You have taken health insurance and are paying the premium every year, but when you fell ill and made a claim, the insurance company refused. Said ‘waiting period not completed.’ It sounds strange but it happens in every policy. If you are not aware of this in advance, you will not get the money at the time of need, no matter how expensive the policy is. If a person knows in advance that he is going to have an operation next month. So he thinks, ‘First I will take insurance, then I will take the money for the operation from insurance.’
If the insurance company allows this, then everyone will do the same: first fall ill, then take insurance, then make a claim. Due to this, the insurance company will incur loss every time because one month’s premium has been paid and claims worth lakhs have been sought.
Actually, insurance works properly when thousands of people pay premiums, some fall ill, some do not. The money of those who are healthy is useful for those who fall ill, but if only those people who are already ill take insurance, then the whole system will get spoiled and the insurance company will have to increase the premium so much that it will become very expensive for everyone. That is why waiting period is kept so that people take insurance in advance and not when needed.
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How many types of waiting periods are there?
There are four types of waiting periods: initial waiting period, pre-existing disease waiting period, specific disease waiting period and maternity waiting period.
1. Initial waiting period
Almost all health insurance plans have an initial waiting period of 30 days. During this period, there is no claim for any disease except accident. That means, if you get fever or have to go to the hospital immediately after taking the policy, the insurance company will not pay the money.
2. Pre-Existing Disease Waiting Period
This is the biggest problem about which most people are not aware. If you have any disease before taking the policy like diabetes, blood pressure, or heart problem, then there will be no claim for it for a maximum of 36 months i.e. 3 years. IRDAI (Insurance Regulatory and Development Authority of India) implemented a new rule from April 1, 2024 in which the waiting period for pre-existing diseases was reduced from 4 years to 3 years. Earlier one had to wait for 4 years, now one has to wait for 3 years.
3. Specific disease waiting period
There are some diseases which were not there before but still there is a separate waiting period for them. There can be a waiting period of up to 2 years for diseases like hernia, cataract and joint replacement. This means that claims on these diseases will be available only after 2 years of taking the policy, not before that.
4. Maternity waiting period
No maternity insurance plan in India is available without a waiting period. All maternity coverage plans have a waiting period ranging from 3 months to 6 years. This simply means that if you take insurance near pregnancy, the insurance will not cover the delivery expenses.
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5. Critical Illness Waiting Period
For fatal diseases like cancer and stroke, there is a waiting period of 90 days to 6 months and only after this time the claim is accepted. That means, if someone is diagnosed with cancer after 2 months of taking the policy, the insurance company will reject that claim. That is why critical illness insurance should always be taken when you are completely healthy.
What are the ways to reduce the waiting period?
Three ways to reduce the waiting period are to buy a policy with a shorter waiting period, buy an add-on rider that reduces the waiting period, or buy the policy early so that the waiting period ends before it is needed.
Apart from this, new rules are now applicable at the time of claim also. According to the new rules of IRDAI, cashless claim authorization has to be given within 1 hour and approval for hospital discharge should be given within 3 hours. Under no circumstances can the policyholder be made to wait for discharge in the hospital.
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