Things You Must Know About Pre-existing Disease Waiting Period


Things You Must Know About Pre-existing Disease Waiting Period

Do you know that medical inflation has outpaced overall inflation in our country? Thus, accessing medical facilities has become more expensive than before. What’s worse is that we are inviting critical illnesses through a sedentary lifestyle, pollution, junk food culture, and a stressful work environment.  A single hospitalisation can derail your entire year’s financial budget. So, to reduce the financial implications and for good health, comprehensive health insurance becomes imperative. It gives you maximum benefits with a wide range of coverage against medical emergencies. 

However, a health policy includes various conditions to discourage policyholders from filing false claims. These are sub-limits, co-payments, exclusions, and deductibles, and the most important is the waiting period. Every insured person must check the fine print as one of the initial steps before buying a health cover. It will help prevent any surprises, hassles, or claim rejections that might lead you to bear the expenses, thus burning a hole in your pocket.

It is essential to get clarity on an insurance waiting period and how you can easily file a claim by completing the waiting period of all types. 

Let’s understand the concept of the health insurance waiting period.

What is a Waiting Period in Health Insurance? 

Under health insurance, your coverage does not start immediately after policy issuance. There is a time frame that has to be completed before the coverage of the policy can begin. This specified period is known as the waiting period. You have to wait till its completion to file the claim under your health insurance policy. 

What are the Types of Waiting Periods?

The range of waiting periods for health insurance depends on the policy, coverage, and type of disease. Read below about the types of the waiting period.

Initial Waiting Period- The initial waiting period starts after you get the policy. Mostly, it is 30 days from the date of policy issuance. During this tenure, you cannot file any claim for hospitalisation due to any disease except for accidents.

Waiting Period for Pre-Existing Diseases (PED)- Usually, the long waiting period of 2 to 4 years in health insurance applies to pre-existing Diseases like diabetes and hypertension. During this tenure, you cannot claim for your hospitalisation and treatment expenses due to such illness.

Waiting Period for Maternity Cover- The period for maternity cover ranges between 9 to 24 months from the date you buy the policy. Thus, females looking for this cover can plan accordingly and opt for a maternity cover much earlier, under 2 years waiting period in health insurance.

What is the need for the Waiting Period in Health Insurance?

Health insurance, like other types of insurance, is based on risk-sharing. The insurer covers the risk of individuals in return for the premium they pay to the company. The premium you pay is low compared to the coverage a health policy provides, including coverage for illnesses after the waiting period.  Health insurance undoubtedly works as a safeguard in case of any medical exigency. However, in past years, IRDAI has recorded several fraud claims and even big scams. Therefore, clauses like the waiting period aim to avoid the misuse of a health insurance policy or trivial claims. 

Can the Waiting Period be Reduced?

Reduction in PED waiting period is offered by leading health insurance companies like Care Insurance, which applies to pre-existing diseases. You can buy an add-on cover that provides a reduction in the PED wait period. Under this feature, the waiting period will be reduced from 4 to 2 years. 

How Does a Waiting Period Work in Health Insurance?

Ageing increases the chances of health issues for an individual. Additionally, younger people are becoming prone to various illnesses due to the increasingly hectic and unhealthy lifestyle. Given this scenario, investing in a health insurance plan is beneficial. It will ensure your financial security in the event of any emergency hospitalisation. 

Suppose a person with a pre-existing illness opts for a health policy. In such a case, he/she cannot get a claim for hospitalisation or treatment during the specified waiting period. The insured can file claims for such illness once the waiting period is over. Usually, the waiting period does not apply to emergency hospitalisation due to accidents or injuries.

Further, the waiting period will not be applicable in subsequent policy renewals. However, if one fails to pay the premium and renew the policy, it will lapse, and the insured will lose the benefits. One has to opt for a new policy in such cases, and the waiting period will start afresh. Thus, it is necessary to renew the health insurance policy on time and ensure continued coverage without any hassle.

Why is it good to Opt for Health Insurance at an Early Age?

Given the medical inflation, surgeries and treatments would become expensive. So, it is advisable to opt for health insurance early. Besides, younger individuals can get medical insurance much more easily without pre-policy medical check-ups. Also, what is noteworthy is that the waiting period for health insurance is one reason to opt for a health plan early in life. It is so because, at this age, people are young and energetic and also less vulnerable to critical or chronic diseases. Thus, they are much more likely to enjoy the advantage of lesser premium, maximum coverage, and reduced waiting periods. 

Some More Important Points about the Waiting Period

  • During the waiting period, you cannot file a claim for hospitalisation or treatment expenses. 
  • If you are diagnosed with any new disease during the waiting period, it will be covered under your policy.
  • An initial waiting period of 30 days can also be considered as a cooling period.
  • Named ailments wait period means you will need to wait for a specified time for filing a claim against ailments that are pre-listed in the policy. For instance, tumours, bladder stones, etc.

So, if you want customised health insurance plans for yourself or your family, check out our wide range of health insurance products and live a stress-free life. 

Disclaimer: Please read the policy T & C, brochure, and prospectus to know more about our health insurance plans. We will settle the claims, subject to policy terms and conditions.

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Q. What is PED in Health Insurance?

Simply put, a pre-existing ailment is a condition that a policyholder has before getting a health insurance policy.

Q. Is there any health insurance with no waiting period?

Waiting period is a standard clause of every health insurance company. However, under two circumstances you don’t have to serve notice period, they are-

  • If you need to be urgently hospitalised due to accident or injury
  • If you have bought a pre-existing add-on that covers you from day 1.

Q. How do you get minimum waiting period health insurance?

You can buy an add-on that reduces waiting period from 4 years to 2 years.


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