Maternity is the one of the best life events for every woman as many of them would be looking forward to enjoying the event. But rising childcare expenses starting from delivery to then going to college, marriage etc has made many families reconsider their maternity decisions. As per the statistics the age of the women giving birth has crossed 25 years and is approaching 30 years. This change could be mainly attributed to the financial planning, education and career goals of women and their families.
One thing that women and their families consider before going for childbirth is the possibility of availing maternity insurance. Maternity insurance cover could either be taken from the employer or have a maternity health insurance policy. Maternity cover is an add on that is being offered in a health insurance policy and is not a standalone cover. Many people make a common mistake of thinking to take maternity health insurance once they are conceived.
In this article we discuss the factors one should consider before taking a maternity health insurance cover so that they can extract maximum benefits from the policy:
1. Sum Insured: The first and basic thing to consider before taking a maternity cover in health insurance is to decide on the sum insured required under the policy. Since maternity is an add on cover there would be a separate sum insured in the policy. Generally, the sum insured in a maternity add on would range from Rs.30.000 to Rs. 2 Lakhs. It is important to remember that this maternity sum insured in turn depends on the base sum insured under the policy.
Higher the base sum insured, higher the options of maternity sum insured. For example, let us assume base sum insured in a health insurance plan ranges from Rs. 5 lakhs to Rs. 1 Crore and similarity maternity sum insured ranges from Rs. 30,000 to Rs. 2 lakhs. If you wish to take Rs. 2 lakhs maternity sum insured, your base sum insured should be somewhere near Rs. 1 Crore. This way insurance companies would link the base sum insured with the maternity sum insured to prevent policyholders from taking advantage of the maternity cover.
If you wish to take a higher sum insured in the maternity section, then you should make sure that your base sum insured is higher. However you should be considerate of your decision to increase base sum insured only for the purpose of maternity sum insured as increase in base sum insured results in premium increase.
2. New Born Baby Cover: The other thing to consider before taking a maternity cover in health insurance is to check if the policy is offering new born baby cover as an inbuilt cover under the maternity section. Most maternity add-ons would extend the insurance cover to the newborn babies up to a period of 90 days after which they could be added in a regular health insurance policy.
The other thing to check is the sum insured under newborn baby cover. Newborn babies could either be covered under the base sum insured or the maternity sum insured. It is advisable to take a health insurance policy that covers newborn babies in the base sum insured as covering a newborn in the maternity sum insured would reduce the benefits that can be availed in case of maternity.
If a newborn is covered in maternity sum insured, there could be an issue when a claim is made for the newborn as the maternity sum insured would be utilized for delivery and policyholders need to spend from their pocket the expenses incurred for the newborn baby.
3. Vaccination: The other factor to consider is if the maternity cover is providing vaccination benefits for the newborn baby. A newborn baby would require certain vaccinations and these would be covered under the newborn baby cover. So again it is important to make sure that the newborn baby sum insured is under the base sum insured and not under the maternity sum insured.
Vaccination cover is usually a one-time event where the basic vaccines are given to the newborn immediately after birth. So, the vaccination cover would not be extended to all the vaccines of the newborn.
4. Co-Payment: The other important thing to consider is the co-payment under the maternity section of the health insurance policy. Co-payment is the amount of claim that has to be borne by the policyholder in case of every claim made under the policy. If the policy has a co-payment clause, then it is important to verify if that clause would be applicable to the maternity cover as well. If the co-payment is applied to the maternity cover, it would further reduce the benefit that could be availed from the policy.
Co-payment should be avoided for extracting maximum benefits from any health insurance policy. In general, there are two types of co-payments- mandatory and voluntary. It is also important to note that copayment is different from excess or deductible under the policy.
5. Pre & Post Hospitalization Cover: This section covers the expenses incurred by the policyholder before and after the inpatient hospitalization. Generally the pre and post hospitalization cover would be given for 30 days and 60 days respectively, although it varies from one insurance company to another. One should make sure if there is any pre and post hospitalization cover available under the maternity section of the health insurance policy before taking the policy.
6. Pre-existing condition: Pre-existing conditions are those that have existed before taking the health insurance policy and are usually covered after a period of 1-4 years depending on the insurance company. If you take a health insurance policy with maternity cover after conceiving, then it would be considered as Pre-existing condition and you would need to wait for the specified period. So, one should be very careful before taking maternity cover in a health insurance policy. You should take the maternity cover when you are planning to have children as the minimum waiting period under this section is 9 months.
So, clearly you need to wait for at least 9 months before making a claim and in such cases you could conceive only after taking the policy. If your maternity health insurance policy has a waiting period of more than 9 months, then you should plan your childbirth accordingly.
7. Cost-Benefit Analysis: The other thing to consider is the cost-benefit analysis for the maternity health insurance policy. A maternity cover means extra premium to be paid to the insurance company and this premium should be far higher than the benefit you would avail from the policy. Maternity add-on would cover up to 2 childbirth or legal abortions and can be used at any time during the policy period.
For example, if you are paying a premium of Rs. 10,000 per year only for the maternity cover and continue to pay so for at least 3-4 years, then the premium itself would amount to Rs.40,000 similar to that of the maternity sum insured under the policy. So, to avail maximum benefit under the maternity cover one should plan to conceive within a few months of taking the policy.
FAQs:
- Can I take maternity cover separately?
No. Maternity cover is offered as an add-on in a health insurance policy and it cannot be taken separately.
- What is the best maternity insurance?
For any maternity insurance policy to be called best it should satisfy the following conditions:-
- Less waiting period (9 months)
- Affordable premiums
- No copayment
- Newborn sum insured should be a part of basic sum insured and not maternity sum insured.
- Can I take maternity insurance if I’m already pregnant?
No. Maternity insurance should be taken before your pregnancy. If you take maternity insurance after pregnancy then it would be considered as Pre-existing and a waiting period would be imposed before a claim is paid under it.
- Can I claim maternity insurance from my retail health and group health plan?
Yes. If you have 2 health insurance plans then you can claim maternity benefits from both the plans. But it is to be noted that despite both the plans you cannot claim more than what you incurred.
- Is maternity sum insured related to base sum insured?
Yes. Maternity sum insured depends on the base sum insured in a health insurance policy. Higher the base sum insured, higher could be the maternity sum insured.
