Maternity as Base Cover
One of the biggest responsibilities as a spouse is to be able to protect and provide for your partner and child during exigencies, especially when it is health-related. While an illness cannot be predicted, you can certainly prepare for such contingencies by investing in a sound health plan that secures you financially.
Childbirth, too, should be accounted for when you are deliberating your family's health funding.
As a responsible couple, when you decide on your family health policy, you should determine whether or not maternity-related benefits are included in the features. These are certain critical factors to keep yourself abreast of:
Generic vs Group vs Specific Health Policy, and Maternity Benefits:
A generic health policy is an individual policy that you and/or your spouse have taken in your name. Adding your spouse to the health plan will make it a family floater policy. Group health policy is applied by your employer for its employees. In both cases, depending upon the type of policy applied for, it may or may not cover maternity-related expenses. In some cases, the insurer offers maternity benefits as an additional offer, or as part of a superior variant of, or top-up on the same plan.
A specific health policy is a standalone maternity-centric plan which primarily covers expenses related to pregnancy, delivery, and postpartum care. These could include delivery and hospitalization expenses, postnatal care, infant vaccinations, and related costs. Some policies also offer additional benefits like free health checkups, ambulance costs, etc. up to permissible limits. Certain times these benefits form part of the main health package.
Remember to ask whether or not maternity expenses are covered in the existing or proposed plan, if so what are the basic benefits offered and up to what amount, and what are the additional benefits offered with corresponding limits (whether as an add-on feature or as a top-up).
Rider V/S Top-up: Many insurers offer maternity benefits as a rider or an add-on feature in the health insurance plan, as explained above. In certain other cases, these features are offered in the superior variant, or as a top-up, of the base insurance plan.
Remember that depending on your budgeted premium amount and expected maternal benefits you could go decide on either getting a base health plan with maternity benefits as a rider, or as a top-up plan, or as a standalone health plan.
Waiting Period: The waiting period in health insurance means the period between issuance of policy and the date by which maternity expenses can be covered. In most cases, the waiting period is 3-4 years before you can claim maternity-related expenses, provided they are covered under your plan. Say your maternity cover was issued in November 2020, the earliest you can claim expenses would be December 2023 or 2024.
Remember that if you and your spouse are expecting a baby during the waiting period you will not be eligible to claim maternity expenses.
Sum Insured: Sum insured is the maximum amount that the insurer will pay in case of hospitalization, based on actuals, as per policy applied for. This could be for cashless hospitalization (where the insurance company directly pays the hospital) or as reimbursement (where the policyholder submits invoices to claim the amount). Any additional amount will be payable by the policyholder. Hence when planning for maternity opt for a sufficiently high Sum Insured so that the expenses are well within permissible limits. Moreover, should you have multiple claims in any one given year a limited Sum Insured might not cover it? Hence higher Sum Insured is better considering your family's health needs.
Remember to choose a slightly higher Sum Insured to cater to all your family members' medical needs for the entire year.
Sub-limits: Sub-limits are the uppermost ceiling placed by insurance companies on the amount you can claim against a specific medical condition. This could be in the form of a percentage of the sum insured or a particular amount.
Remember that should maternity benefits be an add-on feature in your base insurance plan, do check the sub-limit on the claim amount.
Exclusions: There are some expenses incurred during pregnancy that cannot be claimed under your health plan. Some examples are regular check-ups with your doctor, routine tests undergone, supplements are taken, etc.
Remember to find out what specific types of expenses are excluded from maternity benefits and claims in your health plan.
To make your health planning process simple and stress-free, just log on to Sana.Insure and enter some basic information to have a Sana Expert get in touch with you immediately. Your Sana Expert will assist you in deciding which health policy will best suit your and your spouse's family health financial needs.
Wish you a healthy and happy life!