Capping in Policy: Maternity Sub limit
Capping in Policy: Maternity Sub limit
The Health insurance plans which include maternity coverage in them come with an in-built sub-limit. For instance, while your total health cover also referred to as the ‘sum-insured’ may amount to rupees 5 lakhs, but maternity expenses will be eligible for a much lower sum, say for either a 70 thousand or an 80. In order to under the rules applied in a health insurance policy basis maternity and maternity sub-limit, you really need to follow the article. And this information is something from which no one should not run away or keep it at bay, because the information on maternity sub-limits will not alone benefit you as an individual but it can help your family and friends too as ‘you’ will be able to suggest the ultimate benefits of maternity benefits in a health insurance policy if anyone is planning to become a parent. and you will also be able to explain the features of ‘maternity sub-limit’ to them!
What is a sub-limit?
A sub-limit is an extra limit applied in an insurance policy. In simpler words, a sub-limit is a monetary cap that an insurance service provider places on your medical insurance claim.
What is a sub-limit in a health insurance plan?
Now, let’s understand the ‘sub-limit’ in a health insurance policy plan. A sub-limit is an extra limitation applied on a medical insurance plan by your health insurance provider/company.
What’s maternity coverage in a health insurance plan?
Well, maternity coverage is the benefit that helps the insured get a cashless treatment or the reimbursement of expenses on account of hospitalization during one’s maternity period.
Is it important to have maternity coverage?
Maternity coverage is as important as ensuring a new family member’s safety and health. It signifies insured’s keen interest to de-risk self and family from any sudden expense on account of hospitalization due to maternity.
Now the question arises which is the best health insurance plan for maternity coverage amongst the two,
Upon this subject, Plan Cover suggests a wise potential customer to carefully check the benefits or as they say “inclusions” while buying the policy. This is where a Group Health Insurance comes with a host of benefits which may not be possible in a retail health insurance plan.
What are maternity benefits offered in different health insurance plans?
Here comes the answer:
What about the coverage limit of both, C-section and natural/normal deliveries?
The coverage may vary depending whether it is a natural delivery or a C-section.
Is room rent at the hospital covered for maternity?
Yes, the room rented during the maternity process lays under the policy, hence it is covered. It is to be noted that room rent limits are as per those applicable for normal hospitalisations within the specific terms and conditions of the policy. In case the patient avails for a higher than entitled class of room as specified in the policy, then the difference of the ‘room rent’ will be borne by the insured and not the insurance company.
Are the medical expenses pertaining to pre hospitalization and post hospitalization due to maternity, covered in the insurance plan?
The expenses pertaining to OPD and medicines are covered in most of the insurance plans. But the coverage is for 30 days prior to hospitalization for maternity(prenatal) and extends up to 60 days’ post hospitalization(post-natal).
Is hospitalization before delivery date due to complications during pregnancy covered?
Not only the child but even the mother is covered in the maternity section of the insurance policy as she is a part of the childbirth process. In case, other treatments are required by the mother during the pregnancy period/before delivery will be covered. But diseases or illnesses unrelated to maternity like COVID-19, dengue, chikungunya, high fever, dehydration, jaundice, kidney issues, heart issues, blood pressure, HTN, DM, anemia, thyroid and others are not covered under maternity terms, henceforth, their expense can be paid outside the maternity limit of the same policy.
Is hospitalization after the delivery resulting from post-delivery complications, covered?
As mentioned before, according to the pre and post-natal coverage, hospitalisation within 60 days’ of delivery due to complications after the delivery of the child will be paid by the insurer.
If in case, pre and post-natal coverage is not there in the health care policy then complications related to maternity will not be covered. For insurance, in case of natural delivery if the mother catches UTI or any other complication due to giving birth then such will be covered under post-natal terms in the policy. Similarly, in case of C-section delivery if sutures develop infections then it will be covered only if postnatal coverage is there. Therefore, these pay pits are dependent upon specific clauses of the policy’s terms and conditions as there are limits defined for pre and post-natal treatments.
Is premature delivery’s expense covered?
Yes, the expense is covered in case of premature delivery. The costs will be limited to maternity capping only as per the rules in the policy.
Capping in Policy Maternity Sub limit
Capping upon Maternity Cost: Maternity is normally not covered in a retail health policy and has a waiting period of 9 months to it. Some policies even have a 3-year waiting period or lesser. Whereas, a group health policy will allow claim from Day-1 of the policy inception, which is not possible in a retail health policy. The logic is that from the date of inception of the policy, the retail insurer wouldn’t be able to make good business if waiting period is deducted. Therefore, maternity coverage is not possible from day-1. 9 month waiting period means that if there comes a claim of maternity in this period it will not be covered. However, for the group health insurance wherever we pay an extra loading on the premium – this 9-month waiting period is waived off.