What is the importance of waiting period in health insurance?
India TV 23/01/2018
Maintaining an active lifestyle with proper diet and daily exercise can go a long way in improving one’s health condition. Meanwhile, there is a need for health insurance in order to obtain timely and adequate healthcare treatments and services. A health insurance policy covers medical expenses incurred by an insured member during the policy term. An adequate health cover will ensure you are financially protected in your of need. Opt for a health insurance policy that offers cashless facility at the network hospitals of the insurance company so that you don’t have to pay the hospital bill out of your pocket.
Employers in India provide group health insurance plans to their employees as a part of the employment benefits. An employee health insurance policy ceases to exist once the employee quits the job or transfers to another company. That is why, it is advisable to opt for a family floater plan or an individual health insurance policy in addition to a group health insurance policy offered by your company.
Health insurance companies offer riders like hospital cash benefit cover, critical illness cover, maternity benefit cover, personal accident cover, super top-up plan, etc., to help policyholders personalise and enhance their health covers. With a steady rise in healthcare costs and medical inflation, having a health insurance policy has become a necessity rather than a luxury. Furthermore, there is a rise in the number of lifestyle diseases owing to our sedentary lifestyles. Therefore, having a relevant health insurance policy that covers major illnesses and pre-existing diseases can come in handy either now or later.
What is a waiting period?
A term life insurance policy covers the life insured from the date of policy inception. Life insurance coverage is immediately applicable in a term insurance plan. On the contrary, a health insurance policy doesn't cover an insured member from day one, except for unplanned hospitalisation as a result of an accident. The types of waiting periods in health insurance include:
● Initial waiting period in standard mediclaim policies: Usually, the insured member has to complete an initial waiting period of 30 to 90 days before the health insurance coverage can begin. As the insured member grows older, there are higher chances of falling sick or contracting a disease. That is why, senior citizen health insurance plans have a higher waiting period than other types of health insurance plans. There is no waiting period in a group health insurance plan.
● Waiting period for pre-existing diseases: Those illnesses that a policyholder shows symptoms for or is diagnosed with before purchasing a health insurance policy are called pre-existing diseases. Pre-existing illnesses/conditions are usually not covered by a health insurance policy. Some insurance companies offer health insurance policies with coverage for pre-existing ailments. However, it comes with a 4-year waiting period before the coverage for pre-existing illnesses can begin.
● Waiting period for specific illnesses: The waiting period of a health insurance policy varies for specific diseases like hernia, tonsillitis, piles, etc. For example, the insured member has to complete a 2-year waiting period from the date of policy inception to get coverage for the treatment of hernia. Medical expenses incurred during the waiting period for hernia treatment will not be reimbursed by the insurance company.
● Maternity benefit waiting period: Regular health insurance policies don’t cover maternity expenses. Some insurance companies offer maternity benefit cover with a waiting period of 9 months to 48 months. Given the long waiting period, if you are planning on expanding your family, purchase a maternity benefit cover much in advance.
● Critical illness waiting period: In the case of a critical illness cover, the insured member will not get the critical illness benefit if he or she is diagnosed within the first 90 days of policy inception (critical illness waiting period) or dies within 30 days after diagnosis (survival period).
Before purchasing a health insurance policy, go through the waiting period clause carefully. Waiting period varies from policy to policy. The waiting period of a health insurance policy also varies from insurer to insurer. Goes without saying, it is wise to opt for a health insurance policy with a small waiting period.
What happens to the waiting period in the case of health insurance portability?
As per the rules of the Insurance Regulatory and Development Authority of India (IRDAI), a policyholder can port his or her health insurance policy from one insurer to another without losing out on policy benefits such as No-Claim Bonus or waiting period. Hence, your waiting period credit remains unaffected even if you choose to port your policy from the existing insurer to a new one. Policyholders choose to port their health insurance policy to another insurer due to a higher insurance premium and the lack of advanced features/benefits offered by the current insurer.
In conclusion, go through the terms and conditions of the waiting period of your health insurance policy so as to avoid any hassle when making a claim at a later date.