What is a waiting period in health insurance?

A waiting period in health insurance is the time you need to wait after purchasing a policy before you can claim its benefits. It starts from the policy commencement date.

What are the types of waiting periods in health insurance?

The types of waiting periods include initial waiting period, pre-existing disease waiting period, and specific disease waiting period.

How long is the initial waiting period in health insurance?

The initial waiting period in health insurance is usually 30 days from the policy commencement date, during which only accidental claims are covered.

What is a pre-existing disease waiting period?

The pre-existing disease waiting period is the time insurers impose before covering illnesses diagnosed or treated within 3 years prior to buying the policy. It can last up to 3 years.

Are specific diseases covered immediately after buying health insurance?

No, specific diseases like hernia, cataract, and joint replacement surgery may have a waiting period of up to 3 years before coverage starts.

W: Waiting Period

Welcome to our brand-new series, A-Zs of Insurance. In this series, we will venture into the world of insurance to breakdown insurance jargon for you, so you’re empowered to make informed decisions about your financial security.

Health insurance is an important investment; it is a sturdy financial shield that protects you from the onslaught of long medical bills, whether in the case of a health emergency or a planned treatment. It takes care of a range of costs, like room rent, ICU stays, surgery costs, OPD procedures, consultation fees, and more.

But there are some limitations that you should be aware of before getting health insurance, like waiting periods. Let’s understand what this means.

What is a waiting period?

A waiting period is a span of time for which you’re required to wait before being able to claim health insurance benefits. It starts from your policy commencement date.

Types of waiting periods

Health insurance plans typically come with 3 types of waiting periods:

1. Initial waiting period

Each health insurance plan begins covering medical expenses 30 days after the policy commencement date. Only accidental claims will be covered from day 1.

For example, Manish bought a health insurance plan, the coverage of which commenced on 20th June 2024. On 10th July 2024, he got hospitalised for surgery. However, his plan didn’t cover the surgery costs, because the initial waiting period hadn’t been completed till then.

2. Pre-existing disease waiting period

Some health insurance plans cover pre-existing diseases, i.e. illnesses which have been diagnosed or treated within 3 years before getting health insurance. Insurers may impose a waiting period of up to 3 years for such illnesses; however, some insurers may also offer add-ons to reduce the same.

For example, Aarya bought a health insurance plan in May 2024 and experienced a bout of asthma in June 2024, for which she was hospitalised. She claimed the expenses under her health insurance, but was informed that these wouldn’t be covered, since she had been diagnosed with asthma in 2022. Her policy comes with a waiting period of 2 years for pre-existing diseases, and hence, any asthma-related expenses will be covered from 2026.

3. Specific disease waiting period

Health insurance plans may also impose a waiting period of up to 3 years for specific diseases/treatments like hernia, ENT ailments, joint replacement surgery, and more. It’s important to read the policy documents very carefully to understand the exact list of such diseases.

For example, Amir bought a health insurance plan in July 2022. It specified a list of diseases and treatments that would be covered after 2 years, one of which was cataract surgery. Amir needed cataract surgery in August 2024. His health insurance covered the costs, because he had served the 2-year waiting period for specific diseases.

Please note that health insurance plans may come with additional waiting periods for maternity benefits, health check-ups, etc. Go through your plan’s wordings to understand the nitty-gritty details.