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Can single man or woman claim maternity benefit in health insurance policy?

Financial planners advise that health insurance is something one should get early in life. This becomes all the more important when it comes to a maternity benefit add-on. The waiting period of this add-on is usually 2-4 years.

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Last Updated: Feb 21, 2020, 11.12 AM IST
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A woman can avail of this irrespective of whether she is married or not.
Motherhood is probably one of the most important transitions in a woman's life. Not only is pregnancy emotionally and psychically taxing for a woman, but it can also be financially burdensome for the family. That is why it is important to be financially prepared for any exigencies that might come up during and after pregnancy. A health insurance policy with a maternity benefit cover can help.

Men and women can get a maternity benefit insurance cover. However, can you claim the maternity benefit only after getting married?

What is maternity benefit in health insurance cover?
This is a type of insurance plan that covers all the expenses associated with childbirth up to a certain period (pre- and post- pregnancy). You may choose a standalone policy or include it as an add-on health insurance with maternity cover by paying an extra premium.

A. When a single man holds a policy with maternity benefit cover
Financial planners advise that health insurance is something one should get early in life. This becomes all the more important when it comes to a maternity benefit add-on. The waiting period of this add-on is usually 2-4 years.
So, the question now arises as to whether a man, who purchased a health insurance policy with maternity cover four years ago (assuming the waiting period is over now), will be able to claim maternity benefit after/within a year after he gets married?

Naval Goel, CEO, PolicyX.com said men can buy a health insurance plan with maternity benefit cover but cannot get maternity benefits until he adds his wife to his existing health insurance policy. "Moreover, the waiting period will only start when his wife officially becomes a member of his health insurance policy."

When can you add your wife in the policy
After your marriage, you cannot add your wife in the running policy, that is, in the interim period before next renewable date. Sanjay Datta, Chief Actuary, ICICI Lombard General Insurance said that in case the insured, i.e., the husband already has an individual health insurance policy, at the time of next renewal, the insured can add the wife in the existing policy and opt for maternity cover with no additional documents. "However, you must know that that once the wife is added, a fresh waiting period of 36-48 months will begin in order to avail maternity benefit under the same policy. The premium will also change and will be applicable as per the plan opted by the policyholder," he added.

Therefore, it appears that buying maternity benefit with health insurance policy in advance by a single man is not helpful.

What happens in case of a live-in situation?
Let us say two people are living in together (unmarried). The insurance policy is taken in the male's name which also has a maternity benefit add-on cover. In this case, can the woman claim the maternity benefit by adding herself in the policy?

Amit Chhabra, Head- Health Insurance, Policybazaar.com said that a male will not be able to avail the maternity benefit (if available in the base policy) as he is not eligible for the same. "Even an unmarried couple cannot take a policy together (apply for the maternity benefit) as there is no insurable interest," he added.

This implies that it is important to have an insurable interest with the person. Even the fiancée will not be considered as having insurable interest with the man until the marriage is solemnised. Hence, a single man cannot take maternity benefit until he gets married and adds his wife to the health insurance policy.

Also read: Money & Relationships: What are woman’s rights in a live-in arrangement?

B. When a single woman holds a policy with maternity benefit cover
Not all health insurance plans offer maternity benefit cover to single women. However, there are a few plans that provide the required cover to single women and mothers, irrespective of their marital status, after completing the waiting period. The reason being that after completing the waiting period and paying all the premiums, a woman avails all the benefits mentioned in the plan irrespective of her marital status.

Goel said that if the policy is in the woman's name and she wants to claim the maternity cover after completing the waiting period, then she can claim it irrespective of her marital status. "Although, you will be eligible for the same only after completing the waiting period, which is generally longer than other health insurance plans such as family floater health insurance policies," he said.

Thus, this implies that a single woman, who holds a policy in her name, can claim the maternity benefit irrespective of her marital status provided the waiting period condition is met. Hence, she can buy the policy with maternity benefit even before marriage.

Maternity benefit in group health insurance policies
Women can also avail of the maternity benefit under the group health insurance policies provided by their employers. A woman can avail of this irrespective of whether she is married or not.

Anuj Gulati, MD & CEO, Religare Health Insurance said, "It is pertinent to note here that group insurance coverage offered by employers work differently; wherein these benefits (if included in the coverage) do not have any wait periods. It is because the pricing is done based on the employer's requirements and past experience and hence, maternity is covered from day one from the issuance of the policy."

However, you must know that the coverage provided under such maternity benefit has a sub-limit that may not be enough to pay for the entire cost of pregnancy.
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