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What are the most common reasons for Health Claims Rejection: The Series: Part 5

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Waiting Period as a Reason for Health Claim Rejection

Health insurance is a vast subject with many technicalities often overlooked by the buyer when purchasing health insurance. We often buy insurance with the mentality that we are paying the premiums so we will get the claim money. But, it is a contract of trust. And remember, the insurance company is a company whose motive is to earn money so they will do a thorough inspection while processing the claim. A thorough scrutiny of the policyholder and its case ensures that the claim amount is given for a fair reason. 

This series of blogs lets you know the common reasons that can lead to the rejection of your health insurance claim. And today, we will learn about the importance of understanding the waiting period.

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What is a Waiting Period for Health Insurance?

When buying health insurance, the waiting period is an important term everyone must know. In health insurance, a waiting period refers to the duration that must pass before an individual can access the complete benefits of the coverage. Insurance Samadhan wants you to have the deep knowledge to reduce the chances of claim rejection. Health insurance waiting period

Types of Waiting Periods in Health Insurance 

Initial Waiting Period 

The waiting period starts with a 30-day period as soon as you buy the health plan, also known as the cooling period. The important thing to note here is that if you are involved in an accident, only then you will be able to make a claim; otherwise, there is no exception in the first 30 days of the waiting period. 

Maternity Benefit Cover Waiting Period

Second, comes the maternity benefits, for which the health claim will only be given after 9 – 12 months of the policy. Certain companies have a waiting period of 2 years for maternity claims, indicating that customers are eligible for such claims only after these 2 years. It’s important to mention that there is no waiting period if you are covered by group insurance through a corporate company.

Pre-Existing Diseases (PED) Waiting Period

According to the IRDAI, a pre-existing disease is defined as any condition, ailment, injury, or disease that has been diagnosed within the 48 months preceding the purchase of your health insurance policy.

Examples of pre-existing diseases include diabetes, hypertension, thyroid conditions, diabetes, asthma, and others. If you have a pre-existing disease, you must wait for the specified period before making any claims for hospitalization or treatment related to that particular disease. Typically, the waiting period for pre-existing diseases ranges from one to four years, depending on the insurance company and the type of health insurance plan you have selected.

The waiting period for these diseases aims to prevent individuals from buying health insurance to seek benefits specifically for pre-existing conditions.

Waiting Period Related to Specific Diseases

The title is self-explanatory: waiting periods for specific diseases mean waiting for a certain period before making claims for treatment and hospitalization related to those illnesses listed. Typically, the waiting period for these situations ranges from one to four years.

These are the common types of waiting periods found in health insurance plans in India. 

Insurance Samadhan

What More You Should Know?

Now that we have understood the meaning of the waiting period and the types of waiting periods, the next step is to see the view of the insurance regulatory body on the waiting period. 

The insurance regulatory body’s perspective on the waiting period is that it serves as an essential measure to maintain the integrity and sustainability of the insurance system. By implementing waiting periods for certain conditions, the regulatory body aims to prevent individuals from obtaining insurance solely to seek immediate benefits for pre-existing illnesses.

The thing is that many people are not aware of all this information and become a victim of health claim rejection. 

Tips

It is important to read all the terms and conditions of the health plan that you are buying. This will ensure that you clearly understand the coverage, benefits, limitations, and exclusions associated with the policy.

Insurance Samadhan constantly seeks the best interest of the policyholders so that nobody loses their hard-earned money. 

Stay tuned for more valuable information about the different health claim rejection reasons coming this week. Stay healthy and stay safe!

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Also Read:  How much sum assured you should invest in?

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Shikhar Vashisht

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