Should you buy health insurance to cover maternity expenses?

Deepak Yohannan MyInsuranceClub Maternity is a crucial decision for a family and particularly for the mother. Good quality maternity care is absolutely necessary for a safe delivery and health of the mother and child. But if you’re looking for quality healthcare you can forget most government hospitals and the ones that are good have long waiting periods. So, quality treatment in India is synonymous with private hospitals. In Mumbai, the cost of a normal delivery in a multi-specialty hospital private ward will cost anything between Rs. 80,000-200,000 and Rs 60,000-160,000 in New Delhi. Whereas, most health insurance plans which cover maternity charges, do so up to a sublimit of Rs 50,000. This essentially means that the sum assured on your base plan could be as high as Rs 3-5 lakh, however, the limit (or sublimit) up to which maternity costs are covered will be of Rs 50,000. Insurance by definition covers unanticipated risk which pregnancy is not (no puns intended). Therefore, there are no health insurance plans that solely cater to pregnancy, instead health insurers cover pregnancy-related expenses as an additional benefit in the plan. Plans which cover maternity expenses come with long waiting periods and high premiums and it is absolutely important to read the fine print to see what these plan cover and what they don’t. Most insurers such as Cigna TTK, Religare, Apollo Munich, ICICI Lombard, Max Bupa Health Insurance, Cholamandalam General Insurance, United India Insurance, and Star Health cover child delivery expenses in their health plans (available as add-on cover or in-built in the base plan). But there are few that actually cover all maternity-related expenses including pre-natal & post-natal charges (which include ultrasound, regular check-ups, doctor consultation fee), pre & post-hospitalisation expenses, new born baby cover etc and those plans which do cover all these command high premiums.For your medical insurance to be cost-effective, it is essential to consider the following points while looking out for such plan:Waiting period: Generally, there is a waiting period of two to six years before you can claim maternity expenses in such health plans. Getting such as plan with a long waiting period can be counter-productive for those who want to start a family soon. Cigna TTK’ s ProHealth Insurance Plus Plan and Apollo Munich’ s Exclusive Family Health and have waiting periods of up to four years but can be decreased to two years in case of ‘ProHealth Insurance Plus’ by paying an additional premium. Religare Joy has an industry low waiting period of just nine months for a policy term of three years but you have to buy the plan for three years at a go – so the cash outflow is high at one go.Our view: Long waiting periods is probably what discourages couples to opt for such plans. However, planning ahead can address this issue.Sum assured: Apollo Munich’s Exclusive Family Health and Cigna TTK’s Plus provide cover maternity expenses up to Rs 15,000 for normal delivery and Rs 25000 for caesarean delivery for a sum assured of Rs 3-5 lakh in the base plan. Most health plans that have maternity cover as add-on limit the cover amount till Rs 50,000. This amount might be insufficient in metros where this cost could easily touch Rs. 1 lakh or above. Religare Joy a comprehensive plan that covers maternity expenses - has an in-built sub-limit (for maternity including pre-natal & post-natal charges) of Rs 30,000 (sum assured of Rs 3 lakh) and up to Rs. 40,000 for sum-assured of Rs 5 lakh. Another such maternity-related plan, Max Bupa’s Heartbeat health insurance plan is available for both individual and family floater coverage. Maternity cover in Heartbeat health has a sub-limit of Rs 30,000 for a sum assured Rs. 5 Lakh under family first or family floater options. Our View: It’s best to buy a maternity add-on cover on your base health plan at the start of your marriage, in order to factor-in the initial waiting period. The waiting period is nine months in case of corporate group health insurance policies. Ideally, if your employer’s insurance policy covers maternity expenses buying another health insurance plan to cover maternity expenses might not be a very good idea. What is covered? Maternity cover should provide for delivery expenses (including Caesarean) and complications arising thereof, pre-natal & post-natal expenses along with post-birth care and vaccination, maternity-related OPD care (outpatient department) expenses and cost of medicines, ambulance charges and hospital stay. Our View: Religare Joy is one such plan that provides coverage for almost all the expenses mentioned above but sub-limits are tight. The premium paid should justify the cost covered. It would be foolhardy to pay a premium almost equivalent to sub-limit for maternity expenses. New Born Baby Cover: Check if the rider covers day one new born baby cover which means covering costs for treatment of ill-health of new born baby from day one, associated pregnancy complications, pre & post natal expenses. Common exclusions: Many policies do not cover post-pregnancy expenses such as stem cell preservation and illegal termination of pregnancy. Final VerdictIt’s probably good if you have a family floater health plan already covering maternity expenses. This way a single plan will not only cover health care expenses for a family but also maternity expenses at an additional premium payment. This is probably the best way to get be protected against maternity expenses without feeling the pinch on your pocket. General insurance companies cover maternity in corporate group insurance policies mostly as an add-on cover with sub-limit usually not exceeding Rs 50,000. If your employer’s insurance plan covers maternity charges it would not be wise to buy another health plan solely to cover childbirth expenses. However, if you plan ahead and do a cost versus benefit analysis of waiting period, sub-limits, premium paid and benefits, you should be able to draw a conclusion, whether you really need such a health plan.