Mumbai-based software consultant Revati Pradhan developed some complications in the last trimester of her pregnancy. She was undergoing a lot of stress due to anxiety about her first delivery and a high-pressure job. Her blood pressure had also shot up. Despite the doctor's warning, Pradhan wasn't able to relax. Result: A premature delivery.
As the baby was weak, it needed incubation and some extra care. Then, the baby got jaundice. When both the mother and child were discharged after 15 days, the hospital bill was huge. While Pradhan got a part of the hospital bill reimbursed through her family floater plan, the expenses due to the baby's hospitalisation were left out.
|NO CHILD’S PLAY|
How to cover
Newborn babies can be covered under family floater plans but only after informing the insurer. "Insurers provide coverage for a newborn baby right after its birth but only upon notification. Upon intimation of the new family addition (submission of proposal form) and payment of additional premium, a newborn baby can be covered under a family floater plan," says Antony Jacob, chief executive officer of Apollo Munich Health Insurance.
However, for being covered under family floaters, a child needs to be at least three months or 91 days old. The mid-term inclusion is also allowed for the remaining policy period.
Otherwise, some health insurance companies cover newborn babies right from birth, under maternity benefits. The newborn child of an insured mother would be covered under the policy from day one for the expenses (subject to certain limitations) incurred for treatment. Such a policy covers medical expenses for newborns from day one on payment of an additional premium, only when the maternity expenses are incurred under the same policy, adds Jacob.
If not, parents can get coverage for their babies under their existing policy after 91 days. A newborn baby or a 91-day baby can be covered only in a parent policy and not on a standalone basis. One can also include the newborn in the existing individual health plan at the time of renewal or during the policy period, in line with the terms and conditions of the insurer, says Sanjay Datta, chief-underwriting & claims, ICICI Lombard.
An easier way for salaried parents would be to get the child covered from day one under group mediclaim policies, as these are tailormade ones, says Renuka Kanvinde, assistant vice-president, health insurance, Bajaj Allianz General Insurance.
Star Health Insurance's Comprehensive Insurance Policy offers Delivery and Newborn Cover. Here, the insurer covers the delivery charges (normal or caesarean section, including pre-natal and post-natal expenses up to the limits specified); the newborn is automatically covered (including internal and external congenital problems), and vaccination expenses for the newborn (up to Rs 1,000).
This benefit is available after 36 months of continuous coverage under this policy with Star. For a Rs 25-lakh policy, one would have to pay an annual premium of Rs 23,742.
Cigna TTK Health Insurance also covers maternity, new-born expenses and vaccination cover. It provides a coverage up to Rs 50,000 for normal delivery and Rs 1 lakh for a C-section. Maternity coverage will be available after 48 months of enrolment. If your newborn is in need of hospitalisation, the company will cover the expenses of medical treatment up to the sum insured under the maternity coverage.
For Cigna TTK's ProHealth Preferred Plan, a sum assured of Rs 50 lakh will cost Rs 42,351 a year.
Under Bajaj Allianz Health Care Supreme, a newborn child is covered up to 90 days of his age, under maternity sections, with the sum insured limit up to Rs 1 lakh. "Under Apollo Munich's Easy Health policy, coverage for newborn is up to the maximum sum insured available, that is Rs 50 lakh, and the premium levied would be approximately Rs 15,700," says Jacob.
Still, most health insurers prefer covering babies who are at least three months old. Reason: "This is primarily due to the cost attached to the premium. Usually, the incidence of hospitalisation for a newborn is higher and, therefore, there is a proportionate cost implication," says M Ravichandran, president at Tata AIG General Insurance.
Additionally, considering the mortality and morbidity ratios in newborn babies during the first few months of life, due to adverse health conditions, insurers prefer covering babies post 91 days. Every year, nearly 41 per cent of all under-five child deaths are among newborn infants, babies in their first one to two months of life or the neo-natal period, adds Kanvinde.
There is no specific exclusion for babies. Usually congenital ailments (birth defects) and expenses on preventive care (vaccinations, etc) are excluded. Health insurance would typically provide cover for hospitalisation due to ailments. Hence, any ailment that does not require hospitalisation or is preventive in nature or is only for diagnostic purpose is excluded, says Ravichandran.
Apart from pre-existing diseases, Star Health Insurance excludes treatment arising from or traceable to pregnancy, miscarriage, abortion or complications, other than ectopic pregnancy.
If you pay additional premium, Cigna TTK will reduce the waiting period for maternity expenses from 48 months to 24 months from the date of inception of first policy. A newborn baby cover and first-year vaccinations will follow a reduction in waiting period.