In the context of health insurance, the waiting period refers to the time that must elapse before ailments listed in the policy can be covered. Here you will get to know about three types of waiting periods which are typically applicable to individual health insurance. Insurance companies often waive these off for group health insurance. However, group plans may sometimes have these waiting periods as a way to reduce costs.
Types of waiting periods in Health Insurance Policies:
There are three different types of waiting periods: (i) initial waiting period; (ii) pre-existing disease coverage, and (iii) maternity coverage.
1. Initial waiting period in Health policies
The waiting period immediately following the commencement of health insurance is also called the initial waiting period. There is rarely any initial waiting period in a group health insurance policy. In some affinity or non-employer-employee group insurance, insurers may include an initial waiting period. However, most individual health insurance policies typically have a waiting period of 30 to 90 days after the purchase of the plan. This usually depends on the insurance company’s product design.
Read More: What is Domiciliary Hospitalization in Health Insurance Policies?
2. Waiting period for Pre-existing diseases cover
In individual health insurance plans, the insured has to declare their pre-existing disease/ailment (diabetes, thyroid, high blood pressure, etc.) before buying a plan. Based on this, the insurance company will decide whether it can offer individual health insurance coverage.
When the insurer extends coverage for such diseases/ailments, it will usually impose a waiting period of two to four years. This means that the insured can claim related medical expenses only after completing this waiting period with the insurer.
Certain ailments such as ENT disorders, osteoporosis, hernia, and others only have a waiting period of one or two years, and policyholders can ask insurers to waive this waiting period.
A big advantage of group health insurance is that insurers can waive waiting periods for pre-existing conditions. This would mean that the insurer covers all diseases with immediate effect.
3. Waiting period for Maternity coverage
The maternity coverage waiting period is quite standard for most insurance companies. It ranges from nine to 48 months. As in the case of other waiting periods, groups can ask insurers to waive the maternity coverage waiting period for a group health insurance policy. This would mean that the insured persons get maternity coverage from day one of the policy.
Read More: What happens if a Group Health Policy is cancelled?
Case study: No coverage for costs incurred in the initial waiting period in Health Insurance
Ranjan Desai (30) joined MKM Engineering Company in 2013 as a senior engineer. Along with various perks, his company also offered group health insurance. Ranjan also had personal health insurance that he had recently bought.
Within a week of joining MKM Engineering, Ranjan received a diagnosis of kidney stones. Following this diagnosis, his doctor advised Ranjan to undergo a Lithotripsy. Accordingly, his boss granted him ten days’ leave for the procedure and for recovery.
Ranjan was confident that his individual health insurance policy would cover his medical expenses. Therefore, without reading the policy document or checking the facts, he had the procedure. Thereafter, he paid all the bills and approached his individual health insurance company for reimbursement.
However, he got a major shock when the insurer rejected the claim. They pointed out that they would not accept his claim as he hadn’t completed the initial waiting period. There was a waiting period of 30 days in the individual health insurance policy. This meant that the insurer would not cover any medical expenses incurred in the first month after buying the insurance. Fortunately, Ranjan also had a group health insurance policy from his company where all waiting periods were waived. This group insurance policy paid for his claim.
About The Author
Mayank Sharma
MBA Finance
He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.
