{"id":1359,"date":"2017-08-15T11:14:08","date_gmt":"2017-08-15T11:14:08","guid":{"rendered":"https:\/\/pamstaging.securenow.in\/insuropedia\/?p=1359"},"modified":"2026-03-18T10:01:31","modified_gmt":"2026-03-18T10:01:31","slug":"what-is-disease-specific-waiting-period-group-health-insurance","status":"publish","type":"post","link":"https:\/\/securenow.in\/insuropedia\/what-is-disease-specific-waiting-period-group-health-insurance\/","title":{"rendered":"What are waiting periods in Individual and Group Health Insurance Policies?"},"content":{"rendered":"<div id=\"bsf_rt_marker\"><\/div><p>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.<\/p>\n<h2 data-path-to-node=\"5\">Key Takeaways<\/h2>\n<ul data-path-to-node=\"6\">\n<li>\n<p data-path-to-node=\"6,0,0\"><b data-path-to-node=\"6,0,0\" data-index-in-node=\"0\">The Group Advantage:<\/b> The single biggest benefit of employer-sponsored insurance is the <b data-path-to-node=\"6,0,0\" data-index-in-node=\"87\">Waiver of Waiting Periods<\/b>. This ensures that an employee who falls ill shortly after joining is not left with unpaid bills.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,1,0\"><b data-path-to-node=\"6,1,0\" data-index-in-node=\"0\">PED Protection:<\/b> In the retail market, conditions like diabetes or hypertension require years of continuous coverage before a claim is allowed. Group plans often bypass this, making them invaluable for employees with existing health issues.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,2,0\"><b data-path-to-node=\"6,2,0\" data-index-in-node=\"0\">Initial &#8220;Blackout&#8221; Period:<\/b> Individual policies have a 30-day &#8220;initial waiting period&#8221; where no claims (except for accidents) are accepted. As seen in the case study, group plans provide a safety net during this gap.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,3,0\"><b data-path-to-node=\"6,3,0\" data-index-in-node=\"0\">Maternity Readiness:<\/b> While individual plans require a long lead time (up to 4 years) before covering pregnancy, group plans can be customized to cover maternity and newborn expenses from the very first day of the policy.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,4,0\"><b data-path-to-node=\"6,4,0\" data-index-in-node=\"0\">Cost vs. Coverage:<\/b> While waiving these periods increases the premium for the employer, it is a strategic choice that provides maximum utility to the workforce and prevents claim rejections for common ailments like kidney stones or ENT disorders.<\/p>\n<\/li>\n<\/ul>\n<h2><strong>Types of waiting periods in Health Insurance Policies:<\/strong><\/h2>\n<p>There are three different types of waiting periods: (i) initial waiting period; (ii) pre-existing disease coverage, and (iii) maternity coverage.<\/p>\n<h3><strong>1. Initial waiting period in Health policies<\/strong><\/h3>\n<p>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\u2019s product design.<\/p>\n<p>Read More: <a href=\"https:\/\/securenow.in\/insuropedia\/domiciliary-hospitalization-health-insurance-policies\/\"><strong>What is Domiciliary Hospitalization in Health Insurance Policies?<\/strong><\/a><\/p>\n<h3><strong>2. Waiting period for Pre-existing diseases cover<\/strong><\/h3>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<h3><strong>3. Waiting period for Maternity coverage<\/strong><\/h3>\n<p>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.<\/p>\n<p>Read More: <strong><u>What happens if a Group Health Policy is cancelled?<\/u><\/strong><\/p>\n<h3>Summary Table: Types of Waiting Periods<\/h3>\n<table data-path-to-node=\"3\">\n<thead>\n<tr>\n<td><strong>Waiting Period Type<\/strong><\/td>\n<td><strong>Individual Health Insurance<\/strong><\/td>\n<td><strong>Group Health Insurance<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><span data-path-to-node=\"3,1,0,0\"><b data-path-to-node=\"3,1,0,0\" data-index-in-node=\"0\">Initial (General)<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,1,1,0\">Typically <b data-path-to-node=\"3,1,1,0\" data-index-in-node=\"10\">30 to 90 days<\/b> from policy start.<\/span><\/td>\n<td><span data-path-to-node=\"3,1,2,0\">Usually <b data-path-to-node=\"3,1,2,0\" data-index-in-node=\"8\">Waived (0 days)<\/b>; covers accidents\/illness from Day 1.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,2,0,0\"><b data-path-to-node=\"3,2,0,0\" data-index-in-node=\"0\">Pre-existing Diseases (PED)<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,2,1,0\"><b data-path-to-node=\"3,2,1,0\" data-index-in-node=\"0\">2 to 4 years<\/b> for chronic conditions.<\/span><\/td>\n<td><span data-path-to-node=\"3,2,2,0\">Often <b data-path-to-node=\"3,2,2,0\" data-index-in-node=\"6\">Waived<\/b>; covers chronic illness immediately.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,3,0,0\"><b data-path-to-node=\"3,3,0,0\" data-index-in-node=\"0\">Specific Ailments<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,3,1,0\"><b data-path-to-node=\"3,3,1,0\" data-index-in-node=\"0\">1 to 2 years<\/b> for hernia, cataracts, etc.<\/span><\/td>\n<td><span data-path-to-node=\"3,3,2,0\">Generally <b data-path-to-node=\"3,3,2,0\" data-index-in-node=\"10\">Waived<\/b> or significantly reduced.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,4,0,0\"><b data-path-to-node=\"3,4,0,0\" data-index-in-node=\"0\">Maternity<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,4,1,0\"><b data-path-to-node=\"3,4,1,0\" data-index-in-node=\"0\">9 to 48 months<\/b> (standard).<\/span><\/td>\n<td><span data-path-to-node=\"3,4,2,0\">Often <b data-path-to-node=\"3,4,2,0\" data-index-in-node=\"6\">Waived<\/b>; provides coverage from Day 1.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,5,0,0\"><b data-path-to-node=\"3,5,0,0\" data-index-in-node=\"0\">Accidental Injury<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,5,1,0\">Usually covered from Day 1.<\/span><\/td>\n<td><span data-path-to-node=\"3,5,2,0\">Covered from Day 1.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><strong>Case study: No coverage for costs incurred in the initial waiting period in Health Insurance<\/strong><\/h2>\n<p>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.