Becoming a parent is one of the most mesmerizing experiences of life.
But this happiness come with great responsibilities.
If you are planning for a baby in the near future, your first responsibility should be to plan your finances for the big moment, especially the medical expenses during and after pregnancy.
Going by the trends, medical costs are increasing at a breakneck pace in India. Moreover, our rising income levels have failed to catch up with the rising medical inflation.
Therefore, understanding and planning for a maternity benefits inclusion as part of your health insurance plan becomes even more important.
Why maternity health cover is required?
As I have mentioned above, rising medical costs related to pregnancy can easily burn a hole in your pocket.
Talking from my personal experience, I had to spend Rs, 40,000 in a normal private nursing home at the time of the birth of my child. And it was in the year 2018, that too in a tier 2 city.
The starting packages for corporate hospitals were upwards of Rs. 60,000 (for normal delivery).
Also, there are multiple pre-hospitalization and post-hospitalization costs incurred, such as diagnostic tests,room rents,ambulance costs, immunization, medicines etc.
A good maternity health cover can cover a huge portion of such expenses.
What is Maternity Health Benefit?
Maternity insurance is a plan which is designed in order to cover the healthcare costs related to pregnancy.
Usually, maternity benefit plans can’t be bought in isolation.
Rather they are available as an addition to your original health insurance policy (which can be individual/family floater/group plan etc.).
Examples of health insurance plans that come with maternity cover benefits are ;
- Star Health Wedding Gift Pregnancy Cover
- Religare Joy Maternity Health Insurance Plan
- Max Bupa Heartbeat Family First Plan
- Apollo Munich Easy Health Insurance Plan
- Royal Sundaram Total Health Plus Plan
- HDFC Ergo Health Suraksha Gold
- Royal Sundaram Lifeline Elite
- National Parivar Mediclaim Plan etc.,
You can opt for it at the time of buying the health insurance or later by paying extra premium.
But it should be kept in mind that almost all maternity covers bought as part of individual/family floater/group plans come with a waiting period ranging from 24 to 48 months.
So, it makes sense to opt for maternity benefit rider way before you plan the family.
What to look for in Maternity Health Plans?
While buying maternity benefits as part of your health insurance policy, there are certain parameters you should look out for.
1. Limits on maternity medical expenditure
All health insurance policies which offer maternity benefits put a limit on the maximum expenditure that can be claimed. This limit can be a flat amount or it can be linked to the overall sum insured.
Most of the health insurance companies cover maternity expenses to the tune of Rs.50,000 or less.
But the actual costs of delivery and other related expenses may goup to Rs.1,00,000, especially if you are living in a metro and opt for a corporate hospital.
Thus, you should take utmost care of the cover amount while purchasing the maternity rider.
2. Waiting period
All maternity covers come with a stringent waiting period ranging from 24 months to 48 months, sometimes even more. However, some Insurers have less waiting period as well. For example – Religare Health Insurance has a plan in which the waiting period is for just 9 months.
But for Group Health insurance plans purchased by an employer, such waiting periods can be reduced/abolished by paying some extra premium.
Drawing out from my personal experience, my employer had a group plan from ICICI Lombard with no waiting period for maternity benefits, and coverage of child right from day 1. Needless to say, the company was paying an extra premium for this benefit. Overall, you will generally see that when it comes to group health insurance, one can negotiate better coverage terms since the premium involved is quite significant.
Therefore read the plan details thoroughly and be aware about the waiting period clause.
There may be different maternity coverage options offered by different companies as part of a health insurance plan.
For example, there are companies offering coverage for newborn right from day one, coverage for termination of pregnancy, associated pregnancy complications & pre and post-natal expenses.
Also, check whether the plan covers both types of deliveries and any other terms and conditions related to the claim.
Just a caveat, to avail such benefits, the mother should be covered under the base plan.
However,the following expenses are not covered under maternity benefit by most of the companies:
- Maternity expenses in respect of harvesting and storage of stem cells when carried out as a preventive measure against possible future Illnesses .
- Maternity expenses for ectopic pregnancy. However, this expenses may be covered under the Base Plan.
4. Other coverages
As industry evolves, there are new coverages which the providers are offering, as mentioned below. Do have an eye on these while you are buying your policy.
Hospitalization coverage – Many insurance companies give daily hospitalization allowance. In some policies, even room rent and ICU charges are also covered.
Ambulance charges – You can get an ambulance cover which can be a fixed amount or percentage based on the sum insured.
Cashless facility – Prefer a policy which has a good network of hospitals in your city and also offers cashless facility. I didn’t use cashless facility and had to make a claim later. Believe me, paperwork is extremely painful and most of the hospitals are not friendly enough to help you with multiple formalities.
Exclusions – what might not be covered under maternity benefits?
- First of all, you cannot get the claim of anything which is specifically excluded from the base plan.
- There is no benefit for any type of non-allopathic treatment during pregnancy.
- Generally, the claim is not given for any type of infertility treatments.
- Medical expenses incurred on voluntary medical termination during the first 12 weeks from the date of conception are not covered.
- Medical expenses on co-genital diseases to the new born are generally not covered.
An ultimate advice to would be parents
I would advice all the couples to make a well-informed choice while getting a health insurance policy.
You already know that maternity rider is an add on which comes along with the base plan. But while choosing a health insurance policy, maternity rider should not be your sole criterion.
Rather,your focus should be on basic insurance plan, be it individual or family floater. Evaluate the policy for all other benefits too since a major part of your premium goes towards the base plan.
After comparing plans from different companies, you should then move to the maternity rider option.
While comparing maternity rider plans, you must focus on the waiting period. Also, look for sub-limits on different medical expenditures related to pregnancy.
Finally, look at the extra premium (if any) you need to pay to get the maternity benefit rider as part of your health insurance policy.
Bringing a new life to the world is certainly no cake walk.
Proper financial planning can make such experiences more enriching and joyous, both emotionally and financially.
Therefore, take an informed decision and opt for the health insurance policy that matches your needs.
This is a guest by Tushar Jain of JainTushar.com .
About the author
Tushar Jain is a personal finance enthusiast who loves to talk about money, savings, investments and spending. He blogs about financial wisdom and income growth habits at his blog www.jaintushar.com. Contact him to say Hi.
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(Image courtesy of Stuart Miles at FreeDigitalPhotos.net) (Post first published on : 12-July-2019)