Health Insurance
Health Insurance
What is Waiting Period in Health Insurance?
If you’re buying a health insurance policy for the first time, have you noticed something called a waiting period? What does it mean?
In short, the waiting period in health insurance refers to the duration before which certain diseases will not be covered by health insurance. The insured may not receive benefits for claims filed during the waiting period. If that brings you up with a start, keep your worry at bay and read on for everything you need to know about waiting periods in your health insurance, including the significance of waiting periods and the various types of waiting periods.
What is the Waiting Period? How long does it take?
The waiting period in health insurance is a specified period of time before which the insured is not eligible to avail coverage benefits for some listed ailments even during the policy term of a particular health insurance policy.
For instance, a 4-year waiting period for pre-existing illnesses is a standard clause in most health insurance plans. In other words, any insured person will not be able to avail of coverage benefits for pre-existing diseases before the 4-year waiting period has passed.
Also known as the cooling period, the waiting period is calculated from the date of commencement of the policy. The terms and conditions of a waiting period is dependent on the health insurance policy you buy.
Why does health insurance have a waiting period?
Waiting periods in health insurance policies help reduce the insurer’s risk. A health insurance works with gradual premium collection and risk sharing. Therefore, health insurers can only start paying out claims once those insured, pay out their respective health insurance premium.
Moreover, it prevents people from misusing their health insurance policy—for example by buying a policy just days before they make a claim and expect their insurer to pay for all their medical expenses from the next day.
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Types of waiting period in health insurance
There are various kinds of waiting periods present in every health insurance policy. Let’s take a look at what they imply and what the industry average is.
1.Initial Waiting Period
In order to make any claim after the policyholder has been issued a health insurance policy, he/she is required to wait for a specific number of days to be able to receive any claim benefit under the policy. This period is known as the initial waiting period or cooling period in health insurance.
Almost all health insurance plans have an initial waiting period of at least one month and a maximum of 90 days during which no claims are accepted, except for accidental cases wherein the claims are approved only when the insured is involved in an accident and requires immediate hospitalization. Note that the initial waiting period varies from insurer to insurer.
2. Pre-Existing Diseases (PED) Waiting Period
According to the Life Insurance Association of Singapore, pre-existing conditions can vary from policy to policy, but they include any illness or disability that you have—or have had—at the time when you sign up for the health insurance policy. Examples of some pre-existing diseases are thyroid, hypertension, and diabetes.
Generally, the waiting period for pre-existing disease in health insurance plans is 1-4 years. If you do have a pre-existing disease, you will have to wait for the prescribed waiting period before you can claim for any hospitalization or treatment that is related to the disease. Note that the pre-existing disease waiting period varies with the health condition of the insured as well as the health insurance plan they choose.
3.Waiting Period for Specific Diseases
Certain diseases like hernia, tumor, ENT disorder, cancer, stroke, and cardiac ailments, etc., come with a specific waiting period. The waiting period for these diseases usually ranges from 1 to 4 years. Any medical expenses resulting from such diseases are covered only after the waiting period is over. The diseases that qualify for this waiting period vary from insurer to insurer and can be found in the policy details provided by each insurer.
4. Maternity Waiting Period
As part of most health insurance policies for individuals and families, there is an option to include maternity benefits and newborn baby cover. Typically, the waiting period with most health insurance policies ranges from 1 to four years. You may only claim for maternity-related expenses once you’ve completed the waiting period. Therefore, if you’re planning on starting a family sometime soon and the waiting period for your maternity cover is 2 years, then take into consideration the 9-months of the pregnancy term, plus the rest 15-months to complete your two-years waiting period.
5. Waiting Period for Bariatric Surgery
A bariatric surgery is included in some health insurance policies today. It refers to a surgery on the stomach and/or the intestines to help someone with extreme obesity-related issues. It is usually only recommended for those with a BMI above 40 who are dealing with weight-related health problem.
6. Waiting Period for Coronavirus
Amid the COVID-19 pandemic, health insurers have seen higher demand for coronavirus-specific health insurance plans. But to avail of coverage benefits like hospitalization and treatment under these plans, the insured needs to complete a waiting period of up to 30 days.
7. 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 do not account for any waiting period when it comes to accidental hospitalizations. In other words, one can claim for accidental hospitalizations even just days into their new health insurance policy. The initial waiting period doesn’t apply here either.
8. Psychiatric Illness
These days we all know the importance of mental health. Therefore, most health insurance policies include a mental health cover. This covers expenses incurred for hospitalization or in-patient treatment due to any mental illness. Some health insurance plans may have a separate waiting period for mental illnesses as compared to the waiting period for other physical ailments.
Is it possible to reduce waiting period?
Yes, it is possible to reduce your waiting period if your insurer gives you the option to do so. For example, some health insurance companies give their customers the option to opt for a 2, 3 or 4-year waiting period and charge them a higher premium accordingly.
Things to note about waiting period
Take a look at the following important points related to the health insurance waiting period:
- If during the waiting period, the insured is diagnosed with a disease for the first time, it will not be considered a pre-existing disease. In such a case, the policy will cover such ailment.
- Some health insurance plans for senior citizens are available today where waiting periods have been dispensed with by adding a co-pay clause. A co-pay or co-payment clause implies that the policyholders will have to bear a certain percentage of claim amounts while the remaining will be paid by the insurer.
Insure early to stay secured
It is a good idea to buy a health policy when you are still young and healthy. First of all, the premium for younger people is a lot less. Secondly, by the time you actually need to seek benefits under your policy, it is likely that the waiting periods will all be over. For example, if you plan to have kids one day, you can buy a health insurance policy early with a maternity cover so that you complete your waiting period by the time you decide to have a family.
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The above information was provided by Bowtie Team. It is for reference only. In no event shall Bowtie be liable to you or to any other party for any loss or damage whatsoever or howsoever caused directly or indirectly in connection with your access to or use of the content thereon.
