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Why is pregnancy not included in an individual mediclaim policy?

Q: I have read your answer to the question on hypertensive patients being denied health insurance cover. What I want to ask you is why is pregnancy not included in an individual mediclaim policy where as it can be included in group mediclaim policy and so is the case for pre-existing diseases?

A:I acknowledge your concern regarding the importance of covering pregnancy and as well as pre-existing diseases in individual Mediclaim policies. I share the same feelings towards an enhanced cover for all individual policyholders. Let me answer you question in two parts: 1. The concept of insurance favours policyholders more than the insurance companies. This so because individuals have a greater understanding of their medical needs and requirements and therefore more susceptible to purchasing health insurance when they think they will need it most. Thus, women who know of their impeding pregnancy in future will be more susceptible to purchasing this cover. The element of risk in its true sense is missing here, thus there is no inclination to provide a maternity cover to individual women policyholders. Whereas in a group, an analysis is done of the group profile and subsequently if an insurer deems fit, a maternity cover is provided after loading the policy with an appropriate amount (usually 10%). 2. In case of pre existing disease, the same point of skewed information availability applies. More so , if you read my last answer on the DoctorNDTV web site (regarding hypertensive patients and health insurance), you will find the reasons of not covering pre existing disease in health insurance policies. On the other hand, if a group Mediclaim policy is being issued, the insurer assess the risks associated with the group given the profile and then takes a call on covering the pre existing conditions. Here again the insurer loads the premium by a certain percentage (often 25%). A common reasoning given for these added benefits in a group insurance is that the probability of per person claim reduces when group policy is underwritten. The direction in which the health insurance industry is expected to evolve, you may in the future, find policies covering these benefits as well. I hope to have provided a satisfactory answer to your query.


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