Understanding Waiting Period and Survival Period in Health Insurance

Policyholders cannot raise a claim against a certain condition if the waiting period is enforced on that condition

Understanding Waiting Period and Survival Period in Health Insurance
Biresh Giri - 28 December 2020

The two important health insurance concepts are - waiting period and survival period.

At first, they might seem confusing. However, once policyholders are aware of the basics, they are fairly easy to comprehend. Understanding these concepts will help policyholders to know the health insurance coverage in detail before buying a policy.

What is the waiting period in health insurance?

Policyholders cannot raise a claim against a certain condition if the waiting period is enforced on that condition. More specifically, it is the time in which the policyholder cannot claim in some situations even if they are covered in their policy.

For example:

Consider Mr A is 45 years old and has diabetes. He has been suffering from diabetes for the past five years. He bought health insurance at the age of 45. His policy has a waiting period of two years for any ailments that he was already suffering from while buying the policy. This means Mr A cannot raise a claim if he gets hospitalized due to high blood sugar. He has to bear the related expenses by himself.

The waiting period can range from a few months to a few years. The duration of the waiting period depends upon the type of medical condition and the terms and conditions of the insurance policy.

It is important to note that the policyholder is allowed to claim once the waiting period is over. Thus, in the above example, Mr A can claim if he gets hospitalized due to high blood sugar after two years of buying the policy.

Different types of waiting periods:

There can be multiple types of Waiting periods on your health insurance policy.

  1. First waiting period: This is applicable when you buy a new health insurance policy. The duration of this type of waiting period is short i.e. around 30 to 90 days.

  1. Disease-specific waiting period: You cannot raise a claim for the treatment of certain diseases for a limited duration. For example, high blood pressure, diabetes, hypertension. The duration of this type of waiting period is longer i.e. two to four years.

  1. Waiting period for pregnancy: These are expenses related to maternity and childbirth. This waiting period can be around nine to 12 months.

What is the survival period in health insurance?

Survival period is the duration for which a policyholder needs to survive after getting diagnosed with a major illness so that a claim can be raised. Bluntly speaking, the insured must live beyond the survival period to raise a claim against the policy.

For example:

Consider Mr B and Mr C both bought critical illness health insurance policies for themselves. Unfortunately, both got diagnosed with cancer. A survival period of 20 days was enforced on both policies. Mr B survived the survival period and could raise a claim. Sadly, Mr C passed away 15 days after the diagnosis, i.e. before the completion of the survival period. Thus, a claim could not be made against his health insurance plan.

Why is health insurance important?

Health insurance provides a strong financial back-up when an individual suffers from a medical emergency. Policyholders can thus focus on recovering rather than thinking about hospital bills. Neither you nor your loved ones need to worry during such situations if you have a good health insurance policy in place.

A medical issue can be of various types like accidental injuries, major illnesses like cancer, viral infections like COVID-19, small procedures like cataract. Most of these types of ailments can be dealt with financially if you proactively buy a consolidated health insurance policy.

As per new rules, a policyholder is allowed to buy multiple health insurance policies to avail maximum benefit when a medical condition hits. Thus, it is highly recommended that you create a solid health insurance portfolio, with not one but multiple types of policies.

The author is Appointed Actuary, ACKO

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