Are There Health Insurance Plans with No Waiting Period?

MAS Team | 27 May 2022

Health insurance policies come with a waiting period of up to four years during which they don't cover some pre-existing diseases (PEDs). A PED is a medical condition which a person is already suffering before buying the policy. The exclusion of PEDs becomes a pain-point for many who would want a comprehensive coverage from day one. A waiting period is a standard part of almost every health insurance policy in India.

Every health insurance policy has waiting periods that may vary considerably. Given below are the different types of waiting periods in health insurance:

• Initial Waiting Period: Usually up to 30 days

• Pre-existing Diseases Waiting Period: Ranges from one to four years

• Specific Diseases Waiting Period: Ranges from one to four years

• Waiting Period for Maternity Expenses: Ranges from one to four years

Other than these waiting periods, certain insurers may have waiting periods for special health conditions, annual health check-ups, etc.

Why is there a waiting period?

A waiting period is helpful in avoiding any false claims by the policyholders. Initially, when health insurance was introduced to people, many policyholders purchased a plan after getting diagnosed with medical conditions.

Many bought policies once they discovered how expensive their surgeries were. To avoid such situations, many insurers started incorporating waiting period policies to avoid these unethical practices.

The duration of these periods depends on many factors such as pre-existing diseases, different health conditions, type of plan opted (individual, floater or group health insurance) and any add-on cover benefits that you may have purchased.

There is no waiting period in health insurance only under two circumstances:

If you need urgent hospitalisation or care due to an accident or injuries
If you have opted for a pre-existing disease add-on that covers you from day 1

For example, if a person meets with an accident and requires an urgent organ transplant, then it will be covered by their medical insurance plan. Whereas, if they require an organ transplant due to a pre-existing condition then they will need to wait for the stipulated time.

Similarly, if you have bought a plan which offers coverage for pre-existing diseases then there will be no waiting period in that case. This feature is provided by several insurers and must be bought at an additional cost.

For all other situations, you need to wait for the standard waiting period to expire before you can file any claims related to those situations. However, you can buy a plan with a minimum or no waiting period depending on what your insurer is offering.

For instance, Star Health Insurance offers a buyback rider to reduce the waiting period on regular health insurance plans. With PED buyback rider, you can also reduce your waiting period to 1-year from 3-4 years just by paying a nominal extra premium. However, it requires the policyholders/applicants to go through pre-medical screening.

The option to reduce waiting period existed earlier also in some health plans, but what has changed now is the affordability factor and relaxed underwriting norms. Roughly, these plans are 40% cheaper than their variants in the past.

The good news is now you can get coverage from day one. Some insurers such as Aditya Birla Health Insurance, Star Health and HDFC Ergo have some plans that come with day one coverage. Aditya Birla Activ Health platinum Enhanced - Diabetes, Aditya Birla Activ Health Essential - Diabetes, Star Health Diabetes Safe Plan A, Star Cardiac Care-Gold and HDFC Ergo Health Energy Gold are some such plans.

PED- Day 1 cover health insurance policies with key features

1) Aditya Birla Activ Health Insurance Plan

This comprehensive Aditya Birla health insurance plan provides cashless treatment and reimbursement of hospitalization expenses for accidents and illnesses (including mental illnesses) at more than 8200 network hospitals.

This health plan by Aditya Birla General Insurance offers a minimum sum insured of Rs 50,000 and a maximum of Rs 1 crore
The plan features include 100% restoration of the sum insured during the policy term.
The insured can also avail cashless home treatment for specific illnesses like dengue, chemotherapy, etc.
It also includes a cumulative bonus that doubles the coverage amount and provides a waiver of premium upon detection of a critical illness
The health insurance policy also provides health returns up to 100% of the premium by staying healthy, Ayush cover, post-hospitalisation physiotherapy cover, super reload of the sum insured, OPD cover, dental consultation, and medical investigations
This health insurance plan with PED cover from Day 1 provides optional benefits like critical illness cover, personal accident cover and international coverage for major illnesses.

2) HDFC Ergo Health Energy Gold Health Insurance Plan

HDFC Ergo health insurance has launched this wellness management program for people suffering from Type 2 Diabetes Mellitus, Hypertension, impaired Glucose Tolerance (IGT), and Impaired Fasting Glucose.
You can choose a minimum sum insured of Rs 2 lakh and a maximum of Rs 50 lakh.
The policy covers inpatient hospitalization expenses and also offers wellness programs with health rewards for monitoring your health. HbA1C checkup is also covered.
In this health plan, you can go for cashless treatment in nearly 10,000 hospitals across India

3) Star Health Diabetes Safe Health Insurance Plan

Star health insurance plan for diabetes cover includes both Type 1 and Type 2 diabetes patients. This diabetes health insurance plan offers the sum insured on a floater basis as well.

The sum insured amount under Star Health Diabetes Safe Health Insurance Plan is Rs 3 lakh, Rs 4 lakh, Rs 5 lakh, and Rs 10 lakh
PED Day-1 coverage with no waiting period is offered under Plan A. But the coverage is only approved after undergoing pre-medical tests. Also, Plan B provides coverage after a waiting period of 12-months.
The best part is that the insured can file a health insurance claim for out-patient treatments, and modern treatments. The procedures covered are kidney transplant surgery, dialysis, and cardiovascular diseases subjected to sub-limits
Since these health insurance plans are more affordable and loaded with features and the premium is only 20% dearer than regular medical insurance plans with a longer waiting period. It is a no-brainer that people with Pre-existing diseases should consider buying it.

Underwriting Norms Relaxed

For diabetic patients who are on insulin, it can be a difficult task to buy a health insurance policy. A lot of insurance companies shy away from underwriting customers with chronic illnesses/diseases. However, with the above-mentioned health plans, there is still a chance to get health insurance coverage.

As these health insurance plans with PED cover are designed in a way that they benefit patients suffering from asthma, high cholesterol, high blood pressure, and diabetes.

After explaining the underwriting process, the company assesses the customer’s current situation with a short questionnaire in the application form and a few basic medical tests as required.

The underwriting procedure helps the health insurance companies in India to engage with their customers on the journey with a health coach expert. This way they can understand the medical status of their customer and can provide the most suitable health cover based on the customer's consent.

You can opt for a plan that has less waiting period or lets you opt for an add-on to cover your pre-existing diseases. It is important to select a minimum waiting for health insurance plan so that you can claim benefits for your condition and related expenses. You won't be eligible for any claims until your waiting period expires.

While there are many insurers who offer a shorter waiting period, it is better to buy health insurance earlier in life so that by the time you may develop any health complications, your waiting period will be over. Buying health insurance when you’re young will let you easily pass all the waiting periods and let you avail all the insurance benefits whenever you need them in the future.

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