If you are planning a baby, your employer's health insurance may not cover all your hospital expenses. Even if your company offers health insurance worth Rs 5 lakh or Rs 10 lakh, you may still have to pay a large part of the delivery bill yourself.
This is because many employer health insurance policies have a separate limit for maternity expenses. The insurer will pay only up to this limit, even if your total health cover is much higher.
Your total health cover and maternity cover are two different things. The total health cover is the maximum amount available under your policy, while the maternity limit decides how much the insurer will pay for eligible childbirth expenses.
Suppose your employer provides health insurance worth Rs 5 lakh, but the maternity limit is Rs 50,000. If your hospital bill is Rs 90,000, the insurer will pay up to Rs 50,000, depending on the policy terms. You will have to pay the remaining Rs 40,000 yourself.
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Even if your employer-provided health insurance has Rs 4.5 lakh in unused coverage, you may not be able to use it to pay for childbirth if the policy has a separate maternity limit. This makes it important to check the maternity benefit rather than relying only on the total sum insured.
The terms of maternity cover are especially worth checking if you are planning a pregnancy and considering a job change. Some group health insurance policies impose a waiting period before maternity expenses can be claimed, depending on the agreement between the employer and the insurer.
Your health insurance may become active as soon as you join a company, but maternity benefits may not be available immediately. Before switching jobs, check whether the new policy has a waiting period and when you can start claiming maternity expenses.
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Newborn medical expenses are another important factor to check before delivery, as health insurance policies may cover a baby from birth subject to specific limits and conditions. The coverage may also be restricted to a certain period, depending on the policy.
Employees planning to use their company's health insurance for childbirth should review the policy schedule and Customer Information Sheet (CIS) to understand the benefits available and the conditions attached to them.
The Insurance Regulatory and Development Authority of India (IRDAI) advises policyholders to check key details such as coverage limits, waiting periods, deductibles and exclusions. The CIS outlines these provisions and helps policyholders understand the terms of their coverage.
There are six key aspects to check in an employer-provided health insurance policy: the maternity coverage limit, coverage for normal delivery and C-section, waiting periods, pre- and post-natal expenses, newborn coverage and the family members covered under the policy.
The benefits available depend on the group insurance plan negotiated by the employer with the insurer. As a result, maternity and newborn coverage can vary from one employer to another.
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