30 Day Waiting Period For Health Insurance

Waiting Period For Coronavirus

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With the increasing case of coronavirus in India, many people are buying coronavirus specific health insurance plans for themselves and their families. But to avail of coverage benefits like hospitalisation and treatment under these plans, the insured needs to complete a waiting period of up to 30 days.

What Is Waiting Period In Health Insurance: Full Guide

A waiting period is when you are unable to use your group health insurance benefits. Read on to learn more about the waiting period in health insurance.

Providing, or even expanding, employee benefits like comprehensive health insurance will positively influence your employeesâ overall health and wellbeing. And healthier employees make a more productive workforce.

With health issues arising anytime, anywhere, itâs important to secure health insurance as early as possible. However, be cautious of the waiting period in health insurance before purchasing a health insurance plan.

When you sign up for health insurance, it is necessary to understand the waiting period policy. Waiting period is the time you need to wait before your health insurance coverage starts. The waiting period may vary depending on your insurance policy.

Importance Of The Waiting Period In Health Insurance

Lets take an example to consider!

Mr. Ram, 40 years old, working as a software engineer has already been diagnosed with cancer. The doctor advised him to go through chemotherapies that he could not afford on his regular pay check. As a remedy to this problem, he purchased a health insurance plan without informing the company about his illness.

To avoid such unethical tactics, nowadays, health insurance companies have a waiting period before which the policyholder cannot receive any benefits from their health insurance plan. Therefore, a waiting period in health insurance is implemented to prevent individuals from claiming benefits under a health insurance policy with the wrong motive.

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What Is A Zero Or No Waiting Period

As most health insurance policies come with a waiting period clause, there are only two circumstances under which no waiting period is applicable:

  • Emergency hospitalisation due to accidental injury

  • Pre-existing disease coverage available from policy inception

In the event of an accident, the policyholder can opt for medical care and claim the expenses even during the initial waiting period. Similarly, if the health policy safeguards the insured against pre-existing ailments from day one of the plan, then the policyholder can get the benefits without any PED waiting period.

Waiting Period For Bariatric Surgery

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Some health insurance policies cover bariatric surgery too. Bariatric surgery is surgery on the stomach and/or the intestines that helps the patient with extreme obesity-related issues. The surgery is usually recommended to those with a BMI over 40 and those going through health issues due to the same.

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Why Is There A Waiting Period Related To Health Insurance Plans

The need for a waiting period in health insurance has arisen because of the unethical practices to get insurance benefits. Many individuals buy health plans with the intention of getting insurance cover.

Think of the situation in which an individual is diagnosed with a critical illness but did not have health insurance. The doctor recommended an expensive surgery, which he could not afford through the regular income. As a solution to this problem, he bought health insurance but did not disclose the disease.

A waiting period in health insurance was introduced to prevent such unethical practices.

Benefits Of Buying Medical Insurance In Goa From Acko

As you may know, ACKO is a fast-growing, leading insurance company in India and currently caters to a whopping 7.7 crore customers. Our 1 Core Health Plan is a unique offering in the health insurance space and was made after analysing the diverse customer requirements. Its distinct features and benefits make it a must-have policy. The following table lists some of its key features.

Key features

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Get A Free Insurance Quote Today

Still have questions about waiting periods or maternity insurance? Dont hesitate to get in touch with one of our experienced insurance advisors at Pacific Prime. We work closely with top health insurers and partners to help you find the best plan by balancing your budget with your needs. Short on time? Get a free quote now with our online quotation tool!

For more practical insurance knowledge and trends, check out our host of articles and resources.

Do The 90 Days Include Work Days Calendar Days Or Something Else Entirely

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Under the law, the 90 days are just that 90 consecutive calendar days. That means weekends and holidays are swept up in the final count. If the 91st day falls on a non-workday, coverage needs to be switched on before that day or on the exact weekend or holiday the 91st falls on.

Pro tip: 90 days does not equal three months. There are a few other mentions of a three-month waiting period in the ACA, but its referring to a completely different thing.

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Can You Reduce Your Waiting Period In Health Insurance

Itâs nearly impossible to get group health insurance without a waiting period. You can get short-term insurance that kicks in until your coverage starts, or a few insurers may cut wait time by charging more premiums. But group health insurance is one of the greatest options for your company.

However, some health insurance firms have created plans for senior citizens that eliminate the need for a waiting period in group health insurance by including a co-pay provision.

Waiting Period For Accidental Hospitalisation

There is no health insurance waiting period for medical treatment, including hospitalisation, that is required in the wake of an accident. The initial waiting period of your health insurance policy also does not apply in case you meet with an accident. Therefore, you can enjoy coverage for accidental injury from the moment you purchase the policy.

