Waiting Periods in a Health Insurance Policy

When you buy a health insurance policy, you might assume that you are covered from day one. But that’s not always true. Insurance companies apply a waiting period, and it is important that you understand the types of waiting periods.

Background

When you buy a health insurance policy, you might assume that you are covered from day one. But that’s not always true.

Insurance companies apply a waiting period — a time frame during which certain illnesses or conditions are not covered.

Understanding these waiting periods is crucial so that you don’t face claim rejections at the time of medical emergencies.

What is a Waiting Period in Health Insurance?

• A waiting period is the initial time after buying a health policy when specific claims are not allowed.

• If you fall sick or require treatment during this period for certain listed conditions, your claim will be rejected.

• Each insurance company and plan have its own waiting period rules.

• Waiting periods are clearly mentioned in the policy document, and it’s important to read them carefully before buying.

Why Do Insurers Impose Waiting Periods?

• To prevent fraud and misuse: Some people buy insurance only after discovering a health issue and immediately file a claim.

• To reduce the risk of unethical practices, like hiding pre-existing conditions.

• It protects the insurer and ensures that only genuine long-term policy holder benefits from the health insurance coverage.

Types of Waiting Periods

There are five main types of waiting periods in Indian health insurance:

1. Initial Waiting Period

• This is the first 30 days after you purchase the policy.

• During this time, no claims are allowed, except for emergencies or accidents.

• It applies to all health plans, regardless of age or health.

Example:

If you bought a health plan on 1st July and were diagnosed with a minor illness on 10th July, your claim will not be accepted unless it was an accident.

2. Pre-Existing Diseases

• A pre-existing disease (PED) is any illness you had before buying the policy — like diabetes, asthma, BP, thyroid, etc.

• Most insurers apply a 2–4 year waiting period for such conditions.

• In your own interest, you must disclose these honestly when buying the policy.

Example:

If you have diabetes, and the insurer has a 3-year PED clause, you can claim for diabetes-related treatment only after 3 years of continuous policy.

3. Specific Ailments & Procedures

• Some insurers have a list of specific illnesses or surgeries that have their own waiting period — like:

  • Hernia

  • Cataract

  • Joint replacement

  • ENT surgeries

  • Varicose veins

• The waiting period for these may vary from 1 to 2 years.

• And these are different from PED (Preexisting diseases) because even if you are detected with Hernia after one year of taking the policy, your claim will be denied since this ailment comes under the "Specific Ailments and Procedures" waiting period.

Important:
Always check the list of “permanent exclusions” and waiting list ailments in the policy brochure.

4. Critical Illnesses

• In regular health plans, the waiting period for critical illnesses like the ones listed below is usually 30 days:

  • Cancer

  • Stroke

  • Kidney failure

  • Heart disease

• In critical illness-specific plans, the waiting period can be longer — 90 to 180 days.

Important:

The policy may only pay a lump sum benefit (not the actual hospitalization cost) for critical illness after surviving a minimum duration (say, 30 days post-diagnosis). You need to carefully read the policy offer documents before signing up for the policy.

5. Maternity Benefits

• Maternity coverage is offered by some health plans, but it usually comes with a waiting period of 9 to 36 months.

• This is to avoid people buying the policy only during pregnancy.

Tip for young couples:

Buy health insurance early, even if you are not planning a baby soon, to complete the maternity waiting period.

Summary

• Waiting periods are a crucial part of every health insurance policy. They prevent misuse and help maintain insurance discipline.

• Know the five key types of waiting periods: Initial, PED, Specific Ailments, Critical Illness, Maternity.

• Buy insurance early — before you need it.

• Always read the fine print and ask your insurance agent for clarification.

• Be very watchful of the applicable waiting periods while porting policies from one service provider to the other, or when moving jobs, or quitting jobs post freedom/retirement.

References

• Related Blogpost: Strategies and Clauses while choosing a Health Insurance Policy
• Related Blogpost: 8 Strong Reasons to buy your own Health Insurance Cover right now
• Related Blogpost: Personal Accident Cover
• Related Book: From the Rat Race to Financial Freedom

Regards

Manoj Arora
Official Website