Important time frames in health insurance

In the wake of soaring medical inflation and the rise of lifestyle diseases, holding health insurance has become a necessity. A comprehensive health insurance plan provides protection in the time of need and ensures that one does not lose their hard-earned savings in paying the medical bills during medical exigency. Today health insurance contracts have simplified wording which enables customers to understand the policy better. However, at times one may find a few terms a bit confusing. Let us look at a few key terms used in a standard policy and gain a clearer understating of the policy document.

Free look period

Do you wonder what might happen if you do not find the coverage apt after buying the policy? Does it mean that you are stuck? Don’t worry, you can cancel the policy and get the due refund of your premium, with help of the free look period. Insurance Regulatory and Development Authority of India (IRDAI) mandated 15 days free look period which begins from the date you receive the policy document. You must read the policy coverage, terms and conditions in detail after receiving the policy copy so that you clearly know the extent of the coverage that you hold. In case, you realise that the policy does not meet your requirement, you have a free look period to rescue yourself.

Cooling off period

The cooling-off period is also popularly known as the initial waiting period - it is the time that you must serve before you can start availing the benefits of your health insurance policy. The cooling-off period is usually 30 days long, however, it may vary from insurer to insurer. During this time frame, any hospitalisation due to illness will not be covered. At times when a person files a claim, soon after taking the policy, the claim may be rejected simply because the person is still serving the cooling-off period. Although it is important to know that this limitation does not apply to hospitalisation due to an accident, which is covered from day 1 of the policy.

Waiting period

The waiting period in health insurance refers to the pre-defined time in the policy during which the claim cannot be raised for the mentioned ailment or condition. This period begins when the insurance cover commences and it varies from insurer to insurer and ailment to ailment. Typically, the policies have a waiting period for pre-existing diseases, maternity and for specific health conditions or ailments. The policy may require you to serve the respective waiting periods before you can avail the benefits for the particular health condition. Apart from the standard waiting periods as defined in the policy wordings, the insurance company may decide to underwrite a policy with the additional waiting periods based on the declarations made in the proposal form.

Pre-existing diseases (PED): This refers to any disease that you may have been diagnosed with up to 48 months before buying the insurance cover. For example conditions like thyroid, diabetes and hypertension are part of PED; the waiting period for PED typically ranges from one to four years.

Maternity Benefit: In health insurance policies, maternity cover usually has a waiting period of nine months to six years. This implies that you can file a claim for expenses pertaining to maternity after serving the pre-defined period as per the policy.

Disease-specific: As the name suggests, policies have a waiting period for a few ailments, which may range from two years to four years. The insurance policy will explicitly mention the list of diseases along with the corresponding waiting period.

It is prudent to read the terms and conditions of the policy in detail to be clear about the waiting period clause to avoid any surprises later.

Grace period

Does the thought of missing your health insurance renewal bother you? Did you ever find yourself wondering about what would happen if you forget to renew your policy in time? If these questions bother you, then you must know that most insurance companies offer a ‘grace period,’ of 30 days. This 30 days window offers you the opportunity to renew your policy, after it has lapsed, without missing all those benefits that you have accrued during the policy term such as waiting period, cumulative bonus, etc. Please note it is advisable to renew your policy in time, to avoid any kind of hassle. Yet, if mistakenly you have missed the renewal, the grace period, can help you retain the benefits accumulated during the tenure of the policy considering there has been no claim during the break-in period.

(The author heads the health administration team at Bajaj Allianz General Insurance)