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Importance Of Waiting Period In Health Insurance

A waiting period in health insurance is implemented to prevent individuals from claiming benefits under a health insurance policy with the improper motive. Customers without health insurance policies have purchased health insurance policies after being diagnosed with a specific ailment without reporting the diagnosis to the insurance provider in some situations. To avoid unethical acts like these, health insurance policies include the concept of a waiting period.

What Is Waiting Period In Health Insurance

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Waiting period in health insurance is the amount of time you have to wait before you can reap all or some of the benefits of your health insurance coverage. Its crucial to know that usually, you cannot raise any claim against your policy during this waiting period. This waiting period may be applicable to either some health conditions or your entire coverage, and it can vary from one insurer to another.

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The Different Types Of Waiting Period In Health Insurance

  • Initial waiting period
  • In this time period, a person cannot claim the benefits from their health insurance policy in the case of sickness, except for accidents. Generally, the initial waiting period is for 30 days.

    If a person already suffers from a disease before availing the policy, he/she will not get any benefits for those disease for a specified amount of time. Generally, the waiting period for Pre-existing diseases vary from 2 to 4 years. The lesser the waiting period, the better the policy for the customers.

  • Disease-specific waiting period
  • In this scenario, the company does not cover expenses of hospitalization and medical expenses for a pre-specified illness or disease. This is also a type of short waiting period policy. The waiting period generally 2 years for problems like ENT problems, Cataract, tumor, hernia, osteoporosis etc. These are mentioned in the policy details.

  • Maternity benefits waiting period
  • Some health insurance companies give maternity cover in their policy with a waiting period ranging from 9 months to 36 months, so mothers can avail benefits under this time.

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    Q: Can An Employees Elections Be Changed During The Plan Year

    A: Changes are permitted if you experience a qualified life event such as:

    • Loss or gain of other employer or government sponsored insurance

    If the employee provides documentation to support the qualifying event within 30 days of the event, they would be able to enroll or disenroll in the coverages consistent with the event. The effective date of the change coincides with the date of the qualifying event. For example, if an employee waives the health plan because they are enrolled in their spouse or domestic partners plan and that coverage is lost, they would be able to join their companys plan effective as of the date of the loss.

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    # Irdais Notifications On Waiting Period

    The working group recommends that insurers may be allowed to incorporate waiting periods for any specific disease, condition to a maximum of 4 years. Further, waiting period for conditions namely, hypertension, diabetes, cardiac conditions may not be allowed for more than 30 days. With many people suffering from conditions such as hypertension, diabetes, this move will be of great help.

    Waiting Period For Covid

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    The Coronavirus infection has shaken the whole world with fear, with India’s cases rising every day even after all these months of its origin. Many people are buying COVID health insurance policies to ensure the disease will not cause any financial burden if they contract the virus. Still, there is a risk of losing the benefits by not knowing about the waiting period in health insurance for this disease.

    The waiting period in health insurance plans that cover COVID-19 disease is up to 30 days.

    Also Read: Types of COVID Insurance in India

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    Reasons To Buy Health Insurance In Goa

    Here are further reasons to buy health insurance in Goa.

    • You dont need to worry about arranging funds during a medical emergency.

    • You can be financially secured against medical costs like daycare treatments, ambulance charges and hospitalisation, to name a few.

    • According to Section 80D of the Income Tax Act of 1961, you can claim tax benefits against your medical insurance premium.

    • Financially secure yourself, your spouse and your kids under a single policy.

    • Be protected against medical costs up to a massive sum insured limit of Rs. 1 crore.

    Q: Anything Else I Should Know About Waiting Periods And Qualifying Events

    A: There are some insurance companies that allow employers to manage their own eligibility particularly for larger employers and/or self-insured employers. Also, there could be some restrictions in allowing qualifying events depending upon the provisions of a companys Section 125 plan premium pretax plan Finally, because life insurance and disability are not governed by the Affordable Care Act, there is more flexibility on waiting periods and they can extend beyond the 90 days.

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    Q Why Is There A 90 Day Waiting Period For Health Insurance

    Insurance companies often have a 30 to 90 day waiting period because many times individuals seek a claim with the purpose of creating a fraud or claiming against a pre-existing but non-life threatening disease/aliment. To counter such fraudulent issues/claims, insurers enlist a 30 to 90 day waiting period for health insurance.

    Q: Is There A Recommended Waiting Period Length

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    A: The Affordable Care Act limited the maximum length of the waiting period to 90 days for medical plans. Examples of waiting periods are:

    • 30 or 60 days from date of hire
    • First of the month following date of hire
    • First of the month following 30 or 60 days from date of hire.

