What is the Waiting Period in Health Insurance?

Initial Waiting Period

In most circumstances, the initial waiting period for health insurance is 30 days from the date your policy is issued. During this time, you are unable to file any claims, with the exception of an emergency hospitalisation caused by an accident. This clause exists to prevent people from abusing health insurance by attempting to gain coverage after becoming ill. It serves as a safety net for insurers while also providing policyholders with a planning tool. If you or a dependent is scheduled for a procedure, you should include it in your coverage purchase.

Pre-existing Disease (PED) Waiting Period

Pre-existing diseases are health issues that existed before you bought your health insurance policy. Common conditions include asthma, diabetes, thyroid disorders, hypertension, and heart disease. In such cases, insurers typically require a wait of two to three years. During this period, costs associated with pre-existing diseases will not be covered.

Universal Sompo plans, such as CHI and APlus, typically have a pre-existing disease waiting period of 2 to 3 years, depending on your age and the type of policy. However, some insurers may reduce or eliminate waiting periods if you pay a higher premium. The important thing is to be honest: always share your complete medical history to avoid problems with future claims.

Maternity Waiting Period

If you are thinking about starting a family, this is an important factor to consider. Most health insurance plans have a 9-month to 3-year maternity insurance waiting period. This means that maternity-related expenses, such as delivery, newborn care, and prenatal check-ups, will not be covered unless you have held the insurance for the appropriate period.

Maternity coverage is available as an add-on to Universal Sompo's health insurance plans, with a waiting period of approximately 2-3 years. To cover your maternity expenses in a timely manner, it's best to start saving early. Some new-age health insurance companies offer zero or reduced maternity waiting periods as part of special policies, albeit at a higher cost.

Waiting Period for Specific Diseases

Aside from PEDs, insurers set different conditions and treatments that require a 1-2-year waiting period for specific diseases. Examples include cataracts, hernias, kidney stones, hip replacements, and tonsillectomy. All major insurers, including Universal Sompo, use this term to lower the chances of high-cost claims. If you or a family member is at risk for any of these conditions, check the policy brochure for the list of specific disorders. Selecting a plan with a shorter waiting period for these conditions can be crucial.

Choosing the Right Insurer

Not all health insurance companies are alike. Some have less waiting period health insurance or may even waive them under specific circumstances. When choosing a plan, look for ones that provide speedy coverage for maternity, pre-existing conditions, and specific diseases.

For example, Universal Sompo's APlus and Senior Citizen Health Insurance plans include minimum waiting periods and personalised options for different life phases. Search for insurers with:

• Reduced wait time for pre-existing conditions.
• Maternity coverage for 9–12 months.
• Immediate accident coverage.
• High claims settlement ratios.

Choosing the correct insurer can dramatically shorten your wait time for coverage.

Porting to a Better Plan

If your current policy has long waiting periods or is inflexible, consider switching to a more suitable plan. Health insurance portability allows you to change insurers without forfeiting any waiting period benefits you've already earned.

For example, if you move to a Universal Sompo plan after two years with another insurer, you may not face any extra waiting periods for issues you've previously identified. Just make sure that:

• You apply at least 45 days before your renewal.
• You confirm that the waiting period credits have been transferred.
• You choose a plan that offers the same or better coverage.

Porting enables you to expand your coverage without starting from scratch.

Buying Early in Life

Starting young is the best way to avoid the waiting period problem. When you are young, you are less likely to develop major illnesses, so the minimum waiting period in health insurance ends before you might need serious medical treatment. Premiums are lower, and coverage starts sooner. If you are buying coverage for your parents or plan to have children in the future, getting health insurance early makes it easier to cover pre-existing conditions and pregnancy later.

Claim Rejections Due to Waiting Period Clauses

One of the most serious consequences of not understanding waiting periods is having a claim denied. Insurers are very strict about timing. If a treatment happens during an unexpired waiting period, the claim is likely to be denied. Even if your paperwork is perfect, the claim will not be processed until you submit it after the deadline has passed. This is especially important for PEDs and specific treatments like cataract surgery or gallbladder removal.

Delays in Treatment and Hospitalisation Coverage

Waiting periods can restrict access to important therapies, particularly if you depend solely on your insurance. Imagine discovering a medical issue shortly after obtaining insurance, only to learn it won't be covered for another year or two. This illustrates the importance of managing your finances and saving more, particularly in the early stages of a policy. Consider top-up plans or other options that offer shorter waiting periods for elderly parents or individuals with chronic illnesses.

Impact on Pre-Existing Disease Claims

If you have a chronic condition and plan to file a claim, the pre-existing disease waiting period is set, unless the insurer waives it. Many people believe that renewing a policy automatically provides coverage; however, this is not always true, as it depends on whether the waiting period has been completed. Insurers like Universal Sompo maintain detailed health records and track PED claims over time. When renewing or switching policies, always read the PED clause carefully.

Financial Burden During Non-Coverage Period

Throughout the waiting period, you must pay all medical bills out of pocket. This can be a financial strain if you thought you were fully insured. If you need to be hospitalised or undergo surgery during this time, you may incur lakhs of rupees in expenses. This burden can be especially tough for those with dependent family members or for the elderly. It is wise to plan ahead by setting up a health emergency fund or getting insurance with no or short waiting periods.

Buy Health Insurance Early in Life

Starting young is the best way to avoid the hassle of the waiting period. You are less likely to develop major illnesses when you are young, so the waiting period expires before you need serious medical care. Premiums are lower, and coverage begins sooner. If you want to buy health insurance for your parents or plan to have children in the future, getting it early makes it easier to cover pre-existing conditions and pregnancy later on.

Opt for Plans with Low or Zero Waiting Periods

Many modern insurers now offer zero waiting period health insurance or policies with exceptionally short wait times, especially for maternity care and certain medical conditions. These are ideal for those who require immediate protection.

Universal Sompo also offers plans, such as APlus, which have different waiting periods depending on the plan tier. Keep an eye out for plans labelled "health insurance with no waiting period" or "minimum waiting period in health insurance"- but always read the fine print.

Use Portability Benefits to Skip Waiting Periods

Health insurance portability lets you change insurers without losing the credit you earned during the waiting period. For instance, if you complete two years with Insurer A and switch to Insurer B, those two years will count towards your PED waiting time. However, this only applies if you maintain continuous coverage. Universal Sompo supports health insurance portability and the transfer of waiting period benefits in line with IRDAI criteria.

Leverage Top-up Plans for Interim Coverage

Top-up and super-top-up plans are effective ways to enhance your coverage while minimising high premiums. Some services offer short or no wait times for accidents or catastrophic diseases. They act as a cushion when your basic plan has a waiting time or a low sum insured. Check to see if your insurer allows you to stack such plans - Universal Sompo offers flexible add-ons and top-ups with select base policies.

Keep Medical History Transparent During Purchase

Hiding or leaving out health information when applying for coverage is a bad idea. If you later file a claim for a pre-existing condition, the insurer may deny it and cancel your insurance. Being honest ensures that the waiting period for pre-existing conditions is calculated correctly from the start. It also helps insurers suggest better policies, like Universal Sompo's Senior Citizen plan, which considers age-related diseases and has shorter wait times.