Maternity cover: I am 32-year-old and I am looking to secure additional maternity coverage. What should I do?

I am a 32-year-old female who is looking to secure additional maternity coverage. Unfortunately, my current insurance plan, HDFC Optima Restore, does not include this coverage. My corporate insurance policy has a limit of Rs 50-75,000 depending on the type of delivery, and my husband, who is 30 years old, is in the process of transitioning to a new job, so we are uncertain about the insurance benefits available to us through his new employer.

Given the rising expenses and uncertainties associated with pregnancy complications, we are concerned about the financial implications of planning for a pregnancy. We have sought advice from the Ditto insurance team, who recommended dropping the maternity cover due to the waiting period. However, we are both open to waiting, as we are currently focused on saving before starting a family. What would be the best solution for us in this situation?

Advice by Nikhil Kamdar, Appointed Actuary, Go Digit General Insurance

First of all, congratulations on planning to extend your family and actively thinking about your health insurance needs. Given your current lack of adequate maternity coverage and the uncertainties surrounding your husband's new employment, it's crucial to proactively address this gap.

Employer health coverage and benefits can vary from company to company. Therefore, it is important for your husband to understand the employee benefits related to health insurance offered by prospective employers, including maternity coverage and its limits. He should also inquire about whether you, as his spouse, would be covered under their health insurance policy. Normally, employer-sponsored health insurance coverage begins immediately without a waiting period. If your husband secures a new job before the maternity event and you are covered under their health insurance plan, your maternity coverage will expand as you can utilize both employer covers.

The cost of maternity hospitalisation usually ranges from Rs 70,000 to Rs 1 lakh. However, in recent years, costs have been increasing, with some hospitals charging up to Rs 1.5 lakh to Rs 2 lakh depending on the type and location of the hospital. This means that without additional maternity-related coverage from your spouse's insurance policy, you may have to pay significant out-of-pocket expenses. In addition to covering the cost of delivery and hospitalization, a maternity cover typically includes pre- and post-natal care, medical tests, medications, and newborn baby expenses up to a certain period.

Before you decide to opt for a health plan with maternity coverage, there are two things you need to keep in mind. One, any health plan that comes with maternity coverage is typically more expensive. Two, maternity covers typically have a waiting period ranging from 3-4 years. This means you can only avail the maternity benefits in your plan only after 3-4 years or as stated in your policy. 

If you are planning to start your family in a couple of years, you can look at plans that have a reduced waiting period of 9 months or 1-2 years. However, do keep in mind that such plans could be expensive. Also, check on any capping by the insurer for maternity-related expenses. If the maternity coverage is affordable, you can utilize both your group medical cover and personal health insurance plan to make a claim and comfortably cover the medical expenses.

You can also look for plans with "maternity wallets". A key advantage of these plans lies in their unique 'wallet-based' maternity benefit structure. The sum insured within this 'wallet' gradually increases with each claim-free year. For instance, Digit's early start plan offers maternity benefits with a 9-month waiting period and a maternity wallet that receives a Rs 10,000 boost annually if no claims are made. This escalating coverage provides valuable long-term benefits and are typically more affordable compared to other health insurance plans with similar 9-month maternity waiting periods, making them a cost-effective option.

Keep in mind that health insurance is typically needed to protect you from any big unforeseen health emergency. While maternity benefit is good to have in a health plan, don’t ignore the other key aspects when buying a health insurance plan. Prioritize a comprehensive personal health insurance plan with a high sum insured of at least Rs 10 lakh as a cornerstone of your coverage strategy. This plan should ideally have no limits on room/ICU rent, no co-payment, good cumulative bonus and consumables cover. It should also come with good pre- and post-hospitalization coverage and should not have any zone-based restrictions.

Before choosing a health plan with maternity benefits, do a cost analysis of premium and coverage offered. As you are currently planning to wait and focus on savings, evaluate if the additional maternity expenses you are anticipating can be covered through your savings. If a health plan with maternity cover feels more optimal, opt for the same that comes with comprehensive health insurance coverage.