Buying Health Insurance for Maternity Benefits? Think Again!

Health Insurances 204 views

Buying a health insurance plan, which also covers maternity expenses, sounds really nice and exciting. Everyone who is buying a group or family health insurance always looks forward to more benefits. You want to avail maximum benefits on your health insurance. Most of the companies try to sell their health insurance policy by highlighting such add-on cover, that tempts more people to buy a policy. If you are planning to have a baby soon and thinking that after buying a health insurance you can easily cope up with the increasing cost of health care facility and maternity related pre and post expenses. This could be a good option if you have a policy from last three or five years, which covers the maternity expenses. But, if you are a first-time buyer of health insurance policy and you are planning to get maternity benefits via your policy, think again before buying. Here are some important factors, which could help in making the decision about buying a health insurance policy for availing maternity benefits.

Waiting period/lock-in period cost: After you buy a health insurance policy, the coverage for maternity does not start from the day one. The minimum waiting period for such policies is one year and maximum 5 years. Moreover, health insurance with maternity benefits is always costlier than the regular health insurance. Insurer looks at maternity cover, as a high-risk product, as the claim ratio is high and can even be 100%, unlike other insurance products.

Most insurers bundle it with premium policies. To sell the deal on a sweeter note, they put no caps on different features such as room rent, cover for outpatient department consultation, payment for dental procedures and so and so forth. If you are above 40 years of age, so you should not get bothered about the maternity benefits, rather focus on other benefits such as accidental cover, benefits for critical illness and hospitalization. For instance, Ramesh has taken a health insurance policy that also covers maternity. He is paying Rs. 20,000 as a premium of the health insurance policy. The upper cap to claim the maternity benefits is Rs. 50,000. But, there is a catch in the situation as he can't claim the benefits before 3 years.

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This way, he has paid the sum:
Rs. 20000 for 3 years:
20,0000 X 3= 60,000
Total amount paid as policy premium in 3 years: Rs. 60,000
Premium amount-maternity cover: Rs. 60,000-Rs. 50,000= Rs. 10,000

He has not made any claim for other health care facilities during that period and claimed only maternity benefits after 3 years. So, this way he paid Rs. 10,000 extra to claim the benefits of Rs. 50,000 for maternity cover. It is really necessary to calculate the premium with such add-on cover to get the actual scenario.

Restrictions and exclusion: The exclusion and restrictions are mostly based on the sum assured. Generally, insurers don't cover pre and post hospitalization and other charges. This means all visits to the gynaecologist, ultrasound procedures and other illness due to pregnancy can't be claimed. Moreover, none of the plans cover voluntary abortion or in-vitro fertilization procedures. There are very few companies, which cover pregnancy termination, due to complications. The claim cost of maternity cover varies from city to city and insurer to insurer. The maximum limit to claim the amount might range between Rs. 40,000 to Rs. 2.5 lakhs for elite policies.

Should you really buy the policy or not?

If you are buying the maternity plan just to get the maternity benefits, it is not advisable to buy it as you will end up paying a high premium for your health insurance policy than the regular health insurance policy. There are chances that your entire treatment cost would not be covered due to the upper cap linked with maternity cover. It metro cities the upper cap to claim the benefits is Rs. 1 lakh for the cesarean. So it is a good idea to buy a health insurance policy if you are buying it for other health care reasons. If you are getting the maternity cover in your group health insurance from your employer it is better to claim that as there is the lock-in or waiting period is shorter than buying health insurance policy individually. There are companies which offer good health insurance that covers pre and post maternity expenses as well.

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