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Key Highlights
● Women-centric plans offer coverage for maternity, newborn care, critical illness, gynaecological checkups, and reconstructive surgeries post-cancer treatment.● Choose plans wisely by checking age limits, pre-existing disease coverage, network hospitals, and claim settlement ratio.● You should understand the policy exclusions like cosmetic procedures, congenital anomalies, self-harm injuries, substance abuse, and unproven treatments before purchasing.Women in India face increasing health challenges due to lifestyle changes and various external factors. Be it cardiovascular diseases, hypertension, diabetes, or cases of osteoporosis, it is important to ensure their health doesn't suffer while they ensure the health of their family, especially as mothers.Women, and mothers in particular, deserve complete financial security through health insurance. So, let's get started with understanding health insurance and its numerous benefits.
What are the Benefits of Women’s Health Insurance?
Whether you are buying health insurance for your mother or any other family member, here are the benefits you should know:
1. Maternity Expenses
Health insurance for women generally covers maternity-related expenses either in the standard plan or through a rider. The coverage includes prenatal and post-natal care, delivery costs (normal or cesarean), and hospitalisation charges. Some policies may also include coverage for medically necessary terminations. However, these expenses are subject to a waiting period of a year to 48 months, depending on the insurer.
2. Newborn Baby Cover
After childbirth, many women-centric health insurance plans cover the newborn from day one, usually up to 90 days. This includes hospitalisation costs for illnesses or congenital defects. After 90 days, the baby can be added to the family floater plan. Some plans also cover vaccinations for the initial year after birth.
3. Pre and Post-Hospitalisation
Health insurance for women includes expenses incurred before and after hospitalisation. This may cover medical consultations, diagnostic tests, and medication within a specific period, commonly 30 days before and 60 days post-hospitalisation. These are reimbursed if related to the illness or procedure for which hospitalisation was done.
4. Critical Illness Coverage
Certain women-specific plans provide a lump-sum benefit upon diagnosis of critical illnesses like breast cancer, cervical cancer, ovarian cancer, and others. This lump sum is paid regardless of actual treatment costs and helps manage medical and non-medical expenses during treatment, including income loss or specialised care.
5. Daycare Procedures
Modern health insurance covers daycare procedures that don’t require 24-hour hospitalisation because of advanced medical technology. For women, this includes treatments like chemotherapy, dialysis, cataract surgery, and minor gynaecological surgeries. Policies cover over 500 to 1000 such procedures, depending on the insurer and plan chosen.
6. Hospitalisation Expenses
Women’s health insurance plans include inpatient hospitalisation expenses. This covers room rent, nursing fees, ICU charges, doctor consultations, surgery costs, diagnostic tests, and prescribed medications. It is essential to check sub-limits on room rent and ICU charges, which may vary depending on the plan type.
7. Preventive Health Checkups
Many plans offer annual or biennial preventive health checkups, either free or reimbursable up to a certain limit. These checkups include blood tests, mammograms, PAP smears, and other screenings relevant to women’s health. Such features encourage early detection of illnesses and promote overall wellness and disease prevention.
8. Ambulance Charges
Health insurance plans cover ambulance expenses incurred while transporting the insured to a hospital during a medical emergency. There’s usually a cap per hospitalisation or per policy year. In some cases, air ambulance services may also be covered under premium plans for life-threatening emergencies in remote locations.
9. Organ Donor Expenses
If a woman requires an organ transplant, the policy generally covers the organ harvesting surgery costs for the donor. This includes surgery, screening, and hospitalisation costs of the donor. However, post-operative complications or treatment for the donor may not be covered. Coverage is subject to terms and conditions.
10. Domiciliary Hospitalisation
Some insurers cover domiciliary hospitalisation, which involves treatment at home for a condition that would otherwise require hospital care. This applies when hospitalisation is not possible because of a patient’s condition or lack of hospital availability. Necessary doctor certification and insurer approval are usually required to avail this benefit.
11. AYUSH Treatment
Health insurance for women often includes AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) treatment. Coverage applies only if treatment is taken at government-recognised hospitals or accredited centres. This gives women the option to explore alternative therapies for chronic issues like PCOD, menstrual disorders, and other health conditions.
12. Annual Gynaecological Consultations
Some insurance plans for women offer coverage for annual gynaecological consultations. This benefit may include PAP smears, breast examinations, and consultation fees for routine checkups or early detection of female-specific issues like fibroids or endometriosis. It promotes proactive health monitoring and early diagnosis, which is vital for effective treatment.
13. Cancer Reconstructive Surgery
For women who undergo surgery due to cancers like breast cancer, some health plans cover reconstructive surgery. This includes procedures like breast reconstruction post-mastectomy. While not standard in all plans, such features in specialised policies help women regain physical and psychological well-being post-major medical interventions. Also Read: What is Health Insurance - Definition, Types and More
What Is Not Covered in Health Insurance for Women?
When gifting health insurance to your mother, remember that it does not cover all medical expenses or conditions. Here are some common exclusions:
Cosmetic Treatments
Health insurance does not cover cosmetic or aesthetic procedures unless they are medically necessary due to accidents or disfigurement. Elective surgeries like liposuction, breast augmentation, rhinoplasty, or skin treatments for beautification are considered non-essential.
Congenital Anomalies
Most health insurance policies do not cover congenital anomalies, whether internal (for example, congenital heart defects) or external (for example, cleft lip). These conditions are considered present at birth and do not result from illness or injury. Even if discovered later, the claim for treatment may be rejected unless explicitly included in the policy.
Self-Inflicted Injuries
Health insurance does not cover injuries resulting from attempted suicide, self-harm, or any intentionally inflicted wounds.