<\/p>\n<p>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&#8217; leave for the procedure and for recovery.<\/p>\n<p>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.<\/p>\n<p>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\u2019t 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.<\/p>\n<h3 data-path-to-node=\"8\">Frequently Asked Questions (FAQs)<\/h3>\n<h4 data-path-to-node=\"9\"><b data-path-to-node=\"9\" data-index-in-node=\"0\">1. Does &#8220;Day 1 Coverage&#8221; mean I can claim for a surgery I had planned before joining the company?<\/b><\/h4>\n<p data-path-to-node=\"9\"><strong>A)<\/strong> If your employer has negotiated a &#8220;Waiver of PED Waiting Period,&#8221; then yes, even conditions you had before joining are covered. However, the hospitalization must occur <i data-path-to-node=\"9\" data-index-in-node=\"266\">after<\/i> your official inclusion in the policy.<\/p>\n<h4 data-path-to-node=\"10\"><b data-path-to-node=\"10\" data-index-in-node=\"0\">2. Why was my claim rejected in the first month of my individual policy but accepted by my office plan?<\/b><\/h4>\n<p data-path-to-node=\"10\"><strong>A)<\/strong> Individual policies have a standard 30-day &#8220;initial waiting period&#8221; during which they do not cover any illness. Group plans typically remove this clause, allowing you to claim for unexpected illnesses (like a sudden infection or kidney stones) immediately.<\/p>\n<h4 data-path-to-node=\"11\"><b data-path-to-node=\"11\" data-index-in-node=\"0\">3. What happens to my &#8220;waiting period credit&#8221; if I leave my job?<\/b><\/h4>\n<p data-path-to-node=\"11\"><strong>A)<\/strong> If you port your group insurance to an individual policy with the same insurer, the years you spent under the group cover are usually credited toward the waiting periods of your new individual plan.<\/p>\n<h4 data-path-to-node=\"12\"><b data-path-to-node=\"12\" data-index-in-node=\"0\">4. Are accidents covered during the waiting period?<\/b><\/h4>\n<p data-path-to-node=\"12\"><strong>A)<\/strong> Yes. In almost all health insurance policies (both individual and group), there is no waiting period for accidental injuries. Coverage for emergency treatment due to an accident begins the moment the policy is active.<\/p>\n<h4 data-path-to-node=\"13\"><b data-path-to-node=\"13\" data-index-in-node=\"0\">5. Can an employer choose to keep waiting periods in a group plan?<\/b><\/h4>\n<p data-path-to-node=\"13\"><strong>A)<\/strong> Yes. Sometimes, to reduce the overall premium cost, an organization may choose to include a 1-year or 2-year waiting period for certain ailments. It is important to check your specific &#8220;Policy Summary&#8221; provided by your HR.<\/p>\n<p><script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@type\": \"FAQPage\",\n  \"mainEntity\": [\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Does \\\"Day 1 Coverage\\\" mean I can claim for a surgery I had planned before joining the company?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"If your employer has negotiated a \\\"Waiver of PED Waiting Period,\\\" then yes, even conditions you had before joining are covered. However, the hospitalization must occur after your official inclusion in the policy.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Why was my claim rejected in the first month of my individual policy but accepted by my office plan?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Individual policies have a standard 30-day \\\"initial waiting period\\\" during which they do not cover any illness. Group plans typically remove this clause, allowing you to claim for unexpected illnesses (like a sudden infection or kidney stones) immediately.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"What happens to my \\\"waiting period credit\\\" if I leave my job?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"If you port your group insurance to an individual policy with the same insurer, the years you spent under the group cover are usually credited toward the waiting periods of your new individual plan.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Are accidents covered during the waiting period?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Yes. In almost all health insurance policies (both individual and group), there is no waiting period for accidental injuries. Coverage for emergency treatment due to an accident begins the moment the policy is active.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Can an employer choose to keep waiting periods in a group plan?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Yes. Sometimes, to reduce the overall premium cost, an organization may choose to include a 1-year or 2-year waiting period for certain ailments. It is important to check your specific \\\"Policy Summary\\\" provided by your HR.\"\n      }\n    }\n  ]\n}\n<\/script><\/p>\n<h4><b>About The Author<\/b><\/h4>\n<p><strong>Mayank Sharma\u00a0<\/strong><\/p>\n<p><strong>MBA Finance<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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. [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"_lmt_disableupdate":"no","_lmt_disable":"no","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[1,292],"tags":[48],"class_list":["post-1359","post","type-post","status-publish","format-standard","hentry","category-group-health-insurance","category-product-features-group-health-insurance","tag-group-health-insurance"],"acf":[],"modified_by":"SecureNow","_links":{"self":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1359","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/comments?post=1359"}],"version-history":[{"count":18,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1359\/revisions"}],"predecessor-version":[{"id":35725,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1359\/revisions\/35725"}],"wp:attachment":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/media?parent=1359"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/categories?post=1359"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/tags?post=1359"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}