Introduction:
There was a time when Indian households preferred life insurance for their breadwinners rather than purchasing health insurance for the entire family. But gone are those days. Thanks to the increase in awareness about the importance of health insurance among the people in the last few years. But, even today, many policyholders sign up for insurance policies without going through the documents in detail. This, in turn, results in claim rejection during the emergency period. One of the important reasons cited for the claim rejection is the in completion of the compulsory waiting period. So, reading and understanding the policy documents before purchasing them has become essential.
Understanding the waiting period in health insurance:
Not all the benefits of a health insurance policy are available immediately to the policyholder, and it is because of a clause called ‘waiting period’. As the name implies, it is the time policyholders need to wait before enjoying the policy’s benefits. The waiting period starts from the date of policy commencement. One cannot claim before the expiry of the waiting period.
For example, if a health insurance policy has a waiting period of four years for availing maternity benefits. The insurer cannot claim their maternity expenses until the completion of four years from the purchase date of the policy.
Each insurance company will explicitly list the health conditions that can be covered under the health insurance policy only after the end of the waiting period in its policy documents. The waiting period duration varies depending on the medical conditions, coverage and insurance companies, though it usually falls between two and four years.
Most insurance companies started including compulsory waiting periods in their policies to prevent policyholders from making false claims and engaging in unethical practices to get insurance benefits. During the initial period, there were several cases when people purchased health insurance policies without disclosing their pre-existing diseases to cover the treatment cost.
Types of waiting period:
Though different insurance companies have various types of waiting periods with specified conditions, some commonly known types are below.
1. Initial waiting period:
The initial waiting period in health insurance, also called the cooling period, refers to the time that a policyholder needs to wait from the purchase date of the policy to start actively using the policy and availing its benefits. During this period, the insurer cannot make claims for hospitalization. However, there are some exceptions, like accidents. The initial waiting period varies from one company to another. In most cases, the initial waiting period will be 30 days.
2. Maternity waiting period:
Maternity expenses are not covered under all health insurance policies by default. Only specific comprehensive health policies cover the cost. While it comes as a built-in feature in particular policies, it is an add-on cover in others. Either way, the insurer must complete the compulsory waiting period to claim maternity expenses. The waiting period will average range between nine months and four years. Some insurance companies even limit the number of pregnancies covered under a policy.
3. Pre-existing disease (PED) waiting period:
As per the guidelines issued by IRDAI, a policyholder is said to have PED if they were diagnosed with a medical condition up to 48 months before purchasing the policy, and it includes any long-term condition right from high blood pressure and diabetes to thyroid and asthma. In most cases, the insured will be asked for medical tests to confirm the same. Most of the policies cover PEDs only after a waiting period, and no claims raised for PED treatment will be approved during the waiting period. On average, the PED waiting period is between two and four years, but it varies from one company to another.
4. Waiting period for mental health treatment coverage:
In recent times, many insurance companies have started covering expenses for mental health treatment under their policies. Thanks to the rise in awareness among the public. Mental health coverage, also called psychiatric illness coverage, covers the expense incurred for hospitalization and in-patient treatment for any mental health-related illness, depending upon the policies. The coverage comes with a waiting period of one to two years, and the insured cannot make claims during this stint.
5. Waiting period related to specific diseases:
In general, insurers will list a series of medical conditions as specific diseases/illnesses or treatments/medical producers. Insured can make claims for the expenses incurred for the treatment of that particular medical condition can be made only after a certain waiting period. Though the list of conditions varies from one company to another and a policy to another, some of the commonly included conditions are hernias, ENT disorders, joint replacement surgery, cataracts, pancreatitis, rectal prolapse, the disorder of the retina, female genital prolapse, pelvic inflammatory disease, fibroids, ovarian cyst, uterovaginal bleeding and cirrhosis of the liver among others. The waiting period for specific conditions ranges between a year and two.
Conclusion:
Of late, it has become essential not just to purchase a policy to ease the financial burden during difficult times but also to read and understand the policy documents to avoid unwanted hassle or disappointment at the last minute. Policyholders are often recommended to be aware of various waiting periods for the treatments they might encounter soon before purchasing insurance policies.