All about Waiting Periods in Health Insurance, everyone needs to know
It is not at all true that you have just taken health insurance and from day 1 you are covered for all treatments/surgeries, however, there are waiting periods in health insurance applicable to many medical procedures/surgeries in health insurance, which all policyholders should know. This is necessary, without this information, your claim will be rejected.
Here are some most common waiting period that applies in every indemnity policy across the Indian health insurance industry:-
Initial Waiting Periods
PED Waiting Periods
Accidental Injury Waiting Periods
Specific Medical Treatment/Surgeries/Procedures Waiting Periods
Other Waiting Periods
Initial Waiting Periods– after commencement of the policy, risk shall be applicable after 30 days for hospitalization for any illness/surgery/treatment, this will not apply for accidental injury treatment, port policy, renewal policy
PED Waiting Periods– Whatever medical history or disease one has before taking health insurance is called pre-existing disease, depending on plan to plan and insurance company to insurance company, it can be up to 24 months, 36 months or 48 months, this is in the portability policy. A time-bound waiver is available, as if a person has a PED and his policy in the previous insurance company continues for 2 years and then the insured applies for the port and the new insurer passes the PED waiting period of 48 months. There will be a further waiting period of 24 months for the new insurer. One thing to keep in mind is that the insurer does not give a time-bound waiver for a break in policy.
Accidental Injury Waiting Periods– Health cover for treatment/surgery of accidental injury starts from the commencement date itself and there is no waiting period.
Specific Medical Treatment/Surgeries/Procedures Waiting Periods– In health insurance, some special surgeries/treatment procedures are covered only after 24 years, which is commonly called a slow-growing disease.
Other/Hidden Waiting Periods– Whenever you get a call from a health insurance salesperson or come for a meeting, normally they will also tell you about the waiting periods, but there is some hidden waiting period also in health insurance, this is just the insurance company’s internal guideline. This is not even mentioned in their policy wording, it is on a case-to-case basis and depending on the nature of the claim the insurer decides whether to pay the claim or not.
For someone who took a policy and after 40 days got a medical emergency, was admitted to the hospital and also got a pre-authorization from the insurer and at the time of discharge he was diagnosed with final stage cancer, the health insurance company will still say that there is no medical history. How to tell the final stage of cancer, then you will contact the insurer company, it means that you will not get the claim but you will have to file your reimbursement and the insurer will get it investigated by its third party investigator, your report will be positive mileage only then you will get the claim otherwise forget it.
Conclusion: “It is more important to know how health insurance works, rather than how to get the claims.” Be remember one thing Insurance Companies are not charity organisations, they will verify each and everything at the time of Claim, if found payable no health insurance company will deny the claim.”
About the writer – Kumar has more than 2 decades of personal finance Sales, Operations, Health Insurance Underwriting, and Health Insurance Claims, and has been associated with multiple training teams for Learning and Development.