Dental Procedures
Standard health insurance does not cover routine dental checkups, braces, implants, tooth extractions, and cosmetic dentistry. Only dental procedures arising from accidental injury or requiring hospitalisation are considered.
Unproven Treatments
Treatments not scientifically proven or approved by medical authorities like the WHO, ICMR, or FDA are not covered. This includes stem cell therapy (except for certain cancers), ozone therapy, or alternative hormonal treatments not backed by clinical evidence.
Substance Abuse
Health insurance excludes treatment for conditions caused by alcohol or drug abuse. This includes liver cirrhosis due to alcoholism, organ damage from narcotics, or mental health issues induced by substance use. Also Read: Health Insurance for Women - The complete checklist
Tips to Choose the Best Health Cover for Your Mother
Here are some of the factors you must consider when buying health insurance for your mother:
1. Check Eligibility
You must first check the maximum entry age allowed under the policy. Many plans restrict entry after 65 years, while some senior citizen plans accept applicants up to 75 years. If your mother is older, choose a policy that can be renewed over her lifetime and does not have restrictive entry clauses.
2. Prioritise Pre-Existing Disease
If your mother has diabetes, hypertension, or any chronic illness, ensure the policy covers pre-existing diseases. Look for the shortest waiting period. Some insurers offer coverage after 2 years, while others may require 4 years.
3. Evaluate Hospital Network
Ensure the insurer has a wide hospital network with good hospitals near your mother's residence. Check if cashless treatment is offered at these hospitals.
4. Understand Limits
Check whether the policy has restrictions on room rent (for example, ₹5,000 per day) or requires co-payment, especially for senior citizens. A room rent cap may force a downgrade in treatment quality, while co-payments can increase your out-of-pocket burden.
5. Settlement Ratio and Reviews
A high claim settlement ratio (above 90%) indicates the insurer processes claims reliably. Read independent reviews and customer feedback to assess claim processing timelines, ease of service, and responsiveness. This ensures that your mother won’t face delays or denials during medical emergencies.
6. Sufficient Sum Insured
Choose a sum insured that accounts for rising medical inflation; ₹5 lakh may be insufficient in urban areas. Opt for a higher cover or a plan that offers sum insured restoration, which automatically refills the cover if it is exhausted in a policy year.
7. Premium vs. Benefits
Don’t just go for the cheapest policy. Instead, compare the premium with the benefits offered: coverage, exclusions, network hospitals, and support services. Some slightly costlier plans provide better value by reducing future expenses and ensuring better health outcomes.
A Gift That Keeps Giving: Health Insurance for Mom
This Mother’s Day, present your mom with the gift of health insurance , ensuring she has financial security and peace of mind. With women-specific plans offering maternity, critical illness coverage, and more, it is a thoughtful way to show love. Consider key factors like coverage, exclusions, and premiums to select the best plan that suits her needs.If you are wondering which health plan to buy for your mother, turn to Aditya Birla Capital. Explore comprehensive health insurance plans , with up to 100% of the premium as HealthReturns™, an annual health checkup, and benefit from a 150% reload of the sum insured. Also Read: Term Insurance for Women - Know Why its Necessity to Buy
FAQS - FREQUENTLY ASKED QUESTIONS
What types of health insurance plans are available for my mother?
Options include individual health insurance, family floater plans, critical illness policies, and top-up plans. You can choose one based on her medical needs, age, and budget, ensuring comprehensive coverage for both routine and emergency healthcare.
Is it important to consider my mother’s age when choosing health insurance?
Yes, age is a key factor in determining coverage and premium costs. Older individuals may need a policy with higher coverage for hospitalisation, surgery, or chronic conditions. You should select a plan that caters to her specific health requirements.
Can I add my mother to my existing health insurance policy?
Many insurers allow adding family members, including parents, to existing policies through family floater plans. This may reduce premiums and simplify management. However, you should check if the policy suits your mother’s health needs before making changes.
Are there any tax benefits when I buy health insurance for my mother?
Yes, if you choose the old tax regime, then under Section 80D of the Income Tax Act, you can claim tax deductions for premiums paid on health insurance policies for your parents. The maximum deduction is ₹25,000 for parents under 60 years, and ₹50,000 for senior citizens above 60 years.
How do I select the best health insurance policy for my mother?
Research various policies and compare coverage options, premiums, exclusions, and network hospitals. Consider her health status and age, and choose a plan that balances affordability with comprehensive coverage, ensuring her needs are met in case of emergencies.
What does a typical health insurance policy cover for my mother?
A typical health insurance policy covers hospitalisation expenses, pre and post-hospitalisation, medical consultations, surgeries, and sometimes outpatient treatments. Depending on the specific policy chosen, it may also cover maternity, diagnostic tests, ambulance fees, and critical illnesses.
What are the waiting periods in health insurance policies for senior citizens?
Health insurance policies for senior citizens may have waiting periods of 1 to 4 years for pre-existing conditions and certain treatments. Reviewing these terms before purchasing is important, ensuring that the coverage aligns with your mother’s immediate and future healthcare needs.
Is there a cashless hospitalisation benefit in health insurance plans?
Yes, health insurance policies offer cashless hospitalisation at network hospitals. This means your mother can receive medical treatment without paying upfront, as the insurer pays the bills directly to the hospital.
How do I ensure a smooth claims process for my mother’s health insurance?
To ensure a smooth claims process, carefully read the policy terms, keep all necessary documents handy, and inform the insurer immediately in case of hospitalisation.
Are there any exclusions in health insurance policies for my mother?
Health insurance policies typically exclude coverage for certain conditions like cosmetic surgery, self-inflicted injuries, and treatments related to substance abuse. Always read the policy details to understand exclusions and make an informed decision about the coverage your mother will receive.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
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