What should I consider when procuring a maternity cover?


Is there a maternity cover that I can access to meet the cost of hospital bills at the time of our baby’s arrival? FILE PHOTO | SHUTTERSTOCK

My wife and I are expecting a baby. Is there a maternity cover that I can access to meet the cost of hospital bills at the time of our baby’s arrival?

Also, is there a difference in the coverage limits should my wife get admitted for a first-ever emergency caesarean section delivery and if she has a scheduled birth by caesarean section?

With the exponential rise in the cost of living, the big question in the minds of those planning to start their family is whether they will be able to afford the anticipated change in status, especially due to the high cost of medical care.

The journey between the baby’s conception and birth is often marred by unprecedented eventualities that may instil great anxiety in the expectant family.

Not only does the cost of medical care place great financial strain on the family but also often dictates delivery options available to the expectant mother.

Maternal health refers to the health of women during the pregnancy period often referred to as the antenatal phase, childbirth and the postnatal period.

Each stage ought to provide a positive experience, ensuring mother and baby reach their full potential for health and well-being.

Nevertheless, maternal-related complications and deaths continue to be reported across the health service providers in the country even though they are preventable with timely management by skilled health professionals working in a supportive environment.

It is paramount that one plans exhaustively and is aware of the costs applicable for the maternity admission, stemming from prenatal care visits, epidural injections if opted for, to pre-term deliveries and extended hospital stays should they arise.

The most recent data reported by media outlets on July 23, 2022, a summarised analysis of maternity bills from various hospitals indicated a range from Sh30,000 to Sh145,000 for normal deliveries.

Caesarean section deliveries ran to Sh280,000 in some of the high-end private facilities.

The ultimate solution to combat the inevitable high costs arising from maternity-related care is for the expecting family to procure an insurance policy to meet their financial need.

This would provide peace of mind and comfort that the cost of care would be attended to at the time of need.

Most individual medical cover policies in the local insurance industry market have, as an inclusion, maternity cover benefits instilled, to cater for outpatient services on antenatal or post-natal services and inpatient care to cater for normal births (spontaneous vertex delivery) or caesarean section births.

Before one procures the individual medical cover, a detailed narration on the benefits to be purchased as well as the cover limits applicable for the various bouquets of cover limits is provided.

This enables the family to make informed decisions on the type of cover to purchase.

The maternity benefit is engraved into the cover as part of the inpatient cover that allows care during hospital admission. It is often referred to as a rider benefit.

A detailed categorisation of the maternity benefit reveals a split into three; the normal maternity package which extends to the normal newborn delivery, subsequent or elective C-section, and any arising maternity-related complications.

Additionally, a different, yet related package for a first emergency caesarean section delivery in the lifetime of a mother does exist outside the three regular cover provisions.

Pricing of maternity benefits and the first-ever caesarean section delivery is carried out differently.

The first-ever emergency caesarean section benefit would usually have a higher limit allocation as compared to the normal maternity benefits package.

The understanding and rationale towards this is that since the mother would normally plan for a normal first birth, medical costs arising from unexpected circumstances leading to an emergency first-ever caesarean section are not planned for and therefore a soft landing is provided to facilitate the high fees involved.

In a similar fashion to other medical policies, maternity cover policies are subjected to various terms and conditions, for instance, waiting periods, co-payment, age limit restrictions, and pre-advised policy exclusions.

These would vary from one insurance policy to another. It is imperative that the family is made aware of all terms and conditions before purchasing, to avoid inconveniences and misunderstandings at the hospital when the mother is admitted for maternity care.

Most insurance companies in Kenya would provide a maternity cover limit between Sh 30,000 and Sh 500,000 as a rider within the inpatient limit.

Some of the common exclusions or items not regularly catered for in the maternity policy would be:

Maternity care before the end of an indicated waiting period, for example, some maternity policies are only activated after one year of cover.

Treatment cost that surpasses the cover limit purchased; cost of care covered under any other insurance such as NHIF; infertility/family planning costs; maternity supplements other than those specified in the policy document; self-prescribed pregnancy termination or home births/midwifery services, and pre-mature births unless expressly stated to be covered under your maternity policy.

Due to the rising cost of treatment, packaged care has come to the fore with most hospitals now formulating maternity packages that help focus on affordability while maintaining uncompromised care for the maternity experience.

This means that one can pre-empt the financial burden that falls on them and therefore plan accordingly to lift it efficiently.

Moreover, the insurance policy is a contract that will keep to the terms & conditions of its agreement.

One must consider any unexpected emergencies and plan accordingly.

With an in-depth understanding of your budget, timelines & guidance tips from your medical doctor, it’s possible to have a fulfilling experience through the maternity journey.

Various maternity policies are available through insurance agents, brokers or insurance underwriters in the market.

Ms Mugo is Senior Risk Consultant, Medical Broking | [email protected]

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