Understanding ‘waiting ’ and ‘survival’ period in health insurance

As healthcare costs keep rising, more and more people are realising the importance of purchasing adequate health insurance cover for themselves and their families. But did you know the health insurance coverage doesn’t begin the instant you purchase a policy? Your policy document includes few clauses, which may lead to your claims being accepted only after a specific timeframe. That is why it’s critical to read the policy document in detail to understand the product and be a more informed policyholder.

Let’s look at the terms ‘waiting period’ and ‘survival period’.

Many policyholders are either not aware of their significance or find the concepts confusing. To avoid future hassles and ensure a seamless claim settlement, let’s try and understand these two features. Remember, a policyholder needs to be aware of these features to make the best use of your health insurance policy by choosing the right insurance as per your requirements.

What is a Waiting Period?

In simple terms, this is a period a policyholder has to wait before his/her health insurance coverage kicks in. It’s essential to remember that a policyholder can claim under the insurance policy only after elapsing applicable waiting periods. During the waiting period, he/she can’t claim insurance coverage even in a medical emergency unless the nature of the waiting period allows the claims. There are different types of waiting periods. Let’s look at each in detail to understand their differences which will help you choose the right health insurance policy suited to your needs:

Initial waiting period: This is a 30-90 (as per the type of policy chosen) days period after purchasing a health insurance policy. During this period, the customer will not be able to avail coverage in case of hospitalisation, whether planned or in an emergency. The insurance coverage starts from day one in the case of an accident.

This waiting period is applicable only during the policy purchase and shall not apply during the renewals.

Waiting period for specific diseases: For some diseases, the policyholder can claim insurance only after a certain period from the inception of the policy, which is usually two years after the commencement of the insurance policy. This period is much longer than the initial waiting period.

The diseases included are generally Cataract, Varicose veins, Piles, Hernia, Hydrocele, Polycystic ovarian disease, and a few more.

Pre-existing disease waiting period: When a policyholder with pre-existing ailment purchases a health insurance policy, there can be a waiting period for the pre-existing diseases, lasting anywhere from 1 to 4 years on the policy. During this time the customer cannot claim under the insurance for the pre-existing and its related conditions.

Waiting period for maternity: While most health insurance policies come with maternity cover, there is a waiting period of 9 months to 4 years before the coverage kicks in, depending upon the policy purchased.

It is important to note that the waiting period in health insurance is influenced by various factors like the type of health insurance (individual health insurance, group health insurance, etc.).Therefore, it is essential to read the policy wordings related to the waiting periods of a health insurance policy and pick the one with a lesser waiting period.

Also, there are possible scenarios that affect the state of a waiting period. Let us understand them in detail.

Reduce waiting period: The policyholder can reduce the waiting period by paying an extra premium. It may go up approximately 10-15% (depending on the policy and number of years of waiver).

The waiting period in case an individual ports a policy: In case an individual ports the health policy from one insurer to another, here they are allowed to enjoy the continuity benefit of the known waiting periods, such as pre-existing disease waiting period, as they can carry forward the time already associated with the previous insurer.

An increase in SI affects the waiting period: In case a policyholder decides to increase the sum insured at the time of renewal, it is important to note that the insurer is likely to apply a waiting period on the additional sum assured. Generally, health insurance policies have a waiting period of one to four years for pre-existing diseases.

What is a Survival Period?

When someone buys a critical illness policy, it comes with a survival period, which is the duration of time the policyholder has to survive after being diagnosed with the medical condition / underwent the covered procedure to claim coverage under the policy. The tenure generally ranges from 30-90 days, depending on the policy and the insurance company. Upon completion of the survival period, if the policyholder survives, the insurer pays them a lump sum amount, and the coverage gets terminated.

All health insurance plans come with waiting periods, but a survival period is generally a part of critical illness policies. While the waiting period will remain whether or not a policyholder has a particular disease, the survival period will be valid only in the case of a critical illness diagnosis / undergoing a covered procedure.

What to keep in mind before buying a policy: Always opt for a health insurance policy with the shortest waiting and survival periods, provided it offers adequate cover for your needs. Hence, it is advisable to purchase a health insurance policy as soon as possible and when you are young so that the waiting period is over before any health eventuality.

A clear understanding of these terms should help you properly go through your policy documents, understand every detail, and compare health insurance policies before choosing the one that suits your requirements. Understanding the waiting period and survival period in health insurance will help you plan your healthcare requirements and safeguard your well-being and finances.

(The writer is Chief Distribution Officer, ManipalCigna Health Insurance)