Delay in Buying Policy Can Cost You Dearer-Understanding Waiting Period.

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Delay in Buying Policy Can Cost You Dearer-Understanding Waiting Period

One would certainly like to buy a Mediclaim Policy after understanding the need of the same but still many take their own sweet time in taking the decision. Well this is the common mistake many make as the ailment you would require the policy for, can erupt any time without giving any notice. And it would be unfortunate that the disease for which you get hospitalised may come under waiting period. All the policies have a waiting period of 2-3 years for listed ailments as per terms of the policy. The waiting period means that any disease which falls in the listed ailments (refer chart below) that occurs between those periods will not be admissible for the claim resulting in rejection of the claim by the insurance company. All the mediclaim policies have 2 waiting periods-

30 days and 2 years, 30 days no disease would be covered except ailments like Dengue, Malaria or accidental claim and the list of the ailment which are not covered for 2 years ranges from cataract, hernia, Neuro disorders, Joint replacements, surgery for prostate and many more. The reason for keeping the waiting period is that the policy can’t be used for any pre-existing disease which might be unknown to the policy holder as Insurance Company wouldn’t like to bear the expenses of something one is already suffering from. Thus, it brings us to main point that why should one delay the decision of buying the policy. The delay in finalising the policy can deny your rightful claim as any admission for the disease within the listed diseases even a day before the 24 months can result in denial of the claim. Let’s understand the common reasons people delay the buying the policy;
  1. I need to buy best available policy at a reasonable price

  2. I need to discuss with my friends and relatives before finalising the policy.

  3. I am still in a job and covered under Corporate Policy.

  4. I am young can wait for some more time to finalise a policy.

These are some of the reasons why people delay their decision of buying a policy but it can prove them dearer should they get caught in such a situation when they find the claim being repudiated due to the ailment falling under waiting period. However, the condition is applicable only for new policies not for where the old policy is getting port to another company. The policies which have run over 3 years get port; the waiting period gets exempted as one has covered the same in the old policy.

Below is the listing of the diseases with the explanation extracted from wording of the Policy Waiting Period.

All Illnesses and treatments shall be covered subject to the waiting periods specified below.

  • Insurance Company liable for any claim arising due to treatment and admission within 30 days from Policy Commencement Date except claims arising due to an Accident.

  • A waiting period of 24 months from policy Commencement Date shall apply to the treatment, whether medical or surgical, of the disease/conditions mentioned below. Additionally the 24 months waiting period shall also be applicable to all the surgical procedures mentioned under surgeries in the following table, irrespective of the disease/condition for which the surgery is done, except claims payable due to the occurrence of cancer.

ENT

Illness

• Sinusitis • Rhinitis • Tonsillitis

Treatment

• Adenoidectomy • Mastoidectomy • Tonsillectomy • Tympanoplasty • Surgery for nasal septum deviation • Nasal concha resection

Gynaecological

Illness

• Cysts, polyps including breast lumps • Polycystic ovarian disease • Fibroids (fibromyoma)

Treatment

• Dilatation and curettage (D&C) • Myomectomy for fibroids

Orthopaedic

Illness

• Non Infective Arthritis • Gout and Rheumatism • Osteoarthritis And Osteoporosis

Treatment

• Surgery for prolapsed inter vertebral disk • Joint replacement surgeries

Gastrointestinal

Illness

• Calculus diseases of gall bladder including Cholecystitis • Pancreatitis •Fissure/fistula in anus, hemorrhoids, pilonidal sinus • Ulcer and erosion of stomach and duodenum • Gastro Esophageal Reflux Disorder (GERD) • All forms of cirrhosis (Please Note: All forms of cirrhosis due to alcohol will be excluded) • Perineal Abscesses • Perianal Abscesses

Treatment

• Cholecystectomy • Surgery of hernia

Urogenital

Illness

• Calculus diseases of Urogenital system Example: Kidney stone, Urinary bladder stone. •Benign Hyperplasia of prostate

Treatment

• Surgery on prostate • Surgery for Hydrocele/ Rectocele

Eye

Illness

• Cataract

Treatment

• Nil

Others

Illness

• Nil

Treatment

• Surgery of varicose  veins and varicose ulcers

General (Applicable To all organ systems/organs/disciplines whether or not described above)

Illness

• Internal tumors, cysts, nodules,polyps, skin tumors 

Treatment

• Nil