No matter how well you take precautions, serious illnesses can happen at any time. The savings that you have built up over time may be severely strained by the cost of treating the sickness. Let’s say the cost of medications for a cancer patient can add up to ₹18 and ₹20 lakhs per year. Note that this amount is without the hospitalisation charges, doctor consultations, chemotherapy, etc. Eventually, your total out-of-pocket expenses may come close to ₹25 lakh. Not to mention, there is a rising cost of inflation each year.
To fight this, most individuals have already taken the required safety measures to ensure their health and wellness. By investing in a health insurance policy, you can cover the expenses incurred in treatments and save out-of-pocket expenses. However, health insurance comes with several clauses knowing which is imperative. One such concept is PED Waiting Period. Keep reading this article to understand waiting period related to health insurance for pre-existing conditions and the difference between PED waiver and PED modification. However, before discussing PED waiver and PED modification, let’s understand:
The What of a Waiting Period
The term ‘waiting period’ refers to the amount of time you must wait before you start receiving the insurance benefits under most health insurance policies. Under this, you cannot make any claims for health insurance benefits during the period which starts on the date the policy is initiated.
Here’s an example of why understanding the nitty-gritty of health insurance is crucial. Rohan Nair, a 28-year-old banker, purchased a policy. Fifteen days later, he gets terrible pain in his stomach and is operated on for kidney stones. Because he has not yet served the 30-day waiting period he would not be able to make a claim. He will have to cover the cost of treatment out of his pockets. This was quite a shocker for Rohan.
Just like Rohan, many policy seekers get health insurance without being familiar with the basic terminology. You need to bear in mind that purchasing health insurance does not guarantee that you will have access to coverage from the first date on.
Instead, before filing any claims, you must complete the health insurance waiting period. When learning about the waiting period in health insurance, make sure you have also read the inclusions and exclusions of the policy.
Also, keep a note that the length of the waiting time in health insurance policies differs between different insurance providers.
The Why of a Waiting Period
Unscrupulous activities to obtain the benefits of health insurance without a waiting period have led to the requirement of introducing a waiting period in insurance. Many people buy insurance policies just to get instant coverage.
For example, consider a person who was diagnosed with a serious illness. He didn’t have any health insurance in place. As a result, he was unable to pay for the costly surgery that the doctor had recommended with his usual income and savings. A few days later, he purchased a health insurance plan without disclosing the real reason behind it. He kept his illness a secret. To stop these fraudulent activities, a waiting period was introduced in the context of health insurance.
What is the PED Waiting Period in Health Insurance?
Certain conditions, like thyroid, diabetes, and hypertension, are life-long. Hence, when you purchase health insurance after you’ve had any one of these conditions, you will be considered as having a pre-existing disease, aka PED. According to IRDAI, a pre-existing condition is one that was discovered 36 months before the purchase of the health insurance policy.
Recently, the Insurance Regulatory and Development Authority has brought good news for all policyholders. From 48 months, the PED waiting period has been reduced to 36 months. We will discuss this recent update a little later.
When purchasing a health plan, you will be questioned about any pre-existing conditions, and if so, you must undergo certain medical tests to verify it. This process will determine the total waiting period you will have in your policy.
As per the policy documents, the waiting period of health insurance for pre-existing conditions suggests that you cannot get benefits from your insurance if you have a pre-existing condition until the allotted waiting period has passed.
Ways to Deal with a PED Waiting Period
Before learning more about the PED waiting period, it is important to consider its exclusions and limitations. Pre-existing conditions restrict or limit a health insurance claim. This is known as an exclusion.
On the other hand, a pre-existing condition waiver is a type of benefit coverage for PEDs that eliminates or waives the exclusions and pays for hospitalisation costs. Here’s a detailed view!
PED Waiting Period Waiver
In simple terms, a PED waiting period waiver means waiving the waiting period. This indicates that you get health insurance without waiting period. However, with Care Supreme you can shorten the PED waiting period. For a continuous active plan, the waiting time for pre-existing conditions is typically 36 months. However, you can purchase Instant Cover Rider if you would like to shorten this countdown to 30 days.
There is a 30-day waiting period before bringing out any claims. This implies that you can file for a claim starting on the 31st day after purchasing the insurance.
With instant cover, you can file a claim as soon as the first waiting period ends. This is known as a PED waiver. In a nutshell, an Instant Cover can be a fantastic option if you are looking for PED coverage without a waiting period.
PED Waiting Period Modification
The PED modification add-on cover allows you to change (modify) the terms and conditions of pre-existing disorders. For example if you choose the PED modification add-on under the Care Supreme health plan, the pre-existing disease waiting period is shortened.
Note that the PED modification simply reduces the PED waiting time; it does not waive the PED waiting period. As per the IRDAI, the standard waiting period for a PED is 4 years. With the modification add-on, you can reduce this to 1/2 or 3 years.
Therefore, if you want to reduce the lengthy 4-year waiting period and are not seeking instant PED coverage, you can purchase a PED modification add-on.
Latest Announcement by IRDAI
The usual waiting period for PEDs was 4 years. However, from April 1, 2024, the IRDAI has revised the definitions of the moratorium period (MP) and pre-existing conditions in health insurance plans.
The moratorium period has been decreased from 96 months to 60 months, and the waiting period for PEDs has been reduced from 4 years to 3 years. Once the PED waiting 3 years has served, health insurance companies can no longer refuse to provide coverage for a pre-existing disease.
This benefit applies to both first-time policyholders and existing policyholders.
The IRDAI has made the necessary adjustments to guarantee attentive management practices, efficient supervision, and sufficient due diligence on insurance products.
In Conclusion
Summing up, some people find the basic coverage insufficient and may need extra coverage based on their medical requirements. A single hospital stay has the potential to deplete your funds completely. All of this makes it essential to invest in a comprehensive health insurance policy.
To get complete medical coverage, you can invest in the desired add-on coverage to shorten the PED waiting period and access quick treatment in emergencies. Additionally, with Care Supreme, you can even customise your policy to meet your medical needs with the riders offered by Care Health Insurance at a much lower premium.
>> Also Read: What's Instant Cover & PED Modification?
Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.
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