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Waiting Period Clause in Health Insurance

19 May 2022, 3:22 PM

A health insurance plan is purchased by numerous people in India to secure themselves financially in times of medical emergency. However, a health insurance plan comes with numerous exclusions and one of them is Waiting Period. Many people do not know how the waiting period exclusion works. Read on to know everything about the waiting period clause in a health insurance policy.

What is the Waiting Period?

The waiting period under a health insurance plan is defined as a time span wherein no insurance claim is registered and processed by the insurance provider. A waiting period clause states and defines the amount of time a person must wait before making a health insurance claim. The duration of the waiting period varies from one insurance provider to another. In most often cases, the policyholder of a health insurance plan does not receive any reimbursement of claim or health insurance cover until the waiting period is over.

What is the Need for the Waiting Period in a Health Insurance Policy?

Health insurance providers have introduced the clause of the waiting period to keep a tab on insurance customers who avail health insurance plan for availing claims and reimbursements. Introducing the waiting period is a way where health insurance companies can reduce hoax claims and put a check on the moral intentions of the customers. For example – a person having no health insurance policy has been diagnosed with a health condition where he needs to undergo expensive surgery to get  better. 

Knowing that not having a health insurance policy will cost him a huge amount of money thereby creating a hole in his savings. Understanding the financial loss, the person purchases a health insurance plan without disclosing the health hazards and chooses to undergo surgery just after purchasing the health insurance plan. Imagine if there would not have been a clause of the waiting period under a health insurance plan many people would have been undertaking such immoral practices. Therefore, to curb such unethical practices health insurance companies have introduced the waiting period clause under the health insurance plan.

What are the Types of Waiting Period?

The waiting period under a health insurance plan depends on the insurance provider and the type of health insurance plan availed by the policyholder. The following are various types of the waiting period.

  1. Group Health Plan
    A group health insurance policy is provided by the employer to offer health insurance coverage to the employees. Under this case, the waiting period is applicable to a new recruit before he/she can register a claim under the group insurance plan.
  2. Initial Waiting Period
    This waiting period is applicable to individual health insurance policy availed by an individual person. An individual has to wait until the completion of a specific time to receive claim benefit under the health insurance plan. 
  3. Waiting Period for Pre-existing Disease
    Pre-existing disease is a medical condition that the policyholder is suffering at the time of purchasing a health insurance plan. When a person declares his/her existing medical condition at the time of policy purchase then a pre-existing disease waiting period is applicable which usually ranges between 2 years to 4 years depending upon the type of pre-existing disease and it varies from insurance provider to provider.
  4. Maternity Benefit Waiting Period
    Nowadays many leading health insurance providers offer maternity coverage  benefit however these benefits come with a waiting period clause. Usually, the maternity benefit waiting period varies from 6 months to 36 months.
  5. Disease-specific Waiting Period
    Every health insurance provider has provided a list of the disease-specific waiting periods for numerous diseases like a tumour, osteoporosis, ENT disorder, hernia, cardiovascular diseases, stroke, hypertension, kidney disease etc. So, if any prospective policyholder has any medical history of any of the listed diseases, it is wise to check the waiting period for these specific diseases.

Can Waiting Period in a Health Insurance Plan be Reduced?

To every health insurance insured, it’s a surprise to know that YES you can reduce the waiting period of a health insurance plan.

  • Many leading health insurance companies reduce the waiting period of a health insurance policy by charging an additional premium amount.
  • IRDA has announced if an individual who was a member of group health insurance plan upon deciding to leave existing employer chooses to convert his/her existing group health insurance cover to individual health insurance plan. Then in such cases, the individual will get the advantage of not undergoing a waiting period as he/she has already completed the same under the group insurance cover.


The waiting period under a health insurance plan is also referred to as the cooling period. It is important to understand the terms and conditions related to the waiting period before purchasing the health insurance cover.

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