A health insurance policy offers security and financial assistance during a medical emergency. With such a policy at hand, you can focus completely on recovering since it helps take care of your hospital bills. However, in certain cases, people are unable to use their health insurance as there is a waiting period. Policyholders' primary concern is -  What is the waiting period in health insurance? and Is there health insurance without a waiting period? Let us understand this better.
 

Concept of Waiting Period in Health Insurance

The waiting period in health insurance refers to an agreed-upon period before which the policyholder, even during the policy term of a specific health insurance policy, will not be able to receive coverage benefits for certain listed conditions. The policy's start date is used to compute the waiting period.

Types of Waiting Period in Health Insurance

Types of waiting period in health insurance can be of different types. Some of those are:  

1. Waiting Periods for Specific Ailments/Procedures

Health policies include a waiting time of one or two years for several conditions and operations, including joint replacement surgery, cataract surgery, osteoporosis, ENT diseases, and hernias. Only after the one- or two-year waiting period has passed are any medical costs arising from such conditions or procedures covered.

2. Initial Waiting Period

There is a 30-day or one-month initial waiting time that most health insurance plans have before accepting claims, except in accidental instances.

3. Pre-existing Diseases (PED) Waiting Period

Pre-existing diseases are conditions that an insured person has when applying for health insurance, such as diabetes, high blood pressure, thyroid issues, etc. Pre-existing conditions are covered by health insurance plans with a two- to four-year waiting period.

4. Critical Illnesses Waiting Period

Standard health insurance policies reject all claims for critical diseases received within the 90-day waiting period before covering them.

5. Maternity Benefit Waiting Period

Pregnancy benefits and coverage for a newborn are provided by many health insurance policies after a waiting period of nine to thirty-six months.

6. Waiting Period for Bariatric Surgery

Bariatric surgery may be covered by health insurance plans. Bariatric surgery involves surgery on the stomach and intestines to treat conditions associated with excessive obesity.

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How To Avoid Waiting Periods In Health Insurance?

While it may not be possible to avoid waiting periods in health insurance in certain circumstances, you must take care of the following points to steer clear of excessively long waiting periods: 

• Understand Policy Terms: Thoroughly review the terms and conditions of your health insurance policy.
• Explore Group Insurance: If you are part of a group or organization that offers health insurance benefits, inquire about the waiting periods associated with their policies. Group insurance plans often have more favourable terms.
• Maintain Continuous Coverage: Changing insurance providers or letting your policy lapse can reset waiting periods.
• Consider Supplemental Insurance: Supplemental insurance policies, such as critical illness or hospital indemnity plans, can provide additional coverage for specific healthcare needs.

How to claim for conditions that have a waiting period?

Before initiating a claim, ensure you understand the waiting periods applicable to your health insurance policy. Identify which conditions or treatments are subject to waiting periods and the duration of each waiting period.

1. Wait for the Waiting Period to Expire

Once the waiting period has ended, you are eligible to submit a claim for the relevant treatment or condition.

2. Document Treatment and Expenses

Keep thorough records of any medical treatment received and associated expenses during the waiting period. This documentation will be essential when submitting your claim to the insurance company.

3. Submit a Claim Form

Obtain a claim form from your insurance company, either through their website, customer service department, or mobile app. Fill out the form accurately and completely, providing details about the treatment received, dates of service, healthcare provider information, and any supporting documentation.

4. Include a Cover Letter

Write a cover letter to accompany your claim form, explaining the circumstances of your claim and referencing the waiting period that has now expired.

5. Submit Documents to the Insurance Company

Submit your completed claim form, supporting documentation, and cover letter to the insurance company through the specified channels. It may include mailing the documents, uploading them online, or delivering them in person to a local office.

6. Follow-up

After submitting your claim, follow up with the insurance company to ensure they have received all necessary documents and information. Stay updated about the status of your claim and be prepared to provide any additional documentation or clarification, when and if requested.

7. Await Decision

Once your claim has been submitted, the insurance company will review it. This process may take some time, so be patient and monitor your health insurance claim status through the insurer's online portal or customer service department.

8. Receive Reimbursement

Depending on your preferences and the insurance company's policies, you may receive the reimbursement as a cheque, direct deposit, or credit to your account.

Conclusion

Waiting periods in health insurance serve as a protective measure for insurers, but they can pose challenges for policyholders seeking immediate coverage. Understanding the types of waiting periods, exploring options like zero waiting period health insurance, and staying informed about claim status can empower you to make informed decisions about your health coverage.

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