Waiting periods in health insurance policies: What the policyholder needs to know

  • The whole idea why waiting periods exist is that people should not abuse insurance.
  • When there is a pre-existing disease declared in the proposal form, it will have usually a 24- 36 month waiting period
  • A lot of health insurance policies provide options to the customer to reduce the waiting period for pre existing diseases by paying an extra premium

The purpose of health insurance is to cover us in case of any medical procedure or emergency. But the coverage does not start from day one of the policy being issued. There is a certain time, also known as the waiting period after which the policy coverage kicks in.

“A waiting period in health insurance policies refers to the duration that must pass after purchasing the policy before it covers specific diseases, specific surgeries, medical conditions, treatments or any add-ons. These typically range from 1-4 years and vary across insurers,” says Adarsh Agarwal, Chief Distribution Officer, Digit General Insurance.

Types of waiting period

Waiting periods are typically of three kinds.

The first is an initial 30 day waiting period. During this time, no claims or planned procedures are covered.

“Anything like an infection where there is a probability that one may have caught it before buying the policy, is not covered. However any hospitalisation due to accidental injury is covered,” says Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz, General Insurance.

The second type of waiting period is when there is a pre-existing disease (PED) declared in the proposal. Coverage for such diseases will have a 24- 36 month waiting period. Similarly, health insurance policies for maternity also have a waiting period ranging between 9-24 months or more, so as to discourage people from buying a health insurance policy to solely cover maternity costs.

The third type of waiting period is for some of the surgeries like hip replacement and knee replacement surgeries. “These types of surgeries can be postponed by a couple of years. So they have a waiting period as well,” says Nerukar.

“The whole idea why waiting periods exist is that people should not abuse insurance,” he adds.

How to reduce or do away waiting periods

“A lot of health insurance companies offer that flexibility to the customer where they can reduce the waiting periods for certain diseases like asthma, BP, cholesterol or diabetes. If you pay some extra premium, the waiting period can be reduced to day one also, which means after the initial waiting period,” says Siddharth Singhal, Business Head, Health Insurance, Policybazaar.com.

For other diseases, you can reduce the waiting period depending from plan to plan and from insurer to insurer. Apart from the diseases mentioned, the waiting period can be reduced to 90 days, in most cases.

In some policies, there is an inbuilt feature which lets you reduce your waiting period, while in others, it comes as a rider.

What to keep in mindIt is advisable to take health insurance as early as possible when one does not have any pre-existing disease.

“While one must look at opting for health insurance plans with reduced waiting periods, younger individuals, for example, who have no pre-existing diseases can opt for higher PED waiting periods in order to opt for a health plan that is affordable to them. This way one can finish all the prerequisite waiting periods when they are healthy and still keep their health insurance plan affordable,” says Agarwal.

Also, when taking a policy it is important that one makes a clear declaration of all pre-existing diseases. That may mean that there is a waiting period, but one can pay an extra premium and reduce the waiting period. However, not declaring an existing condon may mean that a claim may be rejected altogether.

Mumbai, The share of women investors in mutual funds has increased from 15 per cent in March 2017 to nearly 21 per cent in December 2023, according the latest data of Amfi (Association of Mutual Funds). The overall asset under management in mutual funds crossed the Rs 50 lakh crore-mark in February this year as a large number of passive investors are flocking to mutual funds to save and earn more.

The Amfi data showed the share of women investors in mutual funds increased from 15 per cent in March 2017 to nearly 21 per cent in December 2023.

This pace of growth was more prominent in the hinterland versus the urban centres during the period.

The share of women folios and assets in B-30 cities has increased from 15 per cent to 18 per cent and from 17 per cent to 28 per cent, respectively, the data showed.

The report, prepared by Crisil for Amfi and released by Sebi chairperson Madhabi Puri Buch, further said that almost 50 per cent of women investors fall in the 25-44 age group as against around 45 per cent for overall set of individual investors.

Goa boasts the highest share of women in the mutual fund industry at 40 per cent, followed by northeastern states with high 30s percentages. Chandigarh, Maharashtra, and New Delhi also have over 30 per cent share of women in assets under management.

Most female MF investors continue to invest through the regular plan route and stay invested for longer when investing through a mutual fund distributor.

The number of women MF distributors has also increased and was near the 42,000-mark as of December 2023 with their total AUM (assets under management) of over Rs 1 lakh crore.

Releasing the report, Buch said women can lead and champion the right investment causes by leveraging their perspectives, advocating for inclusive decision-making processes, and fostering environments where diverse voices are heard and valued.

Navneet Munot, Amfi chairman, said the increasing participation of women in MFs is a testament to their growing economic empowerment and greater financial literacy.

According to Venkat Chalasani, Amfi chief executive, increase in the number of women distributors shows their ability to make financial decisions for themselves and guide others reflecting a growing confidence and financial awareness among women.