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Maternity Insurance: What You Need To Know

Maternity Insurance: What You Need To Know

Up until now, I didn’t quite know that insurance cover for pregnancy was actually a thing. I was always under the impression that insurance is only to cover you for accidents and emergencies and I was partly right. If you do some homework you’ll find out that your basic health insurance plan doesn’t cover expenses related to dental surgeries, cosmetic surgeries, eye surgeries, pre-existing conditions, or even pregnancy. But since maternity expenses are rising, and more and more women are choosing to become pregnant at an older age they’re prone to complications and their demand for maternity insurance has increased. So, is this insurance worth it?

We decided to chat with a few women who’ve been covered under maternity insurance and here’s what they had to say:

Health insurance policy from your employer will mostly include maternity cover:

Before buying a maternity insurance plan first check whether the health insurance policy at your workplace covers maternity insurance. In case it doesn’t you can get it by paying an extra premium. If your company doesn’t cover healthcare at all check if you’re covered under your husband’s company policy and whether his plan has a maternity cover.

Presently, insurance companies prefer selling maternity cover to corporate companies who buy group plans for their employees instead of selling it to individual buyers. That’s because such plans have 100% utilization ratio (meaning the policyholders will always claim their insurance) making it an unprofitable product for insurance companies if they sell it to an individual.

Six years ago I was covered with maternity insurance from my husband’s company. After submission of original bills a sum of Rs.50, 000 was reimbursed. And in case of a C-section delivery, the reimbursement would have been Rs. 75,000”
– Anjali Bhanushali

Premiums on maternity insurance plans are high:

Pregnancy related costs are now mounting thanks to expenses incurred on gynaecologists, nutritional medication, caesarean section deliveries, treatment at super-speciality hospitals etc. That’s why more and more women want insurance cover to protect them financially. This increased demand for maternity insurance has made few insurance companies offer individual maternity insurance plans or offer maternity cover as an add-on with your base health insurance plan by charging an extra premium. In insurance lingo such an add-on is called as a rider

But since the idea of insurance is usually to cover unanticipated risks which pregnancy isn’t and the insurer in most likelihood will always claim it to cover maternity expenses, premiums on such plans are high, sometimes even double!

Example the Easy Health Family Floater by Apollo Munich has three different insurance plans – Standard, Exclusive and Premium. The standard plan is a normal health insurance plan with some benefits, but the exclusive and premium plans offer maternity and new born coverage. The premium for the standard plan for a health cover of Rs.2 lakh is Rs.9, 311, for the exclusive it is Rs.13, 010 and for the premium it is Rs.18, 696.

I got it partially covered. There was a cap on the maximum coverage and mine was more than that. So, got the maximum possible amount paid through insurance directly at the hospital – cashless. It is beneficial. Although my company provided this insurance under medical benefits.
– Debolina Banerjee

My company provided me with the insurance. I used the insurance for 2 deliveries. The second time although my delivery was fully covered I ended up paying some amount from my pocket. But I think it definitely makes sense to get the cover.
– Shikhaa Sawhney

Maternity insurance plans usually come with…

Long waiting periods

An insurance plan with a long waiting period, means you cannot claim the insurance amount until the waiting period is over. Usually all plans that cover maternity have a waiting period of at least 2-6 years. So if you want to have a kid a few years after your marriage getting a plan only makes sense if you buy one immediately after you are married. However there are some plans that have lower waiting periods like the Religare Joy Plan with a waiting period of just 9 months for a policy that lasts for 3 years. But this comes with some strings attached, for example you’ll need to shell out premium for 3 years at one go.

Sub-limits

Apart from waiting periods, these plans have sub-limits on how much you can claim, meaning the insurance will reimburse you only up till a certain limit for your expenses and not the whole amount. Example: If your delivery cost was Rs.1, 00,000 and there is a sub-limit of Rs.50, 000 on maternity cover then the insurance will pay you only that much. The rest has to be borne by you. So the insurance wouldn’t make much sense if this sub-limit is almost equal to the premiums you’ve paid. Most individual maternity insurance plans and even add-on maternity cover on health plans have a limit of up to Rs.50, 000.

And exclusions

Exclusions are those things that your plan do not cover. Read these carefully before signing up for a maternity insurance plan. Most common exclusions of these plans are:

  1. Insurance cover is not for those above 45 years of age
  2. Medical expenses incurred towards ectopic (abnormal place or position) pregnancy
  3. Medical expenses incurred on voluntary medical termination during first 12 weeks from the date of conception
  4. In case you’re already pregnant
  5. Congenital diseases, etc.
  6. Costs related to treatments for fertility, sterilisation, birth control procedure etc. taken from someone who is not a medical practitioner example a homeopathy doctor
  7. Cost of contact lenses/spectacles/dental treatment
  8. Cosmetic treatment

Pro Tip-

This isn’t the full list of exclusions and different plans may have different exclusions. Make sure to read them before applying and in case you can’t find them ask your insurer.

Tips from Miss Manage

  1. Due to the long waiting period, the amount you pay as a premium is sometimes almost equal to the cover that you’ll get considering the sub-limits. In such a case you’re better off saving that premium amount in safe investments such as fixed deposits or recurring deposits. You can treat this as a maternity fund.
  2. If you still feel the need for such a maternity plan then take it as an add-on to your health insurance plan because premiums turn out to be cheaper than a separate plan. In case you’re covered by your employer under a health insurance plan you can add maternity cover to this by paying an extra premium.
  3. Treat this like any insurance policy and read the fine print, terms and conditions, exclusions and inclusions and question anything that confuses you
  4. After you buy the policy keep all your bills intact otherwise you might not be able to claim it
  5. Almost all plans don’t insure those who are already pregnant, so before buying a plan check this
  6. Always plan in advance if you wish to buy such a plan

You might also like to read- What to expect when you’re expecting

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Talkative, clumsy, punny, intuitive are just a few buzzes of this queen bee. An aspiring business journalist looking to find her throne in the corporate world.

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