A ‘Waiting Period' is an important clause for every health insurance policy. To understand the concept let us take an example:
Ayub Khan, aged 34, has recently bought a health insurance policy that promises health cover to the entire family. Before buying the policy, Ayub had been diagnosed with certain ailments for which he had undergone treatment in the past. Ayub discloses details about his health disorders while submitting the insurance proposal which the company accepts. Three months after buying the policy, Ayub is suddenly hospitalised and requires treatment for his pre-existing illnesses. Can Ayub seek a claim from the health insurance company? Does the insurance company have the right to reject the claim made despite Ayub having paid all the premiums regularly? How do the insurance companies cover their customers already suffering from certain diseases before applying for the policy?
The most important thing to note is that one cannot make a claim soon after buying the policy. Every insurance company selling health cover has in place a waiting period that may range from 30 days to four years that differs from one company to the other. Waiting period is the gap or period during which a policyholder cannot claim for certain expenses made on treatment. It is the period that the policyholder has to wait before seeking health cover from the insurance company.
The waiting period clauses for individual health insurance and a family floater insurance policy are different. These include:
- Initial waiting period is 30 days – 90 days: Most health insurance companies include a waiting period of one month during which they would not enter any claims barring treatment of injuries resulting from accidents. This waiting period may extend up to 90 days for some insurers. This has been done to protect the interests of the insurance companies against customers who buy health insurance plans immediately after being detected with some serious disorder and attempt to seek claim just after paying the first premium.
- Waiting period for pre-existing diseases: Many insurance companies ask their customers to undergo certain medical tests to check if they are suffering from any ailment(s) including blood pressure problems, diabetes, thyroid disorders, etc. Depending on the medical reports, the insurer may decide to accept or reject a policy proposal. Some insurance companies agree to cover the customers subject to the condition that the health cover is either limited or excluded for any pre-existing disease. Some insurers agree after prescribing a waiting period that may be limited a year or extend up to four years. Patients can seek a claim for the medical expenses incurred for the treatment of the pre-existing disorders only after the passage of the waiting period as mentioned in the policy proposal form.
However, if the customer had been suffering from any disorder before buying the policy but has been diagnosed with the disease only after having bought the policy, then the insurance company is liable to pay the expenses on its treatment. Also, in group health plans offered by companies to their employees, the insurance companies do not insist on including the waiting period clause for health insurance.
- Maternity waiting period: Some insurance companies also extend their benefits to maternity expenses too. However, many of them necessitate a waiting period extending from nine months to four years. This means that one must consider buying health insurance early so that the maternity expenses can be claimed after conception past the maternity waiting period.