Pregnant Wife's Delivery & NICU Expenses: Which Insurance Plan Covers it?

Hello sir, I want a health insurance which covers my wife's delivery cost, and if any complications occurred or my baby is pre delivered in 7 months, insurance to cover the baby NICU fees which may go upto 30 Lakhs for 3 months.

Ans: Hello;

Many health insurance companies offer coverage of maternity expenses in their plans, however you need to look out for:

1. Wating period ranging from 1 to 2 years. Maybe higher if spouse has some previous ailments like hypertension, diabetes etc and also if spouse age is higher.

Some companies may warrant a prior health check up before underwriting.

2. Sub-limits on coverage. For eg some companies offer limited neo-natal coverage.

3. List of network hospitals for cashless claim. Also need to avoid blacklisted hospitals.

4. Do your own study and also seek help from an insurance advisor.

Apart from private insurers do take a look at the offerings by Govt general insurance companies too.

Best wishes;

Ans: Buying comprehensive health insurance and a term plan for your family is a wise decision. It ensures financial security in case of unforeseen medical emergencies and provides life coverage. Let’s explore the best way to choose and purchase these insurance plans.

First, I appreciate your proactive approach towards securing your family’s future. Thinking about health insurance and a term plan at this stage is a responsible move. This decision will safeguard your family's financial well-being.

Understanding Your Needs
You are a family of three: yourself, your wife, and a 3-year-old child. You need comprehensive health insurance and a term plan. Let's break down how to proceed effectively.

Choosing Comprehensive Health Insurance
1. Sum Insured:

Opt for a high sum insured to cover significant medical expenses. Consider Rs. 10-15 lakhs coverage for your family.

2. Network Hospitals:

Choose an insurance provider with a wide network of hospitals. This ensures cashless treatment options in emergencies.

3. Pre and Post-Hospitalization:

Look for plans covering pre and post-hospitalization expenses. These costs can add up and strain your finances.

4. No-Claim Bonus:

Select a policy offering a no-claim bonus. This increases your sum insured for every claim-free year without additional premium.

5. Family Floater Plan:

A family floater plan covers all members under a single policy. It's cost-effective and simplifies management.

6. Maternity and Newborn Cover:

Check if the policy includes maternity benefits and newborn cover. This is crucial for families planning to expand.

7. Daycare Procedures:

Ensure the policy covers daycare procedures. These are treatments requiring less than 24 hours of hospitalization.

8. Critical Illness Cover:

Consider adding a critical illness rider. It provides a lump sum amount on diagnosis of specified critical illnesses.

Evaluating Term Plan Options
1. Coverage Amount:

Opt for a term plan with coverage of at least 10-15 times your annual income. This ensures financial stability for your family.

2. Policy Tenure:

Choose a tenure covering your working years. Ideally, the policy should last until your retirement age.

3. Claim Settlement Ratio:

Check the insurer's claim settlement ratio. A higher ratio indicates reliability and better chances of claim approval.

4. Riders and Add-Ons:

Consider adding riders like accidental death benefit, critical illness cover, and waiver of premium. These enhance your policy's coverage.

5. Premium Waiver:

Choose a term plan with a premium waiver option in case of critical illness or disability. This ensures the policy remains active.

6. Flexibility:

Select a plan allowing flexibility in premium payments. Options like annual, semi-annual, or monthly premiums can be convenient.

7. Online vs. Offline Plans:

Online plans are often cheaper due to lower administrative costs. Compare both options and choose the best fit.

8. Inflation Adjustment:

Ensure your coverage keeps pace with inflation. Some term plans offer increasing sum assured options.

Health Insurance: Key Features to Consider
1. Room Rent Cap:

Check if the policy has a room rent cap. Higher caps or no limits are preferable to avoid out-of-pocket expenses.

2. Co-Payment:

Avoid policies with high co-payment clauses. These require you to pay a portion of the claim amount.

3. Sub-Limits:

Beware of sub-limits on specific treatments. Choose policies with minimal or no sub-limits for better coverage.

4. Network Hospitals:

Ensure the insurer has a vast network of hospitals. This facilitates cashless treatment and reduces hassle during emergencies.

5. Health Check-Ups:

Some policies offer free annual health check-ups. These are beneficial for monitoring your family's health.

Term Plan: Important Considerations
1. Pure Protection:

Term plans are pure protection plans. They provide a high sum assured at an affordable premium.

2. Low Premiums:

Term plans have lower premiums compared to other life insurance policies. This makes them cost-effective.

3. No Maturity Benefit:

Term plans do not offer maturity benefits. The policy only pays out in case of the policyholder’s death.

4. Tax Benefits:

Premiums paid for term insurance are eligible for tax deductions under Section 80C. Death benefits are tax-free under Section 10(10D).

Making an Informed Decision
1. Compare Policies:

Use online comparison tools to compare policies. Look at features, premiums, and customer reviews.

2. Read Reviews:

Customer reviews provide insights into the insurer's service quality. Check for feedback on claim settlement processes.

3. Consult a Certified Financial Planner:

A CFP can help tailor policies to your specific needs. They provide expert advice and personalized recommendations.

Steps to Buy Health Insurance and Term Plan
1. Assess Your Needs:

Evaluate your family’s medical history, lifestyle, and future needs. This helps determine the appropriate coverage.

2. Research and Compare:

Research various policies and compare features. Look for policies offering the best value for your needs.

3. Check Exclusions:

Understand the exclusions in both health and term plans. This prevents surprises during claim time.

4. Read Policy Documents:

Read the policy documents carefully. Ensure you understand all terms, conditions, and benefits.

5. Apply Online:

Most insurers offer online applications. It’s convenient and often comes with discounts.

6. Medical Tests:

Undergo any required medical tests. Accurate disclosure of health conditions is crucial for claim approval.

7. Review Annually:

Review your policies annually. Update them as your needs change.

Benefits of Comprehensive Health Insurance
1. Financial Security:

Health insurance provides financial security during medical emergencies. It covers hospitalization and treatment costs.

2. Peace of Mind:

Knowing you’re covered brings peace of mind. You can focus on recovery without financial worries.

3. Quality Healthcare:

Insurance ensures access to quality healthcare. You can choose the best hospitals and doctors.

4. Preventive Care:

Many policies cover preventive care and annual check-ups. This helps in early detection and treatment of diseases.

Advantages of Term Insurance
1. Financial Protection:

Term insurance ensures your family’s financial stability. It provides a lump sum amount in your absence.

2. Affordable Premiums:

Term plans are affordable. They offer high coverage at low premiums.

3. Flexibility:

You can choose the coverage amount and tenure. This provides flexibility to match your financial goals.

4. Tax Benefits:

Term insurance premiums qualify for tax deductions. This reduces your tax liability.

Final Insights
Choosing the right health insurance and term plan requires careful consideration. A high sum insured and extensive network hospitals are crucial for health insurance. For term plans, adequate coverage and a reliable insurer are key. Regularly review and update your policies to ensure they meet your evolving needs. Your proactive approach and responsible financial planning are commendable. By securing comprehensive health and term insurance, you’re ensuring a secure future for your family.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in