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Category: Health Insurance

Exclusions and Waiting Period in Health Insurance

Posted: April 13, 2020

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy.

It is imperative for any insurance buyer to know the details of coverage extended by various insurers before buying.

Two of the most important terms of health insurance are Exclusions and Waiting periods.

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy. Those are called exclusions and the period of exclusion of coverage is called waiting period.

  1. Pre-existing diseases (PED): Certain or all pre-existing diseases or conditions are excluded from coverage from inception. Some insurers allow coverage of non-critical diseases after a waiting period of 4 years, if they feel the PED may not recur.
  2. 30 days standard exclusion: Any disease or ailment contracted during the first 30 days from the start of policy is not covered. However, the insurer may take a special condition to cover under the following circumstances. If the insurer is convinced that if the policy holder could not have known about the existence of the disease while making the proposal for insurance with the company. If the policy holder is covered under health insurance with any other Indian Insurance company at least for a period of 12 months before making the proposal for this health insurance.
  3. Standard waiting periods: During the first one or two years of the policy, certain named diseases/ailments will not be covered. The diseases and the waiting periods will vary from plan to plan offered by various insurers. Some of the common exclusions under this terms are:
    • Cataract
    • Pregnancy and related
    • Hernia
    • Piles
    • Hysterectomy
    • Congenital Internal Anomaly (Congenital External Anomaly is excluded permanently under any plan)
    • Sinusitis and related disorders

Likewise, there are many diseases and conditions not covered for a specific period from the date of inception of the policy.

It is always prudent for any customer who wishes to buy a health insurance policy to go through the excluded diseases with waiting periods, compare the plans and be aware of the coverage they buy.