A.#1: What is covered under maternity benefit in India
The definition of maternity expense is a part of the IRDAI’s Circular on Standardised Definitions issued in 2013, so all insurers need to follow this uniform definition. It essentially includes any hospitalisation traceable to child birth, and also includes medical termination of pregnancy and pre/post-natal expenses. Maternity expense includes the following expenses:
- Maternity related hospitalisation – pre-hospitalisation expenses are covered up to 30 days prior to delivery and will also cover post-hospitalisation expenses up to 60 days
- Delivery including Pre and post-natal expenses – Maternity insurance covers expenditure related to both caesarian and normal delivery, as well as post-delivery complications for the mother
- Hospitalisation costs- This usually includes room charges, nurse and surgeon charges, anaesthetist consultation charges, medical practitioner fees, and emergency ambulance charges.
- New Born Baby cover (Day 1-90) – Coverage is also extended to infants in case they are diagnosed with a congenital disorder or some critical illness.
#2: What is the waiting period and what are the sub-limits?
There is a waiting period of anywhere between 2 to 4 years before one is eligible to claim a maternity related claim, with some policies extending this up to 6 years,though this of course varies across insurers. Thus, it is essential to buy maternity cover as early as possible, even if you have no plans of having a baby anytime soon. The only notable exception to plans with such long waiting periods is Religare Health Insurance’s specialised maternity product JOY in which the waiting period is just 9 months. To know more about such plans, check out Features of New Age Health Insurance Plans.
There are specific exclusions applicable to the maternity benefit and some are reproduced below:
- Benefit limit for maternity and new born baby related claim is capped between Rs. 15,000-30,000 for normal deliveries and between Rs. 25,000 – Rs. 50,000 for caesarian births. It may seem insufficient considering maternity costs in A-rated hospitals in metros but can help in reducing the burden of these expenses.
- Age of insured for claiming maternity benefit cover is capped at 45 years.
- Termination of pregnancy within 12 weeks from the date of conception is not covered by the policy.
- Medical expenses on ectopic pregnancy are not covered under this benefit.
The major downside to these policies is the high premium. However, the reason these premiums are higher than that of a regular health insurance policy where there’s a high possibility you may not need the cover, maternity insurance covers an almost certain event, and can greatly help lessen its financial impact. For example, Religare’s Joy Rs. 5 lakh cover for an 18-35-year-old woman would be Rs. 27,039 per annum. However, Joy has a waiting period of just 9 months, which so far is the shortest in the industry! Hence, it is important to do a cost-benefit analysis of these plans before picking the one you want.
Related: 7 Women-specific health conditions that your insurance needs to cover
#5: Tips on buying a policy and planning this expense:
- Do not make maternity cover the sole criteria you consider when purchasing a health insurance policy.
- In case your employer provided plan covers maternity expenses, claim from that policy without touching your own policy. This will also allow you to preserve the no-claim bonus.
- Additionally, if the cost you have incurred exceeds the cover offered by your employer’s policy, you can claim the balance through your individual health policy
- Work at creating your own maternity fund which can be parked in a fixed deposit or liquid mutual fund.
- The insurer will not cover you in such policies if you’re already pregnant and also waiting periods shall apply. Hence, it is important to time the purchase properly
A steep rise in maternity expenses over the years is forcing couples to look for options to fund this expense and hence insurers highlight the maternity benefit feature in their health insurance policies. The couple purchasing these policies should fully understand the scope, exclusions and pricing of these policies and also create a separate medical fund to meet this requirement.
Deduction on Section 80D in Income Tax Act (Tax deduction based on Health Insurance Premiums Paid)
- Deduction on Section 80D in Income Tax Act (Tax deduction based on Health Insurance Premiums Paid). You are allowed to claim a deduction up to Rupee. 25,000 per budgetary year for medical insurance premium instalments. The premium should be for you, your spouse, and dependent children. On the other hand, if there is a chance that either you or your spouse is a senior citizen (60 years or above), the limit goes up to Rupee. 30,000.
- Deduction on Preventive Healthcare Check-ups
You get tax reduction on preventive health check-ups annually. Inside the aforementioned limit of Rupee. 25,000 (or Rupee. 30,000 all things considered) under Section 80D income tax, you can also claim expenses incurred for preventive health check-ups up to Rupee. 5,000 for each budgetary year.
The coverage of alternative medicines is dependent on the particular insurer. Some health insurers cover only Ayurvedic treatments while some cover all of them. There is also a cap on the amount covered which usually ranges from 7.5% to 25% of Sum Assured.
Ayurveda has many treatments which are for rejuvenation of the body which are not covered by the health insurer to avoid any misuse by the insured. The Ayurvedic treatments covered by health insurer are dependent on the health insurer.
Health Insurance Covering Ayurvedic Health Care
Chola MS Advanced Individual Healthline plan covers Ayurvedic therapy treatments up to 7.5% of Sum Insurer and also has 20% co-payment clause.
Star Health Medi Classic plan covers non-allopathic treatment up to 25% of Sum Insured subject to maximum of INR 25,000 per policy period.
Apollo Munich Insure health plan covers alternate medicines under Ayush benefit which includes Ayurveda, Unani, Sidha and homeopathy for amount up to 10% of Sum Insured.
HDFC Ergo Health Suraksha plan also covers Ayush benefits up to 20% of Sum Assured.
Though traditional medicines are being covered by the new health insurance plans, there are still few exclusions. One should verify the treatments covered before buying a particular health insurance policy
A Critical Illness benefit policy provides a fixed lumpsum amount to the insured in case of diagnosis of a specified illness or on undergoing a specified procedure. This amount is helpful in mitigating various direct and indirect financial consequences of a critical illness. Usually, once this lump sum is paid, the plan ceases to remain in force.There are also other types of products, which offer lumpsum payment on undergoing a specified surgery (Surgical Cash Benefit), and others catering to the needs of specified target audience like senior citizens.