Waiting period for Health Insurance

Did your claim got rejected because your disease was not covered in the first 2 years of the policy??

Are you suffering from some Pre Existing Disease and want to cover the same??

There are many diseases like Appendicitis, Hernia, Cataract, etc for which an individual can delay the treatment. Many people apply for a policy after discovering they are suffering from one of these diseases. So to avoid such intentional claims, the Waiting Period clause is there in All Health Insurance policies in India.

So, when you sign up for a new health insurance policy, it doesn’t get implemented with immediate effect. The policy comes into effect after a ‘waiting period’, which depends on the kind of insurance and factors such as

·         The nature of disease

·         Your medical history

·         The Insurance company

·         The Insurance Policy Chosen

In other words, the insurer is liable to entertain any claim amount filed only after this waiting period. If an individual undergoes an accident or undergoes hospitalization during the waiting period, the customer may not be covered for a loss.

 

As mentioned before, the concept of waiting period exists across different kinds of insurance policies, and the quantum of waiting period may differ depending upon the insurer and the nature of the insurance policy. However, following are the broad indicators of waiting period.

1)      There is an initial waiting period of 30 days during which no claims is entertained (except maybe an accident case where it has to be proved the accident happened after issuance of policy)

2)      There is an initial waiting period of 1-2 years for diseases like Appendicitis, Hernia, Cataract, Gall Bladder or Kidney Stone, Piles, Tonsillitis, etc

3)      Pre -existing diseases are normally not covered till 4 years of the policy. Previously pre existing was not covered at all. However, now IRDA has made in mandatory for Insurers to cover pre existing after 4 claim free years. In fact, some insurers are also covering pre existing after 1 year like the Varishtha Policy of National Insurance

4)      Diabetes and Hypertension can be covered in many policies from Day 1 on payment of extra premium. Else Diabetes will fall under the Pre Existing Clause

5)      Maternity can be covered in companies like Apollo DKV and Max Bupa after a certain waiting period too

A pre-existing disease refers to any medical condition of an individual prior to the commencement of the policy. Now the policy may be effective for any other ailments in the first few years of the policy. Buy any claim filed for illness related to the pre-existing disease will not be covered in the first 1-4 years of the policy as stated in the policy document. This feature is most common in insurance policies designed for senior citizens. Also, the insurers may insist that you stick with the same insurer if you want the cover to continue without further waiting periods in future.

However, when a corporate takes a Group Policy for all its employees, they can customize the policy to remove the “waiting Period” clause and even “pre existing” disease or “maternity” can be covered from the first Day of the Policy.

For more details, feel free to mail to our Health Insurance Help Desk at health@healthandinsurance.in or call at (+91) 98 30 01 23 88