Why Is There A Waiting Period For Health Insurance?

What Does The Health Insurance Waiting Period Mean?

The term “waiting period” in the context of health insurance refers to the period following the start date of your insurance policy, during which you are not permitted to submit any health claims. The insurance policy sets a waiting period in advance, and different health conditions are covered after various waiting periods. 

You can always utilise a health insurance premium calculator to understand the appropriate level of coverage needed.

Initial Waiting Time

The policyholder must wait a specific number of days after receiving a health insurance policy before filing any claims or using health insurance benefits. This period is the initial waiting or cooling period in health insurance. A waiting period of at least 30 days is typically required for health insurance policies in the industry. *

Waiting Period For Pre-Existing Diseases (PED)

When buying insurance, the policyholder discloses a special waiting period for a few pre-existing conditions. The Insurance Regulatory and Development Authority of India (IRDAI) defines a pre-existing disease as any condition, accident, illness, or disease discovered up to 48 months before the insurance purchase. Among the pre-existing conditions are thyroid, hypertension, and diabetes. #

Waiting Periods For Particular Illnesses

Several illnesses have a set waiting period, including cardiac ailments, cancer, ENT disorders, tumours, and stroke. These plans typically have waiting periods of two to four years.

Waiting Period For Maternity Benefit And Newborn Baby Cover

Individual and family health insurance plans offer maternity and newborn baby coverage as an add-on benefit. Health insurance plans frequently provide maternity coverage. Each time, a 2-4 year waiting period is followed by the availability of the coverage.

Waiting Periods In Health Insurance: Their Importance

The provision of coverage for all insured people and the overall management of healthcare costs benefit greatly from waiting periods. The following list of factors illustrates the significance of waiting periods in health insurance:

  • Cost Control: Health insurance waiting periods can help control costs by preventing individuals from enrolling in a health insurance plan only when they need medical care. Without waiting periods, individuals could enrol in a plan, receive medical care, and then drop the plan once their treatment is complete, increasing the cost of premiums for everyone.
  • Risk Management: Waiting periods give insurance companies time to assess each applicant’s health before covering them, assisting them in managing their risk. This helps insurance companies ensure that they are not providing coverage for pre-existing conditions or other health issues that were present before the policy became effective.
  • Plan Stability: Waiting periods ensure that participants are committed to maintaining coverage for a specific amount of time, which helps promote plan stability. As a result, adverse selection is prevented, and insurance companies can cover every insured person.
  • Promoting Equality: Regardless of a person’s health, waiting periods ensure everyone receives coverage after waiting a specific amount. This helps avoid discrimination against people who have pre-existing conditions and ensures that everyone who enrols in a plan is subject to the same rules and requirements.

* Standard T&C apply.  

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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