Family Health Insurance

Published in Mint on, May 07 2013, Written by Kapil Mehta
Could you tell me if there is a health insurance policy that covers delivery procedures at a private hospital? My wife is in her sixth month of pregnancy.

Insurers will cover a risk or an event only if there is some uncertainty around the event or risk. In your case, there is no uncertainty as your wife will deliver a baby soon and incur maternity expenses. Therefore, insurers will not cover this pregnancy in an individual health insurance policy. Perhaps the only way your wife’s imminent delivery can be insured is if your company has a group medical insurance, where maternity waiting periods are waived off. This is a fairly common benefit provided to company employees.
Many health insurers cover maternity provided you have continuously had a health cover for two or three years. This means that you can cover maternity expenses of a future child by buying the insurance several years in advance. An important consideration when you buy health insurance is the cap, if any, on maternity expenses. I prefer product designs that do not impose restrictions on maternity claims.
I have health policies with two private sector general insurance companies. I recently got operated for cataract at a clinic. Will this be covered under the policy since the operation was done at a clinic? I have all the original bills of the surgery.

Most health insurance policies have a waiting period of two or three years after which cataract is covered. In case you have had these insurance plans for more than the waiting period mentioned in your policy, the cataract cost will be covered. The reason why insurers prescribe a waiting period is because cataract is a planned surgery and they want to avoid situations where someone buys insurance with the explicit objective of claiming cataract costs. Some plans have a cap on the amount they will pay for cataract.
The costs will be reimbursed if the clinic is a nursing home registered with the health ministry. Typically, there are some pre-conditions that a clinic must satisfy to be registered. These often include minimum number of beds, availability of adequate nursing and medical staff, a fully-equipped operation theatre, certain emergency equipment and round-the-clock emergency services. Incidentally, if the clinic does not have a registration, then it was illegal for them to have done the surgery.