Waiting Period

A waiting period is a time window at the start of a health insurance policy during which certain claims are not payable, even if all other policy terms are met. Indian health policies typically have three distinct waiting periods, and each serves a different underwriting purpose. First, an initial waiting period of 30 days applies from the date of inception to almost all new policies — a claim for illness (not accident) within these 30 days is excluded, on the reasoning that the insurer needs a short cushion against people who buy the policy the day before a planned hospitalisation.

Second, a specific-disease waiting period of 24 to 48 months typically applies to a list of common surgeries and conditions such as cataract, hernia, piles, gallstones, joint replacement, and benign prostate conditions — the list is disclosed in the policy schedule. Third, a pre-existing disease (PED) waiting period of 24 to 48 months applies to any condition you disclosed at the time of buying, such as diabetes, hypertension, or asthma. IRDAI regulations limit the PED waiting period to a maximum of 36 months (reduced from the older 48-month cap), and many competitive policies offer 24 months or even 12 months with an extra premium loading.

Worked example: if you bought a policy in April 2023 and disclosed you had type 2 diabetes, a 36-month PED clause means any diabetes-related hospitalisation is excluded until April 2026; a random non-related hospitalisation such as a dengue admission is payable after the 30-day initial waiting period. A common misconception is that waiting periods reset if you switch insurers. They do reset if you surrender and rebuy, but if you 'port' (a regulated process introduced by IRDAI in 2011), the continuity credit on the waiting period is carried forward.

So if you served two years of a three-year PED wait on Insurer A and port to Insurer B in year three, you only have one year of PED wait remaining on Insurer B. Always port before lapsing. Related: pre-existing disease, portability, cooling-off period.