What is the waiting period for critical illness insurance? Read on for key considerations when purchasing critical illness insurance.

Will you be covered immediately after purchasing critical illness insurance? In fact, most critical illness policies have a waiting period, which means that if you are diagnosed during this period, you will not receive any compensation. If you are unclear about the relevant terms, you could easily miss out on the protection you are entitled to. So, what exactly is a waiting period? How long does it usually last? What happens if you are diagnosed during the waiting period? This time, 10Life will answer these questions one by one to help you understand waiting periods and the points to note when purchasing critical illness insurance.

The Waiting Period refers to a specified period after the policy takes effect during which the insurer will not pay a claim, even if the insured is diagnosed with a critical illness or develops symptoms. Its main purpose is to prevent people from taking out insurance after they have already fallen ill, or only purchasing insurance after receiving a diagnosis or developing symptoms, which could expose the insurer to excessive risk. As a result, many insurance products on the market, such as medical insurance and critical illness insurance, include a Waiting Period. The length of the Waiting Period depends on the policy.

Generally speaking, the waiting period for critical illness insurance is usually 60 to 90 days from the policy effective date. However, some policies may impose longer waiting periods for specific illnesses, such as autism or gynaecological conditions, ranging from 6 months to 1 year. As the Insurance Authority has not established a uniform standard for waiting periods, insurers may set different waiting periods based on the product or illness. Therefore, be sure to read the policy terms carefully before taking out a policy to ensure that you clearly understand the coverage.

As mentioned above, the primary reason for a waiting period is to prevent “adverse selection”, whereby policyholders who already know that they may be ill purchase insurance at the last minute to obtain compensation, increasing the risk to insurers and creating an unfair situation for other honest policyholders.

Generally speaking, if any symptoms of a critical illness appear or an insured illness is diagnosed during the waiting period, the insurance company has the right to reject the claim. In addition, the insurance company will determine the validity of the claim based on the medical records issued by the medical institution.

It is worth noting that insurance contracts are based on the principle of “utmost good faith”. Policyholders must proactively and truthfully disclose all material information to the insurance company when applying for insurance, including their health condition and medical history. Regardless of whether the “material fact” is directly related to the illness for which the claim is ultimately made, the insurance company may reject the claim or even cancel the policy if the policyholder’s failure to disclose that fact prevented it from making a fair and accurate underwriting decision when the policy was initially taken out.

When purchasing critical illness insurance, in addition to the waiting period, there is also the Survival Period, but the two are different concepts. The Survival Period refers to the period the insured person must survive after being diagnosed with a critical illness or undergoing surgery in order to receive a payout. It is usually between 14 and 30 days, with the exact number of days depending on the policy terms of the relevant insurer. One of the reasons critical illness insurance has a “Survival Period” is to avoid overlapping with life insurance coverage. The waiting period refers to a specified period after the policy takes effect during which the insurer will not make a payout even if the insured person falls ill. Simply put, the waiting period is calculated “before falling ill”, whereas the Survival Period is calculated “after diagnosis”. Therefore, you should read the terms carefully before taking out a policy to ensure that you fully understand the relevant coverage conditions.

Waiting Period and Survival Period Clauses

As mentioned above, both waiting periods and survival period clauses can affect claims, so it is essential to check them carefully before purchasing.

Definition of Covered Illnesses

Different insurance companies have different definitions of “critical illness”. Although cancer, heart disease and stroke are all standard areas of cover, certain illnesses, such as carcinoma in situ, specific surgeries (such as angioplasty) or diseases affecting specific organs, may not necessarily be covered. Policy terms and conditions generally set out in detail the specific medical criteria required for the diagnosis of critical illnesses and the performance of surgeries. Therefore, when purchasing critical illness insurance, you should pay close attention to the list and definitions of covered illnesses to avoid having a claim rejected in the future due to differences in the definition of an illness.

Multiple-Claim Mechanism

Some critical illnesses, such as cancer and stroke, carry a risk of recurrence. Therefore, some critical illness policies provide a multiple-claim mechanism to ensure that the insured can receive protection at different stages. However, the multiple-claim mechanisms of different policies vary, so you should pay particular attention when purchasing, including whether there is a limit on the number of claims for a single illness, the definitions of a “new illness” and a recurrent illness, and the waiting period between two claims.

Exclusions

Every policy has exclusions, and common exclusions include:

• Pre-existing illnesses or certain hereditary diseases
• Illnesses related to AIDS or caused by alcohol or drug abuse
• Illnesses caused by war or terrorist attacks
• Injuries caused by dangerous sports or high-risk work

Before purchasing, you should read the policy terms and conditions carefully to ensure that you understand which illnesses or circumstances are not covered and avoid claims-related issues in the future. If you have any questions, you may consult the insurance company or a professional adviser to ensure that the cover meets your needs.

Declaration of Health Conditions and Medical History

Insurance contracts are based on the principle of “utmost good faith”. Insurance companies need to ensure that the insured declares their health conditions truthfully in order to conduct fair underwriting. Therefore, when applying for insurance, the insured should honestly declare their health conditions, including their medical history, family medical history and recent health examination results. This enables the insurance company to assess the risk, determine whether to provide cover, set the premium level and establish the terms of the contract. If the insured deliberately conceals or fails to disclose any health conditions, the insurance company may have the right to reject a claim or even cancel the policy in the future. Therefore, no health issues should be concealed when applying for insurance.

Claims Process and Time Limit

Critical illness insurance generally has a time limit for making claims, usually requiring the insured to submit a claim within 90 days of diagnosis; otherwise, this may affect the compensation payable. Claims generally require a diagnosis certificate issued by the attending doctor or hospital, medical records, laboratory test reports, pathology reports and personal identification documents. The claims requirements may vary between policies, and the insurance company may require the insured to submit additional documents. To avoid affecting the compensation payable, the insured should ensure that they understand the required claims process and time limit before applying for insurance.

Most critical illness insurance policies have a waiting period. Therefore, taking out cover as early as possible while you are healthy can help avoid the waiting period affecting your protection. If you would like to learn more about critical illness insurance or have any questions about the policy details, please feel free to contact 10Life Licensed Insurance Adviser Consultation for professional advice and to prepare for the future.

Further reading:
【Critical Illness Insurance 2025】Whole-of-Life Critical Illness vs Term Critical Illness! A Complete Comparison of Premiums, Cover and Savings Components
【Critical Illness Insurance Comparison 2025】Which Whole-of-Life Critical Illness Insurance Is Best? Key Insights into 5-star Insurance
Unable to Get Insurance After a Major Illness? Which Critical Illness Plans Offer Renewed Hope for Survivors
 

Last updated: 8 April 2025

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.