If you have an employer provided group health insurance cover and an individual health insurance policy, you may have an advantage that many policyholders overlook. Some group health insurance policies waive waiting periods that may apply under individual health insurance policies.

For example, an individual health insurance policy 4 types of waiting periods,
· 30 Days Initial Waiting Period
· 90 Days Waiting Period
· 24 Months Specified Disease Waiting Period
· Pre-Existing Disease (PED) Waiting Period

Your employer’s group policy may cover that condition without the same waiting period applicable under individual health insurance policy. However, this is not guaranteed for every group policy and every policy member registered under group policy. You must check the policy wordings, Customer Information Sheet (CIS) and your policy document to confirm whether the waiting period has been waived or not.

Why Can this Matter when you Make a Claim?
Imagine you purchased an individual health insurance policy six months ago and you also have a group health insurance policy available through your employer. Under individual health insurance policy, there is a waiting period for a particular pre-existing condition but if group health policy covers that condition from the start of your eligible coverage and if you require hospitalization for that condition, then the group policy may be the more appropriate policy to approach first, provided that the treatment is covered and all the applicable terms and conditions in the policy wordings are satisfied.

This is one reason you should take into consideration at the time of a medical emergency.

 The above table shows only generalized benefits. The exact coverage, waiting periods, exclusions and benefits depend on the policy.

Which Policy Should You Claim From First?
There is no universal rule that you must always claim from your employer’s policy first. IRDAI guidance allows a policyholder with multiple indemnity health insurance policies to choose the policy under which to make the initial claim. If that policy does not cover the full admissible amount, the balance claim payout can be shared with the other insurer.

Therefore, before choosing, check

· Waiting Periods – Does either policy cover the relevant disease or treatment without a waiting period?
· Coverage & exclusion – Is the treatment covered under both policies?
· Co-payment & Sub-limits – Will one policy leave you with a larger out of pocket expense?
· Cashless Facility – Which policy can provide suitable cashless access at the hospital?

For example
Suppose your hospital bill is Rs 4 lakh. Your group policy covers the treatment and has no applicable waiting period, while your individual policy still is within a waiting period for that condition. In this situation, the group policy may be the appropriate first choice. If the group policy does not settle the full admissible claim amount, you can ask the individual insurer whether any balance is payable under their policy terms and conditions.

Do not assume the individual policy will cover a condition that remains within its waiting period.

Why you should Keep Your Individual Health Insurance
Your employer’s group cover is valuable, but it may change when you change job, retire or become ineligible under the employer’s scheme. An individual policy can provide protection independently of your employment, provided you maintain it, renew it time to time. It can also offer benefits and coverage limits that differ from your employer’s policy. Review both policies annually rather than relying entirely on the cover provided at work.

Final Takeaway
Having both group and individual health insurance can provide useful flexibility but only if you understand the terms of each policy.

Before hospitalization, review your insurance policy document, policy wordings, waiting periods, exclusions and claim procedure. A little preparation can help you make a more informed decision when you need your insurance the most.

INSURANCE AWARENESS > INSURANCE IGNORANCE
Helping individuals and families make informed insurance decisions through education, transparency, and awareness.

Last Updated – 28/10/2026
Author Name - Abhishek Borkar

Disclaimer
This article is intended solely for information and educational and awareness purposes and should not be considered financial, legal, tax, investment, or insurance advice.

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Cover images and illustrations may be generated using Artificial Intelligence (AI) tools for educational and illustrative purposes.