Imagine someone purchases a health insurance policy today, and the very next day, they fall ill with a non-accidental condition. Would you expect their insurer to pay the medical bills immediately? 

Not quite, as most health insurance plans include a waiting period, during which certain benefits are not available. This clause helps insurers manage risk and also ensures policyholders commit to coverage before expecting major benefits.

In this blog, we will dive into the nitty-gritty of the waiting period in health insurance and how it can prevent surprises when you make a claim. 

What is a Waiting Period in Health Insurance?

A waiting period, sometimes called a qualifying period or elimination period, refers to the time when policyholders cannot make a claim. These could be for various aspects such as specified illnesses, conditions, or treatments. 

However, this does not mean that you cannot get protection after buying a policy. Many health insurance plans allow claims for accidents from day one. 

Insurance providers use waiting periods to discourage people from buying a policy only after a diagnosis or immediately before expensive treatment. 

What are the Types of Waiting Periods in Insurance? 

When you buy a health insurance policy, you have to follow the health policy waiting period rules. 

1. Pre-Existing Disease Waiting Period

This is one of the most common and mandatory waiting periods, usually ranging from 2 years to 4 years. Within this waiting period, you cannot claim your insurance for any pre-existing disease that you had before purchasing the policy. 

2. Initial Waiting Period

The initial waiting period, also known as the cooling-off period, refers to the time after you purchase a policy during which you cannot claim any health insurance. This 30-day period prevents people from buying health insurance solely to cover a major operation or illness. 

3. Critical Illness Waiting Period

These waiting periods are applicable for diseases such as heart attack, cancer or stroke. Usually, insurance companies have a 90-day period, during which you cannot claim for the critical illness listed in your policy document.

4. Waiting Period for Specific Ailments

Lastly, insurance companies often place waiting periods for specific illnesses or operations such as hernia or cataract. They can last up to 3 years. Therefore, you can only avail these benefits after you complete the waiting period.  

5. Maternity Benefit Waiting Period

Maternity health insurance or add-ons are crucial for families planning to have a baby. However, you must review the waiting period before buying one. Usually, a waiting period of 6 months to 3 years is prevalent in insurance policies. 

Note: Waiting periods are subject to the respective insurance providers and their policies. Please read the policy documents for proper information. 

How Does the Waiting Period in Health Insurance Work? 

Let us understand how the waiting period works with a hypothetical example. You buy a health insurance plan on 1 January 2025. The policy has:

• An initial waiting period of 30 days (so non-accident claims before 31 January will be rejected)

• A pre-existing disease waiting period of 2 years

• A cataract waiting period of 1 year

• Maternity cover waiting period of 2 years

Now, suppose you need treatment for a cataract in July 2025, which is just six months after you buy a policy. The insurer will likely decline that claim because the waiting period for cataract surgery has not yet elapsed. 

You can only get that benefit after January 2026. Meanwhile, if you are hospitalised due to a car accident in February 2025, that would typically be covered. This is because insurance companies often bypass the waiting period during accidents.

If you have a declared pre-existing condition like hypertension, you may not claim expenses related to that condition until January 2027 (i.e. after 2 years).

Why Do Waiting Periods Exist in Health Insurance?

Waiting periods serve multiple purposes:

1. Prevent Adverse Selection: Without waiting periods, people might wait until they become sick, purchase insurance, file a large claim, and then cancel. Waiting periods discourage that behaviour. 

2. Risk Control for Insurers: It gives insurers a buffer and a predictable risk pool by ensuring that claims are not front-loaded. 

3. Encourage Continuous Coverage: If you maintain a policy for several years, the waiting periods will pass when you are still healthy. So when illness strikes, you will be eligible. 

4. Fairness Among Policyholders: If everyone waited the same period, those buying later or just in time would not enjoy an unfair advantage.

The Bottom Line 

The waiting period in health insurance may feel like a barrier, especially when you are newly enrolled and eager for full coverage. But it plays an essential role in maintaining a balanced and sustainable insurance system. As a policyholder, you must be aware of how waiting periods apply to your plan. This will help you plan and choose policies that align with your health needs and timelines.