Maternity cover under group plans more beneficial

But it would be wise to set aside a corpus in case of late pregnancy

With the average maternity age on the rise, most consumers are opting for individual covers. General insurers say there has been a sharp rise in demand for such covers in the last six-nine months.

“More people are buying individual covers because the average maternity age has increased to 32-33 from 27-28 years. As a result, pregnancy-related complications have increased,” says Amit Bhandari, vice-president, health underwriting and product, ICICI Lombard.

However, individual policies may not be the only solution for people seeking this cover. Group health policies being offered by companies also cover maternity-related issues. And, there are several advantages.
 

ADVANTAGE GROUP POLICIES
Claim can be denied by individual policies in case of

• Age-related complications leading to delivery
• Pregnancy-induced hypertension, gestational diabetes 
• Already suffering from hypertension or diabetes 
• Uterine inertia leading to higher chances of instrumental or Cesarean delivery 
• Miscarriage in the second or third trimester

For one, the waiting period is much lower, at 9-12 months. For other insurance plans, the waiting period is much higher. Apollo Munich’s policies require a waiting period of six years, Max Bupa has a waiting for two years and for Oriental Insurance’s policy it is 12 months. Besides, there is a mandatory waiting period of 30 days applicable to all policies.

Then, follow prices or premiums. Most players bundle maternity cover with a health plan for individual policies. These include Apollo Munich, Max Bupa and Oriental Health Insurance. Only Star Health provides maternity cover on a standalone basis.

Most maternity covers, which come as part-bundled policies, provide limited cover of Rs 1 lakh or less. Max Bupa’s Heartbeat Gold Policy provides a sum assured of Rs 10 lakh, but the maternity cover is only Rs 50,000. The premium of the policy is Rs 19,042. A Star Health standalone policy would cost you an annual premium of Rs 18,550 for Rs 3 lakh cover and Rs 19,335 for Rs 5 lakh. On the other hand, under employee group policies, one will be able to get refunds for most expenses by paying a small premium.

In the case of individual policies, there are other surprises as well. Though claims cannot be denied if once the cover has been bought, there might be situations in case of late pregnancy (35 years and above) where the insurer refuses to pay.

Says Neeraj Basur, chief financial officer (CFO) of Max Bupa Health Insurance, “We cover complications arising out of (delayed) pregnancy, provided it warrants 24 hours of hospitalisation. But if such complication requires the patient to deliver a child, normally or through Cesarean then,such hospitalisation is not covered.”

Maternity benefits might also be declined in situations like stress due to hyperemesis gravidarum (excessive vomiting) in the first trimester, which is more likely for an elderly pregnancy. Pregnancy-induced hypertension or those who already have hypertension or diabetes may also be denied maternity benefits.

In the later case, increasing age may aggravate hypertension or problems related to diabetes during pregnancy. There are several other situations like this where an individual policy may fail to deliver.

However, many cover miscarriages, but only if it happens in the first trimester. And some like Max Bupa may “cover maternity expenses related to termination of pregnancy if it is medically necessary”.

Given the costs and complications that women with late pregnancy are likely to face, it makes sense to be covered under the group health plans for maternity-related benefits. However, if you are not working in a company, set aside a corpus that you can dip into for expenses.