Waiting Time For Health Insurance Cover – How To Health Insurance Cover Work

Health insurance Cover

The waiting period in health insurance cover refers to the time the insured must wait after the health insurance policy is issued before it can utilize its benefits. From insurance company to insurance company, a waiting time has different terms and conditions.

The waiting period in health insurance is before the insured person needs to be qualified to receive coverage benefits for some conditions stated in the policy, even throughout the policy term. 

For instance, niva bupa health insurance plans often include a waiting period for pre-existing conditions. Any insured person will only be eligible to use coverage benefits for pre-existing conditions once the four-year waiting period has passed. The waiting period is measured from the policy’s start date.


Health Insurance Waiting Period Types

Health insurance programs have a variety of waiting periods. Read on to discover what they imply:

  • Initial Waiting Period

After receiving a health insurance cover, the policyholder must wait a predetermined number of days before making any claims or receiving any benefits. In health insurance, this time frame is known as the initial waiting or cooling period. Every health insurance plan has a waiting period of at least one month and no more than ninety days per industry standards. Accidental claims are the only exception to the initial waiting time; these claims are only accepted when the insured is involved in an accident and needs to be hospitalized immediately. Bear in mind that each insurer has a different initial waiting period.

  • Existing Conditions (PED) Waiting Time

It is a unique waiting period for some pre-existing conditions that the policyholder disclosed at the time of insurance purchase. A pre-existing disease is defined by the Insurance Regulatory and Development Authority of India (IRDAI) as any condition, accident, illness, or disease that has been identified up to 48 months before the insurance purchase. Thyroid, hypertension, and diabetes are a few pre-existing conditions. Pre-existing condition waiting periods in health insurance plans typically range from one to four years. However, the pre-existing disease waiting period varies depending on the insured’s health status and the health insurance plan they select.

  • The Waiting Period for Particular Illnesses

Several illnesses have a set waiting period, including hernias, tumors, ENT disorders, cancer, stroke, and heart conditions. The typical waiting period for these programs is between two and four years. The conditions that are exempt from this waiting time vary from insurer to insurer and are included in the policy information that each insurer provides.

  • Waiting Period for Maternity

Maternity and new-born baby coverage are available as an add-on benefit for subscribers of individual and family health insurance plans. Maternity Insurance is a standard inclusion in health insurance plans. In each case, the coverage is available following a 2–4 year waiting period. However, some health insurance providers offer shorter waiting periods, but the policyholders must pay higher health insurance rates to take advantage of that.

  • Bariatric Surgery Waiting Period

Several health insurance plans additionally cover bariatric surgery. Surgery affecting the stomach and intestines, known as bariatric surgery, assists patients with severe obesity-related problems. Those with a BMI above 40 and those experiencing health problems due to the same are typically advised to get the operation.

  • Coronavirus Retention Time

Many people purchase coronavirus-specific health insurance plans for themselves and their families due to its rising prevalence in India. However, the insured must wait up to 30 days before utilizing these plans’ coverage advantages, such as hospitalization and therapy.


What Does the Waiting Period in Health Insurance Mean?

A waiting time is used in health insurance to prevent individuals from incorrectly intending to collect benefits under a health insurance policy. There have been instances where people without health insurance who had received a specific disease diagnosis went out and bought a health insurance policy without telling the insurer about it. Therefore, the idea of a waiting time is adopted in health insurance policies to avoid unethical acts like these.


Is a Waiting Period Reduction Possible?

Many insurance providers offer health insurance plans that let covered people shorten the waiting period. However, the insured must pay an additional premium to use this benefit. There is typically no waiting time in the health insurance policies that corporations provide to their employees. The waiting period is shorter than that of a standard individual health insurance policy, even in those circumstances when it does exist. However, when a person leaves their workplace, the Insurance Regulatory and Development Authority of India (IRDAI) permits them to convert their group health insurance plan into individual health insurance coverage. Since they have had to wait for coverage under the employer’s group health insurance plan, the people in this situation will receive the policy immediately.


IRDAI’s Waiting Period Notifications

It is advised that insurance companies be permitted to include up to 4-year waiting periods for any particular illness or condition. Additionally, waiting periods for particular disorders like diabetes, hypertension, cardiac issues, etc., shouldn’t last longer than 30 days. The change will be very beneficial because many people struggle with these illnesses.