Every MEDICLAIM policy has a number of waiting periods. You need to be aware of them. Otherwise there is disappointment at the time of claim.
The general waiting period is that for every fresh policy there is usually a waiting period of 30 days. In the first 30 days only claims arising out of injury is allowed.
If you get a new policy and have a severe bout of Dengue fever or Malaria within the first 30 dyas waiting period, then your hospitalization claim will be rejected.
However, if within a week of buying a new policy you have a fall and fracture your leg in a messy fashion so that you need to be hospitalized, then the cost of hospitalization will be paid. Please check your policy for the exact waiting period.
A number of surgical operations have a waiting period. Here is an illustrative list of waiting periods commonly offered in MEDICLAIM policies. However exact duration will vary depending on your policy.
Here is a sample from one MEDICLAIM policy
Waiting period of 2 years
1. All internal and external benign tumors, cysts, polyps of any kind, including benign
breast lumps
2. Benign ear, nose, throat disorders
3. Benign prostate hypertrophy
4. Cataract and age related eye ailments
5. Gastric/ Duodenal Ulcer
6. Gout and Rheumatism
7. Hernia of all types
8. Hydrocele
9. Infective Arthritis
10. Piles, Fissures and Fistula in anus
11. Pilonidal sinus, Sinusitis and related disorders
12. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from Accident
13. Skin Disorders
14. Stone in Gall Bladder and Bile duct, excluding malignancy
15. Stones in Urinary system
16. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus
17. Varicose Veins and Varicose Ulcers
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Renal Failure
( However, if any of these above existed at the time of buying fresh policy then the waiting period will be 4 years )
Waiting Period of 4 years
1. Joint Replacement due to Degenerative Condition
2. Age-related Osteoarthritis & Osteoporosis
When is the waiting period waived ? If you have ported your policy to a new one, then your waiting period will be waived. However, there have been many disputes on this count.
So while porting your policy make sure that the waiting periods a re waived. Some insurers in a bid to attact new business will waive the waiting period depending on your previous policy.
Here is an example. You have a policy with company a running for 6 years without any claim with a sum insured of 2 lacs. Rather than enhancing the sum insured in your own policy, you would like to buy a new health insurance policy from Company B for 2 lacs . In that case the Company B might add an endorsement in your policy document that they are waiving the waiting periods in your new policy.