Waiting periods in health insurance, pre-existing and specific diseases, IRDAI 2024 limits

What a waiting period means

A waiting period is time after your policy starts when some conditions are not covered. If you are treated for one of them inside that time, the claim can be refused. Once the period ends, and as long as you renew without a break, those conditions are covered.

IRDAI's Customer Information Sheet format has three kinds. Your own sheet lists each one under row 7, "Waiting period", in the format IRDAI set in its Master Circular of 29 May 2024.

Kind	What it covers	Current IRDAI limit
Initial waiting period	All illnesses in the first days of the first policy	Days set by the policy; not for accidents or continuous renewals
Pre-existing disease (PED)	Conditions you had before buying	Up to 36 months
Specific waiting period	Listed diseases or treatments	Up to 36 months; not for accidents

The initial waiting period

This is a short wait at the start of your first policy. The 2024 Customer Information Sheet shows it as a number of days "for all illnesses", and says it does not apply to accidents or to continuous renewals. The 2024 rules do not fix the number of days. The standard exclusion IRDAI set in 2020, code Excl03, used 30 days. Check your own policy for the figure.

Pre-existing disease waiting period

Under the 2024 product regulations, a pre-existing disease is a condition, ailment, injury or disease that a doctor diagnosed, or gave advice or treatment for, within 36 months before the policy started.

For diseases you disclose when buying, the waiting period can be at most 36 months of continuous coverage. Insurers may offer a shorter wait. Disclose every condition on the proposal form, because non-disclosure can put a claim at risk until the moratorium ends.

Specific waiting period

Some policies name diseases or treatments that are covered only after a set time. The 2024 regulations define this as a period of up to 36 months from the start of the policy. It does not apply when the treatment is needed because of an accident. After the period, the listed conditions are covered if the policy was renewed without a break.

What changed in 2024

PED waiting period capBefore 48 months, now 36 months
Specific waiting period capBefore 48 months, now 36 months
MoratoriumBefore 96 months, now 60 months

Before Now, in months

Rule	Before	Now
PED waiting period cap	48 months (2020 standard exclusion Excl01)	36 months
Specific waiting period cap	48 months (2020 standard exclusion Excl02)	36 months
Moratorium	8 continuous years	60 continuous months

The IRDAI (Insurance Products) Regulations 2024 came into force on 1 April 2024. The Master Circular of 29 May 2024 told insurers to bring existing products in line by 30 September 2024. It also required them to protect and carry forward waiting period and moratorium credit already earned.

The moratorium

After 60 continuous months of cover, counting ported and migrated time, the insurer cannot contest the policy or a claim for non-disclosure or misrepresentation. The only exception is established fraud. If you raise your sum insured, the 60 months for the extra amount count from the date of the increase.

Keeping your credit

Portability. When you move to another insurer, you carry credit for pre-existing disease and specific waiting periods, and the moratorium. The old insurer must share your records within 72 hours of the new insurer's request, and the new one must decide within 5 days.
Migration. Moving to another plan with the same insurer carries the same credit.
Grace period. Renew within 15 days for monthly premiums, or 30 days for other modes, and your credit is protected.
Higher sum insured. Any waiting period starts afresh only for the enhanced portion.

Have a hospital stay coming up? Send your policy on WhatsApp and a person checks it for you.

Questions

What is the maximum waiting period for pre-existing diseases?

36 months of continuous cover, under Schedule III of the IRDAI (Insurance Products) Regulations 2024, in force from 1 April 2024. Insurers may offer a shorter wait.

Do waiting periods apply to accidents?

The 2024 regulations say a specific waiting period does not apply to treatment needed because of an accident. The initial waiting period in the Customer Information Sheet format also does not apply to accidents.

If I port my policy, do I lose my waiting period credit?

No. IRDAI's May 2024 master circular lets you carry credit for time served on pre-existing disease and specific waiting periods, and the moratorium, to the new insurer or plan.

Does increasing my sum insured restart the waiting period?

Only for the extra amount. The 2024 Customer Information Sheet format says any waiting period starts afresh only for the enhanced portion of the sum insured.

What is the moratorium period in health insurance?

It is 60 months of continuous cover. After it, the insurer cannot contest the policy or a claim for non-disclosure or misrepresentation, except for established fraud.