Mr. Antony Jacob's Interview in NDTV

Take Maternity Coverage with Low Waiting Period

While buying health insurance, the policyholder mainly compares the features available under various products and premium payable for each one of them. In the past few months one distinct feature that has come to fore is the maternity coverage. Although all insurers under their retail product lines do not provide this, it is being provided by all three standalone health insurers, Star Health and Allied insurance company (Star Wedding Gift Insurance Policy), Apollo Munich Health Insurance Company (Easy Health Family Floater Exclusive and Platinum Plan) and Max Bupa Health Insurance Company (Heartbeat Family Floater Plan).

An FCRB analysis reveals whether taking a health insurance policy to get coverage for maternity expenses is practical or not. As it turns out it is beneficial if the waiting period is low and the extra premium paid by the policyholder is not too high.

FCRB found out the estimated child delivery expenses of few hospitals in Delhi and compared them with the actual premium being charged by these insurers.

The charges in economy accommodation for a normal delivery at DR Maternity and Nursing Home in north-west Delhi are around Rs 18,000 to Rs 22,000 while the charges go up to Rs 25,000 to Rs 30,000 for the caesarean delivery. Sri Balaji Action Medical Institute in west Delhi, charges about Rs 17,000 to Rs 20,000 for normal and Rs 24,000 to Rs 27,000 for caesarean. BL Kapur Memorial Hospital in central Delhi, charges around Rs 20,000 to 22,000 for normal and Rs 35,000 to Rs 37,000 for caesarean. Holy Family Hospital in South Delhi, charges around Rs 12,000 to Rs 14,000 for normal and Rs 24,000 to Rs 28,000 for caesarean. In these charges, the expense for medicine, room charges, doctor’s fees, dietician and pediatrician’s fees, medical investigation charges, operation theatre charges and nursing expenses are included.

In order to get coverage for maternity and delivery charges, one has to opt for family health insurance policy and wait for a few years before becoming eligible to claim the same from the insurance company.

Apollo Munich has the longest waiting period of four years, while in Star Health it is three years. In case of Max Bupa the waiting period is two years.

The analysis shows that the average premium for a couple of around 27 years of age, the premium for a plain vanilla family health insurance policy with Rs 3,00,000 sum insured comes to Rs 4,700. While the premium comes to Rs 6,167, Rs 7,354 and Rs 11,366 from Apollo Munich, Max Bupa and Star Health respectively for their family health plans with maternity coverage. “The extra premium being charged by insurers to cover maternity is reasonable and is based on actuarial calculations for bearing extra cost of maternity,” said SK Sethi, vice-president of Insurance Foundation of India.

Also, premium for 32-year-old couple, the premium for Max Bupa policy increases to Rs 7,910 while it remains same for other health insurers.

Under the family health insurance policy with sum insured of Rs 3,00,000 the policyholder is allowed to claim upto Rs 30,000 for normal as well as caesarean delivery from Max Bupa, Rs 15,000 for normal and Rs 20,000 for caesarean delivery from both Apollo Munich and Star Health.

Supposing the policyholder has to avail the maternity cover after two years and is insured under Max Bupa, then in that case the extra premium (as compared to a normal health insurance policy) that he has already paid for the cover is Rs 5,308. If the same benefit is availed after four years, then the extra premium paid for Apollo Munich is Rs 5,868, Rs 10,616 for Max Bupa and Rs 26,664 for Star Health. After six years of policy period, the excess premium comes to Rs 8,802 for Apollo Munich, Rs 15,924 for Max Bupa and Rs 39,996 for Star Health. The difference comes to Rs 11,736 for Apollo Munich; Rs 21,232 for Max Bupa and Rs 53,328 for Star Health after eight years of holding the policy.

This clearly shows that Apollo Munich which charges around Rs 1,500 of extra premium on yearly basis, is value for money in long run, however the waiting period is high and coverage for maternity is low.

The extra premium charged by Star Health is highest, the waiting period is also high and coverage for maternity is low.

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