there is a claim due to an accident despite this waiting period, it is allowed.
According to the definition given by the Insurance Regulatory Authority of India (IRDAI), “an illness, injury or pain or condition diagnosed 6 months before the purchase of a health insurance policy is called a pre-existing disease.” Pre-existing diseases include diabetes, hypertension, thyroid, etc. People with pre-existing disease have to complete a waiting period before claiming hospitalization or treatment. It is pertinent to mention here that if the Sum Assured is increased in the policy then the waiting period is applied anew.
Waiting period for certain illnesses/procedures
The waiting period for certain illnesses / procedures means that the claim can be passed only after the completion of the waiting period. Under normal circumstances this type of waiting period is two to four years.
The list of specific ailments/procedures under normal circumstances is:
- Cataracts, glaucoma and retinal problems
- Benign prostatic hypertrophy (cancer-free prostate dysfunction)
- Mycectomy, hysterectomy performed without cancer
- All types of hernias and hydrocele
- Hemorrhoids, hemorrhoids, fissures and fistulas
- Rheumatism, arthritis, rheumatoid arthritis and spinal problems
- Joint implants that should not be done in the event of an accident
- Sinusitis and related complications
- Stones in the urinary tract and biliary tract
- Dilation and curettage, endometriosis
- All types of skin and internal tumors/cysts/polyps and non-cancerous tumors in the breast
- Dialysis in chronic renal failure
- Surgery of tonsils, adenoids and sinuses
- Stomach ulcers
- Curved nose
- Varicose veins/varicose ulcers
- All kinds of internal congenital defects/diseases
Waiting period for maternity benefit and cover for newborn
Many companies offer extra maternity benefits and cover for newborns. Couples who want to have children after about two years can take such a policy. Such add-ons usually have a waiting period of one to four years.
The cover for the newborn covers the first 30 days after the birth of the baby. This includes essential vaccinations and other medical care. One way to reduce the waiting period is to pay a higher premium. In this way the waiting period can be reduced from 6 months to 6 months. To reduce the waiting period for senior citizens, companies offer the policyholder the option to bear a portion of the amount themselves.
It is important to note here that if a disease is diagnosed for the first time during the waiting period, it is not called pre-existing disease. The illness is covered under the policy.