I want to include my wife in my health insurance policy. Are maternity/pregnancy-related expenses covered under health insurance plans?
-Name withheld on request
Yes, you can include your spouse and children in your existing health insurance policy and you would also have the option of having individual sum insured for each member of the family or a floating sum insured for the whole family.
Maternity expenses are generally not part of the built-in cover and would be optional. They would also come with a waiting period of 2 or 3 years. Please check on this aspect by going through the policy terms and conditions carefully or speaking to a company representative or intermediary such as an agent who would be able to advise you further.
You also need to check the conditions of coverage, for e.g. there may be a limit on number of pregnancies covered under the policy or a sub-limit on the maximum expense allowed to be claimed under the maternity benefit.
I am told that I might have to undergo a bypass surgery in next one year. Can I take a health insurance policy now so that it covers the expense when I go for the surgery next year?
-Name withheld on request
Retail health insurance policies generally exclude pre-existing conditions for a period of 2 to 4 years and accordingly, if you are already suffering from a heart condition which might require a bypass surgery, it is unlikely to be covered under the policy. It should also be remembered that at the time of taking a health insurance policy, a full and frank disclosure of all pre-existing illnesses/diseases/conditions is expected. Failure to do so could impact claim payments at a later stage.
However, if you are covered under a group health insurance policy provided by your employer, pre-existing conditions could be covered from Day 1 without any waiting period or exclusion.
Queries answered by Subramanyam Brahmajosyula, head – Underwriting & Reinsurance, SBI General Insurance