A group insurance policy is a blessing for employees. It is one of the features that many employees value the most is maternity cover. Depending on the features covered within the group insurance policy, maternity benefits may be offered.
However, many companies may not offer this coverage as it can increase the overall premium payable to the employer. Also not all the employees may require this benefit. Here we see the difference between maternity benefits offered under group insurance health plans and personal health plans.
Maternity Benefit Coverage under Group Insurance Plans:
Maternity benefit offered under a group insurance policy is often restrictive and limited as compared to personal health insurance plans. Under the group insurance scheme and individual plans, the maternity sum assured is lesser than the total sum assured of the plan. There are no standardised coverage specifics. The extent of coverage in this regard would depend on the preference of the employer. However, in Group plans, it is usually capped at Rs 50,000. It can be Rs 1 lakh for a maximum of 2 children.
Also, the maternity sum assured is different for normal deliveries than Caesarean deliveries. Caesarean deliveries is in sync with the medical cost incurred in any hospital. Usually, insurers offer a higher limit for caesarean deliveries as it is more expensive. It is due to the involvement of a surgical procedure.
The employer has the power to determine the extent of coverage that can be provided under the maternity benefit. It is often a generic coverage which does not cover all costs associated with maternity as the employee’s requirements, and local maternity-related expenses. It is not evaluated to provide coverage accordingly.
Individual health plans can provide additional maternity coverage with pre and post-hospitalisation benefits. It comes along with pre and post-natal coverage of the newborn child along with vaccination up to 12 years of age.
Complications and exceptions coverage under maternity benefit:
Typically, late or difficult pregnancies and related coverage such as treatments, miscarriage, etc. may or may not be covered under group insurance policies. It depends upon the employer if the group insurance policy availed will offer cover from day 1 for the newborn baby. Fertility treatment and emergency or lifesaving abortions also may not be covered under the standard policy.
The employer may also opt for co-pay wherein a part of the expense would be covered practically using the group insurance policy. Meanwhile the balance would be payable by the employee.
However, under personal health insurance, the extent of coverage can be as desired by the insured. However, for maternity coverage under the personal health insurance plan, you have a waiting period. Any feature coverage addition in a personal health insurance plan would come at a cost. Many coverages would be covered at a substantially higher cost when compared to the coverage offered under the group insurance health plans. These are maternity-related complications, pre-existing diabetes, hypertension, emergency miscarriage, and newborn coverage. Even in your health insurance, you can opt for co-pay wherein you will have to pay a part of the medical expense incurred.
Waiting period:
Under the group insurance health plans, maternity benefits if availed will be offered from the first day or maximum after 9 months from the date of joining. The entire waiting period is usually waived off in the case of a group insurance scheme for employees. This essentially allows the employee to claim maternity benefits as required immediately after availing of the group insurance policy. This is one of the key benefits offered by a group insurance policy.
However, maternity coverage under a personal health insurance policy has a waiting period ranging between 2 – and 4 years. Hence, it becomes necessary to plan for personal health insurance at the time of the wedding itself. This will ensure that your waiting period is over by the time you are ready to start your family.
In a nutshell:
If you have plans of going the family way, then check if your employer provides ample maternity coverage. Evaluate the coverage from all angles and assess if it would be sufficient. In case there is a need for personal health insurance with maternity benefit. Then you may have to include the waiting period whilst planning for the same. It is important that you compare products and understand the inclusions/exclusions. Also, assess the waiting period and chooses the one that aligns with your needs in the most seamless manner. To know more such plans in detail visit https://www.oneassure.in/