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The Concept Of Waiting Period In Health Insurance Explained

Updated: Apr 24, 2019




Good things come to those who wait – even if in the form of health insurance! To explain on a more serious note, a health insurance policy is taken as a financial cover in case emergency health situations arise. This can be an accident, a disease, a sudden diagnosis of a chronic ailment, etc. Some policies even cover annual health check-ups, screenings, counselling and consultation, etc. But what is a waiting period?


Though life and the discomforts of the ageing process don’t wait for us, we need to wait for the financial backup required to handle them. That is, health insurance policies specify a certain waiting period before a pre-decided set of ailments become eligible to be covered under the policy. During this waiting period, your claim to the health care coverage will not be processed, even if all the documents are in place and you are already a policyholder.


Why is a waiting period Health Insurance necessary?


This condition is imposed to avoid unethical practices. For instance, a person recently diagnosed with a serious ailment requiring surgery, may buy a policy but keep his ailment a secret, and reveal it right after purchasing. If there was no waiting period, the company would have no choice but to cover the surgery, although they did not know about it before they sold the policy.


Types of waiting period Health insurance


Here are some types of waiting periods in health insurance:


  • Pre-Existing Diseases (PED)If you already have a disease or disorder at the time of taking the health insurance policy, it is counted as a pre-existing disease, for instance, diabetes, high blood pressure, thyroid, and so on. In such cases, the insurance companies demand that the policyholder should undergo certain tests to determine the extent to which the disease affects him or her. Then they decide whether or not to accept the proposal, based on the reports. If they do accept it, the waiting period is 4 years, which means that hospitalisation expenses related to this ailment can be claimed only after 4 years. However, this does not include diseases diagnosed for the first time during the waiting period.

  • Initial waiting period generally ranges from 30 to 90 days from the start of the policy, except in cases of accidents.

  • New-born babies have a waiting period of 90 days.

  • One or two-year waiting periods are assigned to certain specific ailments such as a hernia, osteoporosis, ENT disorders, tumour, etc.

  • Maternity waiting period, covered in a few insurance policies, usually has a waiting period of 9 to 36 months, depending on the company and plan. Since it cannot be taken after conceiving, it is sensible to sign up before you start family planning.

As is evident, the claim period varies depending on the type of ailment and policy, and even the company. This waiting period can sometimes be reduced by paying a higher premium. Certain plans for senior citizens provide a co-pay clause wherein the insured can split the payment with the insurer in a pre-decided ratio. Also, group insurance policies do not come with a waiting period health insurance. Otherwise, there is no way to avoid the waiting period and the best you can do is to look for a plan with the lowest waiting period. For easy-EMI and easy-return policies, visit ManipalCigna’s website here and choose a plan that suits you best.

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ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address – www.manipalcigna.com
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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