Group Health Insurance

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Maternity benefits in group health insurance

One of the features that young employees value in group health insurance is the maternity benefit. This post explores what makes this feature so appealing to employees.

Maternity sum assured

Group insurance policies for young groups typically carry maternity benefits. A group mediclaim policy specifies something called maternity sum assured, which is different from the overall sum assured. The maternity sum assured differs for normal and Caesarean-section (C-section) delivery. Generally, companies provide a higher sum assured for a C-section delivery.

The market average is Rs 25,000 for normal delivery and Rs 35,000 for a C-section delivery. While most insurance companies limit the benefit to Rs 50,000, some provide as much as Rs 100,000. HR managers should carefully evaluate the needs of employees, the local maternity healthcare costs, and negotiate appropriate maternity sums assured.

Waiting periods

Some individual medical insurance policies that offer maternity benefits have a waiting period of three to four years. However, the waiting period is usually completely waived off in a group health insurance. This means that employees can avail of maternity benefits immediately with no waiting at all.

Late pregnancies

Late pregnancies (35 years or above) are usually covered under a group health policy. Such policies can also cover excessive vomiting in the first trimester (hyperemesis gravidarum). With late pregnancies becoming the norm nowadays, it would be helpful for employers to negotiate cover for the same.

Cover for new-born babies

Another advantage of a corporate health insurance plan is that you can customize it to include cover for newborn babies. It is fairly common for newborn babies to be kept under observation immediately after birth. This would incur medical expenses. A standard policy does not cover newborn babies until they are 90 days old (some companies might increase this to 150 days).

However, as an employer, you can customize this to offer cover from day one. You can fix the sum assured for the baby’s care between 0 and 90 days as the maternity sum assured or the sum assured available to the employee. Ideally, you should choose the higher sum assured so that employees can deal with any complications.

Cover for abortion

Most group medical insurance providers cover emergency or life-saving abortions. However, they do not cover self-inflicted or voluntary abortions. Similarly, insurers do not usually cover fertility treatments. By paying some additional premium or negotiating with the insurer, you can also offer cover for fertility treatments. However, it is very difficult to cover voluntary abortion treatments.

Cover for internal congenital disease

Typically, individual and group health insurance exclude treatment for internal congenital diseases detected in babies. However, organisations can waive off this exclusion and get it covered in a group medical insurance policy. But nearly all insurers tend to exclude external congenital diseases.

Co-pay on maternity

Some organizations select a co-pay option for their group health insurance plans to reduce the cost burden. However, insurers do not generally apply co-pay on maternity claims since the benefit is already capped. Organizations must, however, ensure that insurers clearly specify this in the policy terms, since ambiguity can lead to claim disputes and employee dissatisfaction.

Other benefits

Unlike individual health policies, group health insurance plans offer cover for:

  • age-related complications in delivery
  • hypertension due to pregnancy and gestational diabetes
  • pre-existing diabetes or hypertension
  • higher chances of Caesarean delivery due to uterine inertia
  • miscarriage occurring in the second or third semester

Case study: No waiting periods 

Within a few months of joining JN IT, Ruchika got married. About a year later, she was pregnant. Her employer offered group health insurance which included maternity cover up to Rs 50,000.

Read More: Should You Include Dependent Parents of Employees in Group Health Insurance?

However, Ruchika and her husband decided to invest in individual health insurance with maternity benefits to cover any expenses that the group insurer might not cover. But they were shocked to learn that there was a waiting period of three years before the individual health insurer would cover maternity.

Thankfully, Ruchika’s group health insurance had no such waiting period and covered not only her normal delivery expenses of Rs 45,000 but also the cost of vaccination and consultation charges for her daughter. As the little girl was underweight, she had to stay in hospital for a few days and the insurer covered expenses related to this as well.

Case study: Cover for late pregnancies

Meghna works with NS Software Company. Dealing with different family responsibilities meant that she was 36 when she finally married.

Read More: How Many Times can you update the Employee List in Group Health Insurance?

Since Meghna had a late pregnancy, she was sceptical about maternity coverage. However, her HR department told her that the office offered maternity cover under a group health insurance policy that was for all employees, irrespective of their age. In addition to covering her delivery expenses, the group health insurance would cover her baby as well.

Accordingly, when Meghna gave birth to her daughter, a lovely little child, her group health insurance provider covered all her maternity expenses. Her daughter was also automatically covered under the group health policy.

 

Given the many reasons why maternity benefits in group health insurance are an appealing feature of the policy, you might want to consider adding them. To make sure you pick a corporate health insurance plan ideally suited to the demographics of your group, get assistance from SecureNow, an experienced insurance broker. Click here to get an instant indicative quote with or without maternity benefits.

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