Waiting Period In Group Health Insurance: Meaning And Types Explained

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Group Health Insurance

People who are buying a health insurance policy for the first time aren’t sure what the waiting period in group insurance means. Moreover, if there’s something known as a “waiting period,” how long is it, and what does it include?

Well, keep your doubts at bay and keep reading to know everything about waiting periods in your health insurance.

What Is Waiting Period In Health Insurance?

The waiting period in health insurance is simply the amount of time you need to wait before you can avail of any benefits.

One of the most prevalent sorts of waiting periods, for instance, is the amount of time you must wait before using special benefits like maternity coverage. In that case, most health insurers will include a waiting period of 2 to 4 years. That means, before you can actually benefit from the maternity cover, you must have your policy for at least 2 years. [The amount of time depends on the health insurance policy you buy.]

4 Types of Waiting Periods In Health Insurance

There are several kinds of waiting periods present in every health insurance policy. Let’s examine what they suggest in more detail and what the industry average is:

  • Initial Waiting Period
  • Pre-Existing Disease Waiting Period
  • Waiting Period for Specific Diseases
  • Maternity Benefit and Newborn Baby Cover Waiting Period

Initial Waiting Period

The initial waiting period is also called the cooling down period. It refers to how long you will have to wait after your health insurance coverage is issued before you can utilise it in a meaningful way.

As a standard in the industry, all health insurance policies nowadays have at least a waiting period of one month.

Pre-Existing Disease Waiting Period

When you buy a health insurance policy, you will have to inform the company asked about pre-existing diseases and take a few tests.

A pre-existing condition is defined by the IRDAI [Insurance Regulatory and Development Authority of India] as any injury, illness, or disease that has been diagnosed during the past 48 months prior to buying your health insurance policy.

Diabetes, thyroid, hypertension, and other disorders are a few examples of pre-existing conditions. In such a case, you will have to wait for the prescribed time limit before claiming any treatment.

On average, the pre-existing disease waiting period is three to four years. It also depends on your health insurance provider and the type of health insurance plan you have chosen.

Waiting Period for Specific Diseases

The waiting period for specific diseases means that you will have to wait for the prescribed amount of time to claim hospitalization.

On average, the waiting period for specific diseases is generally 2 to 4 years.

The list of applicable specific diseases are listed below:

  • Non-infective arthritis, osteoarthritis, osteoporosis (if age-related), systemic connective tissue disorders, dorsopathies, arthrosis, spondylopathies, inflammatory polyarthropathies, and intervertebral disorders (unless due to accident).
  • Pancreatitis, gastric and duodenal erosions/ulcers, calculus disease of gall bladder/biliary tract and urogenital system, varices of GI tract, cirrhosis of the liver, rectal prolapse.
  • Cataract, glaucoma, and retina disorder hyperplasia of the prostate, hydrocele/Varicocele, urethral strictures, and Spermatocele.
  • All abnormal uterovaginal bleeding, endometriosis/adenomyosis, female genital prolapse, fibroids, ovarian cyst, and pelvic inflammatory disease.
  • Hemorrhoids, fissures, fistula and pilonidal sinus/cyst, and fistula.
  • Hernia of all sites.
  • Varicose veins of lower extremities.
  • Psychiatric illness and disorders such as schizotypal, schizophrenia, delusional disorders, mood [affective] disorders, neurotic, stress-related, and somatoform disorders, and unspecified mental disorders.
  • Neurodegenerative disorders include, but are not limited to, Alzheimer’s disease and Parkinson’s disease.

Maternity Benefit and Newborn Baby Cover Waiting Period

As a part of most health insurance policies for individuals and families, there’s an option to include a maternity benefit and newborn baby cover add-on.

The typical waiting period for the majority of health insurance plans runs from one to four years. Add-on maternity benefit covers delivery expenses and the baby for its first 90 days. Further, it includes all necessary vaccinations and other medical care required for the baby.

Waiting Period In Group Health Insurance

The group health insurance waiting period will usually be around 30 to 90 days after you purchase a group health insurance policy. Moreover, this depends on the terms and conditions of the insurance policy. However, in the case of group health policy, you can waive the waiting period.

For pre-existing disease coverage, the waiting period is typically 4 years. After the waiting period has expired, the holder’s claim cannot be denied by the insurance company.

The way this clause works is easy. Before buying the policy, the insured declares his/her pre-existing disease/ailments such as diabetes, hypertension, thyroid, etc. Based on the disease or ailments declared, the insurance company will decide whether the coverage under the group health insurance can be granted or not.

When they accept to cover these diseases or ailments, the insurance company will force a waiting period of 4 years. This means that only after the waiting period of 4 years, the insurer can claim any medical expenses.

However, certain diseases, such as ENT disorders, osteoporosis, hernia, and others, typically require a waiting period of one to two years. Furthermore, the group policyholder can waive the waiting period.

This is typical for the majority of insurance companies, just like the waiting period for maternity benefits. The typical waiting period is between nine and 36 months. The maternity cover waiting period can also be removed from a group health insurance policy, just like other waiting periods, so that the person is covered from the first day of the policy.

Is It Possible To Reduce Waiting Period In Health Insurance?

It is not a pre-existing condition if you are first diagnosed with a disease during the waiting period. Accordingly, the approach will cover such infections or illnesses. Similarly, the addition of a co-pay can also help reduce the waiting period for health insurance.

For instance, insurance companies have devised plans for senior citizens. Here, you can remove the waiting period by adding a co-pay clause.

The co-pay clause proposes that policyholders will have to bear a certain percentage of claim amounts. For instance, for a co-pay clause of 30% in a claim of Rs.1 lakh, the policyholder will have to pay Rs.30,000 to reduce the waiting period in insurance.

Conclusion

We hope that you are clear with the concept of the waiting period in health insurance. As to no doubt, there are many terms that you need to be familiar with before buying health insurance. Click on this link to learn more about the waiting period and other insurance terms by downloading this free e-book.

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