    For ease of administration we recommend one of the first of the month versions of these options to avoid prorated billing for an employees initial enrollment especially when there is an employee payroll deduction.

    Generally, if your business has a high turnover of employees you would want to choose a longer waiting period. If your business is in a competitive environment for talent acquisition, you would want to choose a shorter waiting period.

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    Waiting Period In Health Insurance

    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. Different conditions and coverage have different waiting periods and have different rules for the same.

    The most important types of waiting period in an individual or family health insurance policy would be:

  • Initial waiting period of 30 days to 90 days – Most health insurance companies have an initial waiting period of 30 days to 90 days so that any disease contracted within that period of time will not be paid for, except accident cases. This restriction has been put so that people do not take the health insurance policy after being diagnosed a serious disease.
  • Pre-existing Condition Exclusion Waiting Period – A pre-existing condition exclusion period is a type of waiting period that involves those who have a condition during the six months prior to signing up for health insurance. This type of waiting period means that your insurance coverage can be limited or excluded for any pre-existing condition. The length of this type of waiting period can vary from 12 to 48 months. Thus pre-existing conditions will only be covered under the plan after the passage of the timeframe mentioned.
  • Waiting Period For Accidental Hospitalization

    Accidents can cause the most unexpected injuries and other medical concerns. Therefore, given the nature of accidents all health insurers including Digit do not account for any waiting period when it comes to accidental hospitalizations.

    This means, one can claim for accidental hospitalizations even just days into their new health insurance policy. The initial waiting period doesnt apply here either.

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    More Details About Waiting Period In Health Insurance

    • The duration of any health insurance waiting period is determined by the health insurance plan you select. Your health insurance company may also recommend a waiting period based on your age, overall health, and medical conditions.
    • A claim may be refused if the policyholder fails to disclose a pre-existing condition at the time of policy issuance.
    • Various insurance companies have eliminated the waiting period for senior citizens with the help of a co-pay clause. The provision of co-pay states that the policyholder will be responsible for a portion of the claim amount. Therefore, if the claim amount is Rs. 2 lakhs and the co-pay is 40%, the policyholder will be responsible for Rs. 80,000.
    • In case the insured contracts a disease during the waiting period for the first time, the insurance will cover the cost of the disease and the waiting period will not be applicable.

    Frequently Asked Questions

    It is suggested that you purchase a health insurance policy as soon as possible. This is because your health is at its best when you are young. This means you can simply finish the waiting time without having to file a claim. As a result, in later years of life, you will be allowed to file a claim even for conditions that have a waiting period, as this is when you may be in need of those benefits.

    Cooling Period Or Initial Waiting Period

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    This type of waiting period in health insurance refers to the period starting from the date of issue of your policy, for which you need to wait to start using the policy actively and avail of its benefits.

    As an insurance industry standard, most health insurance plans have an initial waiting period of up to one month. However, it is not applicable to accidental hospitalization cases in general .

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    Q Can You Change The Health Insurance Waiting Period

    No, every insurance policy provider has a standard waiting period of 30 days as the initial waiting period and generally 2+ years of waiting period for pre-existing diseases. You are required to serve the waiting period, even if you port the existing policy. This means that if your new policy has a waiting period of 4 years and you have already served 3 years under the previous policy, you will be required to serve the remaining one year.

    There are a few insurers who provide the option of reducing the waiting period at the cost of additional premium. Under group insurance plans, there is no waiting period offered to employees.

    Fewer Waiting Periods With Group Health Insurance

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    A standard individual health insurance policy comes with different waiting periods for various diseases. What this means is that after buying an individual medical insurance policy, you might have to wait for some time before submitting a claim. The amount of time you have to wait might differ based on the medical treatment as well as the insurance provider. One of the biggest advantages of having group health insurance is that many waiting periods can be waived off. This post looks at some standard waiting periods and how they change with standard or customized group medical insurance.

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    Waiting Period For Accidental Hospitalisation Expenses

    There is no Waiting Period in your Health Insurance plan for accidental hospitalisation. The coverage for treatment expenses for accidental injuries starts from day 1 of the Policy commencement.

    The initial Waiting Period of your Health cover is not applicable in case you meet with an accident.

    The insured can opt for the Buyback of Pre Existing Disease by paying an additional premium for the first year of the Policy. The Waiting Period will be reduced from 36 months to 12 months for the declared Pre-existing disease, subject to approval from the Underwriter.

    However, this reduction of the Waiting Period will not be applicable for specified 2 years Waiting Period diseases/ conditions.

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