Understanding Maternity Insurance

A recent report by the World Economic Forum has put India at the bottom of the list of countries in terms of gender equality. India is ranked way below at a dismal 100+ position. The report has blamed the lack of essential maternity and healthcare services in the country as one of the reasons for this. Inaccessibility to these important facilities has led to unhealthy trends in the country’s healthcare services industry. Moreover, maternity is not covered by many insurance companies. The argument they offer is that pregnancy and childbirth are not unexpected risks and hence insurance companies are not expected to cover them.

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Moreover, in India with more than 50 per cent people having more than one child, such a proposition will turn out to be a loss-making deal for most insurance companies. It is for this reason there are no standalone maternity insurance covers. With the evolution of the insurance market however, there are still some options for covering maternity expenses. The ideal policy to cover maternity expenses is the group health cover taken by employers wherein corporates negotiate for and incorporate this cover as an added benefit of overall employee insurance.

 

Maternity cover is also available as a rider (add-on cover) to an individual mediclaim by some companies. In an individual mediclaim, an individual has to wait for a period of four years or more (depending upon the policy) to avail of maternity benefits.

 

Group health insurance offered by employers covers only the costs directly related to the delivery of the child. In most cases it doesn’t cover pre-hospitalisation period, which includes ultrasound, regular checkups, termination of pregnancy within the first 12 weeks and the doctor’s consultation fee. Similarly, the group cover doesn’t compensate for post-hospitalisation expenses such as extra treatment given to a premature baby, etc. In an individual mediclaim, you can cover pre-natal expenses if you have taken the maternity insurance as an additional rider. However, it doesn’t compensate for hospitalisation, delivery and post-natal charges.

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If you don’t have a group mediclaim, then you have to rely on your regular health insurance policy. However, in such plans, the insured values for maternity are very low and hardly cover 20-25 per cent of maternity expenses. Hence, only group health cover seems like a good option. As for premiums for group mediclaim, it depends on the profile of the company, the industry, and the associated risk factors.

 

Other factors include the number of employees working there, the age profile of the employees, and the previous health insurance claim ratios pertinent to the company.

 

 

Coverage: It covers maternity expenses incurred in a hospital/nursing home to the limit of the sum insured or Rs 50,000, whichever is lower.
Note: The holding period is nine months and is available in the form of a group policy.

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Coverage: It covers pre-natal, hospitalisation, delivery charges and post-natal expenses with specified ceilings. For a sum assured of Rs 3-5 lakh, the ceiling on the normal delivery is Rs 15,000, caesarean delivery Rs 25,000 (including pre/post-natal limit of Rs 1,500 and new-born limit of Rs 2,000).

Note: Six years of holding period for easy health and four years for easy health family.

 

Coverage: Covers maternity expenses under OPD only in the health advantage plus plan, which is up to Rs 8,000. The premium for the policy is Rs 15,000, which covers expenses under a regular mediclaim policy for up to Rs 2 lakh.
Note: Most maternity expenses other than the OPD benefits are excluded.