Due Diligence. Loopholes in maternity plans

If you believe you are fully covered for maternity expenses through your health insurance plan, think again. Despite all the product innovation that the health insurance space has witnessed, loopholes continue to exist in the maternity plans offered to women.  

Insurance companies say that maternity is not an illness, and expect you to plan for it. Well, that’s the underlying philosophy behind the waiting period clause which is typically stretched to between two and six years for such policies.

For instance, maternity expenses incurred before and after child birth procedures are covered under Apollo Munich’s Easy Health Individual Premium after a period of six years. Max Bupa’s Heartbeat Gold, on the other hand, extends maternity benefits after two years’ waiting period. As far as standalone maternity plan is concerned, this waiting period can be anywhere between 9-24 months, as in the case of Religare Health Insurance (JOY).

Several important and critical aspects of maternity are not covered in individual and group health plans — health check-ups during the nine months of pregnancy, diagnostic tests, the new born baby’s critical illnesses and or any complication during or post-delivery.

No coverage is provided for the unfortunate termination of pregnancy (miscarriage/abortion) either. What’s more, even IVF treatments are not covered under individual or group health policies.

You may, however, avail of some benefits should you opt for standalone maternity plan at a higher price.

Besides, mostly, health plans with maternity covers have a cap and if you exceed that cap, you have to pay from your pocket.

If you opt for individual health cover with maternity rider, the premium is on the lower side.

Standalone maternity policy, on the other hand, would cost you dearer as it offers holistic coverage. For example, Max Bupa’s Heartbeat Gold for ₹5 lakh sum insured, with two-year policy tenure, would cost around ₹16,306 for a maternity coverage of ₹40,000 vis-à-vis Religare JOY’s ₹43,815 for a maternity coverage of ₹50,000. (sum insured of ₹5 lakh).

The catch, however, is once you opt for an individual plan with a maternity rider, you can’t get out of it till the end of the chosen term. This might pinch you harder in case you don’t require maternity cover at a later stage. You could opt out of standalone maternity cover at the end of the policy tenure.  But having said that, even standalone plans don’t provide adequate coverage and are much costlier than the individual or group plans.

Many health insurance plans come with a sub-limit. That is, while your total health cover may amount to ₹5 lakh, you can only of avail maternity benefits for a lower amount — ₹15,000-₹30,000 in case of normal delivery and ₹30,000-₹50,000 in the case of Caesarean birth.

Now, this amount may fall short in terms of meeting your actual medical expenses which could be between ₹50,000 and ₹1,50,000, should you opt for treatment in metro cities.

What’s more, insurers look at maternity cover as ‘high-risk’ as it generally involves a 100 per cent claims ratio, unlike other insurance products. Consumers opt for maternity plan with an intention to meet medical expenses. They later port to a health plan without maternity coverage.

Individual health or group insurance policy is often enough for people who undergo normal or straight forward Cesarean delivery. However, this might not be sufficient in case of any complication which demands extended hospitalisation and medical care. This is where even standalone maternity plans fail to come to the rescue.

Though it takes into account any unplanned emergency during delivery or with post-natal care, the product fails to provide sufficient coverage.

Therefore, before choosing a plan, ponder the fact that there is a shift in average maternity age (from 26-35 years), which has led to an increase in complications that women are exposed to during pregnancy.

Assess your situation wisely and choose a plan that fits your scheme of life.

The writer is CEO& Co-founder, Policybazaar.com