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Should women consider health insurance plans with maternity benefits?

Given the skyrocketing cost of various maternity treatments, which can cost anywhere between Rs 50,000 to Rs 5 lakh, bearing this expense may turn out to be an expensive affair for many families

A health insurance plan offering maternity as a feature usually provides cover for delivery and newborn charges for a mother and the infant. Maternity is an important phase in a woman’s life that needs to be prepared well in advance so that one may embrace parenthood with ease.

Ashish Mehrotra, MD & CEO, Max Bupa Health Insurance, said, “Couples planning to start a family need to be well prepared to deal with childbirth and maternity-related expenses such as regular diagnostic tests, medicines, hospitalisation, etc. Given the skyrocketing cost of various maternity treatments, which can cost anywhere between Rs 50,000 and Rs 5 lakh, bearing this expense may turn out to be an expensive affair for many families.”

Should an insurance plan with maternity benefit be purchased?
Young and middle-aged couples between 20 years and 35 years should opt for such plans. Brijesh Parnami, Executive Director & CEO of Essel Finance Wealth Services, said, “You should apply for maternity insurance before you conceive. Most insurers will deny cover if you are already pregnant.” This happens because insurance companies term the case as pre-existing.

Vikas Mittal, Deputy CEO, Magma HDI, said, “Insurance plans with maternity benefit come with a long waiting period. Hence, it is advisable to purchase it soon after one gets married, so that the waiting period for coverage is over by the time a couple plans a family.”

Key points to know while buying an insurance plan
Plans which cover maternity benefit come with various important terms and conditions. One should be careful while choosing the best suited plan. Mittal said, “Most important points to consider are coverage limit for maternity benefit, sub-limits for normal and cesarean section delivery, waiting periods and other ancillary features like coverage for new born baby from day one, vaccination benefits and their individual limits, etc.”

Antony Jacob, CEO, Apollo Munich Health Insurance, added, “Sub-limits vary by plan. The overall sum insured is also subject to the selected plan.” So, customers should ensure that they check the costs of maternity packages within preferred hospitals before choosing the plan.

Long waiting period
Jacob advises customers to purchase the policy early since most plans have a waiting period for maternity-related benefits, usually in the range of 2-4 years.

The waiting period can be reduced with some insurance companies. Jyoti Punja, Chief Customer Officer, Cigna TTK Health Insurance, said, “One should check the terms and conditions of an insurance policy while buying a plan. Some companies allow the waiting period to be reduced to 2 years by paying additional premium.”

Vaidyanathan Ramani, Head Product and Innovation, Policybazaar.com said, “Very few insurance plans like Religare’s Joy newborn and maternity health insurance policy comes with a waiting period of only 9 months.”

Most health insurance plans available in the market come with the following inclusions:
– Coverage for in-patient hospitalisation and delivery charges for normal delivery/ C-section or lawful termination of pregnancy
– Newborn expenses up to 90 days post birth
– Vaccination charges

Mayank Bathwal, CEO, Aditya Birla Health Insurance, said customers should look for insurance plans which cover comprehensive needs related to maternity: the delivery should cover needs such as storage of stem cells for the newborn baby.

Anuj Gulati, MD & CEO, Religare Health Insurance, said, “Common exclusions are treatments arising or traceable to any fertility, sterilisation, birth control procedure etc and treatments taken from someone who is not a medical practitioner.”

Punja added, “Medical expenses in respect of the harvesting and storage of stem cells when carried out as a preventive measure against possible future illnesses and voluntary termination of pregnancy during the first 12 weeks from the date of conception, surrogate or vicarious pregnancy.”

Know maternity benefit in your employer group insurance plans
Maternity cover is an add-on feature in health insurance policies with some companies. While it has become almost standard to offer maternity cover under employer health insurance policies, not all subscribe to this add-on. This might be the reason for rejection of maternity claims in several cases. Parnami said, “Some policies carry a waiting period of 9 months or more to avail this benefit in an employer group insurance plan. The waiting period is counted from the date the employee enrols in the group insurance plan.”

Why should you buy an add-on cover with maternity benefit?
The premium on an add-on cover are low compared to health plans with maternity benefit. So, Parnami feels it is better to buy an add-on cover with a maternity benefit as the “high premium coupled with the long waiting period that policies with a maternity cover come with diminish their effectiveness.”

For a benefit of Rs 25,000 (cap in maternity coverage), buying a Rs 3 lakh health policy and paying an annual premium of Rs 8,000-9,000 with a long waiting period of 3-4 years doesn’t make much sense.

Health plans with maternity benefit shown for illustration purpose

Note: Above premium calculation is based on two adults, female: 27 years and male: 30 years, living in a metro with a Rs 5 lakh sum insured and no pre-existing medical condition

DrawbackAlmost all insurance plans provide limited maternity coverage from Rs 15,000 to Rs 50,000. Very few plans offer limits as high as Rs 1 lakh. Ramani said, “Maternity expenses can be expensive with costs going up to lakhs depending upon the city you live in and the type of hospital you opt for. Therefore, there is a pretty good chance that a person with a maternity plan also needs to bear out-of-pocket expenses.”

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