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WaItIng peRIod are such SPOILERs, that it can be DISASTROUS to your WEALTH

WHY planning in advance can help you later in case of MEDICLAIM ?

Almost all health insurance (mediclaim) policies have certain waiting period conditions.

The concept of waiting period in a health insurance policy is defined as the period of time specified which must pass before some or all of your health care coverage can begin. Hence, this is the period during which claim is not admitted.

Types of Waiting Period in Health Insurance
Here’s all you need to know before making an insurance claim:

  1. General health insurance waiting period  is one month for every policy except for accidental cases.
  2. There is a 90 days waiting period for infants or new born babies.
  3. There are a few Insurance companies that offer maternity benefits, but with a waiting period ranging from 9 months to 36 months

Pre-Existing Diseases (PED)
 At the time of taking health insurance, if an insured declares that he has specific ailments say diabetes, high blood pressure, thyroid, etc., these are called pre-existing diseases. In such cases, insurance company’s health underwriters insist for medical tests for assessing the level of impact of the diseases on the policyholder. Based on the reports, they decide if a proposal is to be accepted or not. In case they accept the proposal, they prescribe a waiting period usually of 4 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 4 successful years with the insurer.  Hence, it is important to take health insurance policy early in life to avoid any waiting period.

One/Two Years Waiting Periods for Particular Ailments

There are certain listed ailments such as ENT disorders, hernia, osteoporosis, etc. for which health policies normally have one or two years of waiting period.

Recently, Mr. Raj Purohit, a resident of GURGAON, bought a health insurance policy worth Rs 15 lakh sum insured and was very happy with his decision. He was quite aware of his lifestyle habits and family medical history which made him prone to various illnesses. Considering the cost of treatment of those diseases, he was sure that buying health insurance cover is the best thing to do. However, little did he know that every health insurance policy comes with a defined ‘waiting period’.
Just two weeks after Raj bought the health policy, he was diagnosed with a 7.8 centimetres bladder stone and was advised to go for a Lithotripsy (surgery for removing stone). Unaware about the waiting period in his health insurance policy, he got admitted in his choice of hospital and went for the surgery thinking his insurer will take care of all the medical expenses. However, he was totally shocked when he was informed that as he hasn’t completed the initial waiting period of the health insurance, his claim would not be accepted. Unfortunately, Raj himself had to bear all the medical expenses which included hospitalisation and surgery charges amounting to Rs 1.5 lakh.

Different Types of Waiting Periods
# Initial Waiting Period
# Disease-specific Waiting Period
# Pre-existing Disease Waiting Period
# Maternity Waiting Period

WHY Waiting Period in Health Insurance

The clause of waiting-period in health insurance is implemented to avoid wrong intention of a person to claim benefit under insurance plan. There had been instances where customers without any health insurance, after being diagnosed with a specific disease purchased a health insurance without disclosing the disease to the insurer. So, in order to avoid such unethical practices, the concept of waiting period is implemented in health insurance cover.

Other Important Points Related to Health Insurance Waiting Period:

If during the waiting period, the insured is diagnosed with a disease for the first time, it will not be called a pre-existing disease. The policy will cover such ailment.

With changing times insurance companies have designed plans for senior citizens where health insurance waiting periods have been done away with by adding a co-pay clause. Co-pay clause implies that policy holders will have to bear a certain percentage of claim amounts. For example, for a co-pay of 30%, in a claim of Rs. 1 lakh, policy holder will have to bear Rs 30000.