Can a maternity cover taken with health insurance help cut costs? – Mint

(On a personal note, my wife and I will be welcoming our firstborn in April. We are not worried about any exorbitant inpatient department (IPD) costs. Our health insurance policy will cover most of the hospitalization expenses as it has a maternity insurance cover. We have already spent around ₹75,000 in outpatient department (OPD) treatment, including on regular doctor visits, diagnostic tests, covid RTPCR tests, etc. Yet, our policy may not cover the entire OPD hospitalization expenses. It will only cover pre-hospitalization costs of 30 days and post-hospitalization costs (for up to 90 days). Besides, the overall costs will be subject to a maximum limit of ₹50,000, including IPD costs. Nonetheless, we would save around 50-60% of the total maternity costs.)

So, choosing the right insurance policy is the first step towards cutting hospitalization costs. For instance, a husband and wife having separate health cover with maternity insurance could save more as both can make claims from their respective policies.

“In indemnity-based policies, you can claim from multiple policies up to the expenses or losses incurred, of course, subject to the terms of the policies. Hence, if both parents have maternity cover in their employer’s policies, they should be able to claim from both these policies,” said Mahavir Chopra, founder and CEO of Beshak.org.

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Since the cost of healthcare is climbing sharply with each passing day, health policies with maternity cover can help you save on hospitalization costs. Naval Goel, founder and CEO of PolicyX.com, said that expenses are very high these days in view of the rising inflation. These policies help families bear the cost of various things associated with childbirth and the newborn’s medical expenses.

“However, as these policies come with a mandatory waiting period, it is imperative to carefully choose the maternity insurance so that the policyholders can benefit,” he said.

Waiting period: It is a period during which the insured cannot claim some or any policy benefits from the insurer. This duration varies from insurer to insurer and policy to policy, but the typical waiting time for such a policy with maternity cover ranges from 9 months to 4 years. “For instance, Care Health Insurance offers a policy called Joy Today, where the waiting period is nine months. But it is a three-year policy, which means you have to pay a premium for three years in one go. Hence, it is quite important to check your policy’s waiting period before claiming any medical-related expenses,” said Goel.

Policy coverage: Health insurance with maternity cover generally includes normal and caesarean delivery. It can come both as a standalone policy and as an add-on cover along with the base health policy (by paying some additional amount). Typically, a health insurance policy with maternity cover includes the hospitalization expenses during both pre-and post-natal stages, newborn expenses (up to 90 days), daycare treatment, vaccination expenses of the newborn, ambulance expenses, cashless claim facilities, etc. However, this coverage entirely depends on the type of policy and insurer you select, and hence it might vary.

Rakesh Goyal, director of Probus Insurance, said, “Some of the common exclusions under this kind of health coverage are pre-existing diseases that could probably affect pregnancy, treatment expenses related to infertility, any medicinal expenses out of the treatment purview, pre-natal and post-natal expenses with no hospitalization, expenses involved in harvesting or storing stem cells, etc.”

Adding to this, Abhishek Misra, CEO and principal officer of Bonanza Insurance, said, “Women who are already pregnant are not eligible to buy these policies. Besides , those not falling in the age group of 18-45 years also cannot purchase such policies.”

Sub-limits: Under the sub-limit clause, your insurance will only bear a fixed amount of the expense for certain procedures. In other words, a sub-limit is a monetary ceiling that your insurer imposes on your medical insurance claim for specific coverage. They are often represented as a fixed amount but may also be expressed as a specific percentage of the entire sum insured. Goyal said, “Most insurers usually limit their maternity payouts. Generally, the sub-limits for normal deliveries range from ₹15,000 to ₹25,000, whereas for caesarean this is anywhere between ₹25,000 and ₹50,000 (it can vary based on the type of policy and insurer).”

Policy cost: The cost of such policies depends on certain factors such as the type of insurance, age of the policyholders, area pin code, sum insured, etc. However, Goyal said, “The premiums of such covers are mostly on the higher end since the certainty of claim filed is high under this cover. You must do proper research and compare the options available online to find the ideal policy that could fit both your needs and budget.”

So, when you decide to buy such coverage, you should undertake a detailed cost-benefit analysis between different policies offered by various insurance providers.

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