Group v/s individual maternity health plans- what you should know

Group v/s individual maternity health plans- what you should know

Maternity coverage is an essential coverage that one seeks in a health insurance plan. This can cover a wide range of medical expenses related to pregnancy such as pre-natal check-ups, hospitalization expenses during delivery and post-natal care and expenses of newborn baby etc.

In most of the group health insurance plans offered by the employer, maternity coverage is automatically included. Maternity cover is also offered as an add-on rider to individual health plans by many insurance providers to give financial backup during the crucial phase of pregnancy. Let’s take a look at both the plans to understand what should be chosen to have a wider range of coverage.

What is a group health plan with maternity cover?

Group health insurance is a health plan that particularly covers a group of people like employees of an organization or of a society. Basically, it is the health insurance plan offered by the employer to an employee. It provides various medical benefit coverages for the employee, spouse, children and their dependent parents.

Maternity benefit is included in almost all the group insurance plans as a bundled cover and is usually considered more beneficial. Group health insurance is offered at a reduced cost as the risk is spread across the group. It covers almost all the expenses related to pregnancy (both cesarean and normal delivery) and any complication involved.

What is individual maternity health plan?

The individual maternity health plan is a health plan that can be purchased by any individual to get complete coverage for all types of hospitalization and medical expenses including maternity. Maternity coverage is usually offered as an additional rider in any individual health insurance that covers all the maternity related expenses including complication that arise during the period such as age-related, hypertension and gestational diabetes etc.

Each of these comes with its own merits and demerits. Let’s take a look!

Group Health plan with Maternity coverage V/S an individual one with maternity coverage

Waiting period: Usually, there is little or no waiting period in a group health plan for maternity coverage. The little waiting period for group health plans with maternity coverage is as low as nine months. However, in individual health plans, pregnancy is considered as a pre-existing condition and hence the waiting period gets applied. Usually, the waiting period would be two to four years to avail the maternity benefit which varies from insurer to insurer.

Addition/deletion of new members: As group health insurance plan covers the insured’s family, addition and deletion of a family member into the policy can be done with the help of an employer. But, there is no question of addition and deletion of members in individual health plans as it is bought in a single name. However, you can offer family floater plans for your clients wherein easily new members can be added.

Continuity: Group health insurance do not offer continued benefit. The benefits of maternity are discontinued as soon as the insured employee quits the job. However, individual health plans provide an option of lifelong renewability and hence the continued coverage.

The scope of coverage: As group health insurance provides limited coverage maternity benefit will also be limited. But, individual health plans can offer adequate coverage with high sum assured, maternity coverage will also be adequate.

Sub-limits: Most of the health plans with maternity coverage comes with in-built caps on coverage. That means maternity benefit that can be availed is limited to a certain amount or percentage of sum insured. Usually, coverage offered in group plans are limited, maternity benefits will also be capped and hence provide lower coverage. On the other hand, individual health plans can be customized based on your customer’s requirement, even with the sub-limit plan can be chosen to adequately cover all maternity expenses.

Additional benefits: As group health insurance plans are designed for a group, your customer cannot have control over it on the generic coverage offered. Maternity benefits under this are limited to delivery procedures, hospitalization expenses, and certainly specified complications. On the other hand, individual maternity health plans can be customized and chosen based on your client’s requirement, additional benefits like coverage for newborn baby vaccination, baby cover for congenital disorders and other emergencies etc can be covered.

Even though many employees are covered under group health insurance for maternity, it’s important to offer them a separate individual maternity health plan.

So, why an individual maternity plan should be chosen despite having group cover?

 Here are a few reasons:

Higher sum insured: Group insurance plans may not offer an adequate amount of coverage. Need-based choice can be made when buying individual health plans.

Lifelong renewability: Offer your clients a continued and lifelong coverage with individual health plans covering maternity expenses.

A wider scope of coverage: You can offer your client’s customized health plan with maternity benefits covering a wide range of expenses which is unlikely to get from their employer-provided health plan.