Maternity Cover

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   Independent insurance cover for maternity was unheard of until a few years ago. Insurance is about covering unforeseen eventualities and maternity really does not count as one, was insurers' common refrain.

At best, it was included in the group health policies bought by organisations for their employees and their families. In the last couple of years, however, some companies have started selling individual and family floater policies that reimburse maternity expenses as well.

But before you buy such an independent health policy, you need to understand their terms of coverage and other intricacies. Here's what you need to know about maternity benefits provided under group health packages as well as individual covers:

Sub-Limits

Health insurance plans that include maternity coverage come with an inbuilt sub-limit. That is, while your total health cover may amount to say . 3 lakh, maternity expenses will be eligible for a much lower sum. Typically, it ranges from . 15,000-25,000 for normal deliveries whereas caesarean ones will be covered to the extent of . 25,000-50,000.
If you opt for certain high-value policies with a sum assured of over . 10 lakh, the maternity part could even touch . 1 lakh. Under group covers, the pregnancy-specific sum insured could be slightly higher. "Fifty-three per cent of the (surveyed) employers in 2011 have the same sublimit for normal and caesarean delivers.

In 2011, the average sub-limit for normal deliveries has been in the . 35,000–40,000 range and that of caesarean delivery is higher, in the . 45,000–50,000 range," states a Vantage Insurance Brokers survey, while pointing out that employers are increasingly looking at different sub-limits for normal and caesarean deliveries. Some employers, though, continue to have similar sub-limits for both procedures. Pre- and postnatal expenses are also covered under group as well as individual plans, though the sub-limits, if imposed, may vary.
If individual policies fix a sub-limit of up to . 2,500, it can go up to . 5,000 in case of group covers. New-borns are covered to the extent of . 3,500, depending on the policies. Some companies have eliminated the sub-limits for pre- and post-natal as well as new born baby covers; they are included under the sum insured earmarked for maternity expenses are a whole.

Exclusions    

As mentioned earlier, some policies — group as well as individual — do include pre- and post-natal expenses in the scope of coverage. But in case of several others, this features as a key exclusion. Pre- and post-natal expenses would mean costs pertaining to ultrasound, regular checkups, doctor's consultation fee, medicines and so on. These are similar to pre- and post-hospitalisation
expenses that are admissible under a standard health insurance policy. Likewise, not all policies cover expenses related to new-born babies. You should take into account all these nuances at the time of making a comparison before buying an independent health plan.

Waiting Period

This, perhaps, is the biggest hurdle for someone looking to buy an individual cover with maternity benefits in mind. The waiting period — when the expenses are not payable by the insurer — can stretch to six years. Even the lower limit for the waiting period is nearly three years. "In case of group health covers, the waiting period could be up to nine months," informs Sanjay Datta, head – underwriting & claims, ICICI Lombard General Insurance.

MERIT OF INDIVIDUAL POLICIES

So, if an individual is covered under group health packages, which do not impose such stringent restrictions, s/he may not find value in individual maternity covers. The argument could be that since the premium amount paid over three or six years is equivalent to the maternity coverage, they would be better off investing the money elsewhere.

However, they need to remember that apart from maternity coverage, the policy entitles them to general health cover too. This would not be the case if they simply save the money instead. If planned well, such covers may turn out to be useful. The key factor, of course, will be your employers' package. If it encompasses maternity benefits, you may not need to buy an individual policy, assuming that you do not face the threat of a job loss. Besides, the claim settlement procedure is usually simpler and more efficient when it comes to group covers.

Employed professionals may not require such plans as they are already covered. Such policies may be more relevant from the point of view of self-employed professionals and businesspersons, who do not have the security of a group cover. Also, remember, such covers are not meant for all age groups, as they do not suit everyone's requirements.

For instance, a senior citizen will not need such policies. These covers are targeted at those who are likely to plan a family in the future.

 

 

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