One of the most important features of a Group Health Insurance Policy is Waiting Periods.
Ignoring Waiting Periods can be the difference between your Group Health Insurance Claim getting rejected or accepted. This article explains in detail and clears the misconceptions about Waiting Period in Group Health Insurance Policy.
What is Waiting Period in Group Health Insurance Policy?
Waiting Period in Group Mediclaim Insurance Policy is the time period that the Insured Person needs to wait before the GMC Policy pays claim for that specific purpose.
For example: If a Health Insurance Policy has a Waiting Period of 4 years for Pre-Existing Diseases, this means that the Health Insurance Policy will not pay for any claims arising out of Pre-Existing Diseases for the first 4 years.
How many types of Waiting Periods does a Group Mediclaim Insurance Policy have?
A Group Health Insurance Policy has 4 types of Waiting Periods:
- Waiting Period for First 30 days
- Waiting Period for Pre-Existing Diseases
- Waiting Period for Specific Diseases
- Waiting Period for Maternity Coverage
What is the First 30 days Waiting Period in a Group Health Insurance Policy?
Another form of Waiting Period in a Group Health Insurance Policy is the first 30 Days waiting period.
The First 30 Days Waiting Period in a Group Health Insurance Policy refers to the Expenses related to the treatment of any illness within 30 days from the first policy commencement date.
Usually, an Individual or a Family Floater Health Insurance Policy does not pay for any expenses arising out of any form of illness within the First 30 days of commencement of the Policy. The only exception is accident claims where the hospitalisation expenses incurred by the Insured on account of an injury due to an accident are covered by the Health Insurance Policy.
An advantage of the Group Health Insurance Policy is that the First 30 days waiting period can also be waived off, that is there is zero waiting period for the First 30 Days in a Group Health Insurance Policy so that all claims, even those arising in the first 30 days of Policy Commencement are covered.
What is the Pre-Existing Diseases Waiting Period in a Group Health Insurance Policy?
Pre-Existing Disease Waiting Period refers to the waiting period for pre-existing disease before the GMC Policy pays out any claims for Pre-Existing Diseases.
A Pre-Existing Disease refers to the existing diseases that the insured has prior to applying for the insurance. Some examples of pre-existing diseases are diabetes, thyroid, hypertension etc.
Pre-Existing Disease in a Group Health Insurance Policy is typically defined as any condition, ailment or injury or disease:
- diagnosed by physician within 48 months prior to the effective date of the policy issued by insurer or its reinstatement or
- For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
Individual and Family Floater Health Insurance Policies usually have a Waiting Period of 48 months for Pre-Existing Conditions.
However, a benefit of Group Health Insurance Policies is that there is no waiting period for Pre-Existing Conditions. The Waiting Period for Pre-Existing Conditions can be waived off by paying a nominal amount as additional premium. As a result, Group Health Insurance Policies can be customised to have zero waiting periods.
What is the Waiting Period for Specific Diseases in a Group Health Insurance Policy?
Another type of Waiting Period in a Group Health Insurance Policy is the Waiting Period for Specified Diseases.
All Group Health Insurance Policies have a list of specified diseases for which the claims are not paid during the Specified Diseases Waiting Period.
These Specified Diseases in a Group Health Insurance Policy are listed below:
- Benign Prostatic Hypertrophy
- Hysterectomy for Menorrhagisa or Fibromyoma
- Congenital Internal Diseases
- Fistula in anus
- Sinusitis and related disorders
Typically, the specified diseases waiting period in most health insurance policies is 24 months. However, the Specified Waiting Period in Group Health Insurance Policy can also be waived off. This is a big benefit of a Group Health Insurance Plan.
What is the Maternity Coverage Waiting Period in a GMC Policy?
Most health insurance policies have a Waiting Period of 3-4 years before providing maternity coverage under the policy. However, there is a provision in GMC Policies to provide No Waiting Period for Maternity Coverage in a Group Health Insurance Policy by paying additional premium. This is especially beneficial to female employees who can avail for Maternity Health Insurance Coverage.
Can we reduce Waiting Periods in Group Mediclaim Insurance Policies?
The biggest advantage of Group Mediclaim Policies is the provision for waiver of waiting periods. Yes, it is possible to waive off all the four waiting periods in a Group Mediclaim Policy by paying additional premiums.
Compare Group Health Insurance Plans with Qian!
This article covered the concept of Waiting Period in Group Health Insurance Policy in detail. The employers need to check all the features of Group Health Insurance Policy in detail before finalising a Group Mediclaim Policy.
Qian is an experienced Group Health Insurance Broker in India. We provide GMC Policies with Zero Waiting Periods to our clients. Moreover, there are good tax benefits in a Group Health Insurance Policy, which is another advantage of a GMC Policy.
Visit here for more details on group health insurance policies.
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