Buying a health insurance policy does not always mean you can claim hospitalisation expenses immediately. Most health insurance plans have an initial waiting period, generally lasting 30 days from the date the policy is issued. During this period, hospitalisation expenses arising from illnesses are usually not covered. However, accidental hospitalisation is generally covered from the first day, subject to the policy’s terms and conditions.
A longer waiting period may apply to pre-existing medical conditions such as diabetes, high blood pressure and asthma. Understanding these rules is important before choosing a health insurance plan, particularly for people who already have medical conditions and senior citizens.
What Is the Waiting Period for Pre-Existing Diseases?
The Insurance Regulatory and Development Authority of India (IRDAI) has specified that the waiting period for pre-existing diseases cannot exceed 36 months of continuous coverage under a health insurance policy.
According to Rohan Goel, Business Head of Health Insurance at Policybazaar, this provision applies to regular policyholders as well as senior citizens. However, the actual waiting period may differ between insurance products depending on factors such as the policyholder’s age, the insurer’s underwriting assessment and the policy conditions.
Goel also advised people aged 60 and above to pay particular attention to these clauses. Senior citizens may be more likely to have existing health conditions when purchasing insurance, making it important to understand when those conditions will become eligible for coverage.
Therefore, buyers should not compare health insurance policies based only on premiums and the sum insured. They should also examine waiting periods, exclusions and other coverage-related conditions.
What Qualifies as a Pre-Existing Disease?
A pre-existing disease generally refers to an illness, medical condition, injury or ailment that was diagnosed by a doctor during the 36 months before the start of the health insurance policy. It may also include a condition for which medical advice or treatment was recommended or received during this period.
Goel explained that a medical condition does not necessarily need to result in hospitalisation to be classified as pre-existing. Someone taking regular medicines or attending medical consultations for an existing condition may also fall under this category.
He further stressed the importance of providing complete and accurate medical information while purchasing a policy. Applicants should disclose their medical history, previous diagnoses and ongoing medications.
Failing to disclose relevant health information or providing incorrect details can create difficulties when submitting a claim and may affect the insurer’s decision.
Can Health Insurance Waiting Periods Be Reduced?
Some health insurance plans provide options to shorten the waiting period for pre-existing diseases. These benefits may be available through additional riders or optional covers, for which customers may have to pay an extra premium.
For example, a policy with a standard three-year waiting period may offer an option to reduce that duration through a pre-existing disease waiting-period reduction rider. The availability and extent of the reduction depend on the insurer’s terms and underwriting requirements.
According to Goel, certain policies may also offer day-one coverage options for specified conditions. However, such coverage is subject to the particular product’s eligibility criteria and conditions.
What Should You Check Before Buying Health Insurance?
Before selecting a health insurance policy, customers should carefully review the initial waiting period, the waiting period for pre-existing diseases and the exclusions mentioned in the policy document.
People with existing medical conditions should disclose their complete medical history and check whether their required treatments will be covered after the applicable waiting period.
It is equally important for senior citizens to compare different policy options rather than focusing only on the annual premium. Understanding the coverage conditions in advance can help avoid unexpected difficulties during the claim process.
Disclaimer: This article is intended for general informational purposes only and should not be considered insurance or medical advice. Waiting periods, coverage benefits, exclusions and optional riders vary between insurance providers and policies. Customers should read the policy wording carefully and confirm all applicable conditions with their insurer before purchasing a health insurance plan.