Although pregnancy and childbirth are not usually covered on PMI plans, certain maternity benefits are available. Angela Faherty reports
For women of childbearing age, having a baby is a life changing experience. There are many things to take into consideration both during and after pregnancy, and while dwelling on matters may not be encouraged, it is important to carefully consider all available options.
Full understanding
Choosing whether to have a baby in the private sector is one of these options. However, as with all aspects of healthcare, it is imperative that women fully understand what is available to them and what they are covered for under their private medical insurance (PMI) policy.
Perhaps the most important aspect of childbirth and PMI is that most medical insurance does not cover hospital treatment for normal pregnancy and childbirth. Understandably, pregnancy is not considered a disease and as insurers cannot insure against it, many choose not to cover it.
"It is important that women realise pregnancy is excluded from most private medical insurance policies because it is not regarded as an illness. However, in some cases, they may be covered for certain complications that arise so it is important to fully understand the intricacies of the policy they hold," says Howard Hughes, sales and marketing manager at BCWA Healthcare.
The pregnancy exclusion on most PMI policies means that women with PMI who want to be in a private hospital or wing when they give birth will have to pay for it themselves or opt to use the standard facilities of the NHS. It is important that women taking out PMI understand this from the outset rather than learn this information further down the line when it is perhaps too late.
"The fact that pregnancy and childbirth are not covered on many insurance policies is a surprise to many women and their partners. There is often an assumption made that their expensive private medical insurance policy means they are covered for treatment in a private hospital or a private wing of an NHS hospital, when in fact, they are not," says Dermot Cox, managing director at independent private healthcare advisory firm, CareHealth.
While some policyholders may bemoan the lack of cover for pregnancy, insurers are quick to stress the benefits of the NHS in this particular area. "Catering for maternity needs is one of the things that the NHS does particularly well. There are no waiting lists and the emergency facilities are on site if any complications do arise," says Julian Ross, head of marketing and communications at Standard Life Healthcare.
The advantages of having a child in an NHS hospital are very clear and despite the bad press it receives for lengthy waiting lists, its maternity facilities are more than adequate. However, there will always be a number of women who will still want to have a baby privately and for those with a PMI policy, understanding what maternity benefits are available on the plan is important.
For those women that do opt for a private delivery, another major concern is the fact that there are very few specialist hospitals to choose from outside London. The three specialist hospitals in London are the St John and St Elizabeth, Queen Charlotte's and Chelsea Hospital and the Portland; the latter charges approximately £10,000 all in for a normal birth.
The importance of these specialist hospitals is that there are facilities on site to specifically cater for maternity and childbirth. In contrast, private hospitals in general do not have the emergency facilities to act swiftly if something should go wrong and in many cases, do not provide the full adequate facilities that are available in the NHS.
Specialist facilities
"Provision is an overriding factor for women when considering maternity facilities in the private sector. I would be hard pressed to think of any hospitals providing specialist maternity facilities outside London anyway, so there is not a great deal to choose from," says Hughes.
Although normal pregnancy and childbirth is not covered under the majority of plans, some provide different levels of maternity benefits. As a general rule, it is important to remember that a qualifying period of anything between 10 and 24 months applies in the majority of cases.
Almost all PMI policies cover complications of pregnancy or childbirth such as ectopic pregnancies and medical intervention following miscarriage but there are a handful of providers that do offer more benefits on their higher level plans.
Clinicare's Carte Blanche for example, covers 90% of total costs up to a maximum of £3,000 towards private maternity and delivery care such as ante and post-natal treatments, as well as maternity costs of home or hospital delivery. Similarly, Standard Life Healthcare's Primecare Gold pays up to £3,000 maternity benefit after two years' membership. This includes full ante and post-natal consultations, the stay in hospital and a normal delivery.
Complications
Such maternity benefits are only available on its exclusive Gold package however, while its cheaper PMI plans provide cover for complications arising from childbirth only. For the lower level budget options, PrimeCare Saver and PrimeCare Supersaver, no maternity benefits are offered at all.
"The simpler budget plans do not provide any maternity cover because we need to strike a balance between price and benefits. The NHS provides a very good service for childbirth and therefore, only the key traditional benefits are offered," says Ross.
One of the key changes in maternity benefits over the last two years has been the withdrawal of cover for caesarean section procedures. The decision followed the growing number of women opting to have the operation rather than requiring it for medical reasons. AXA PPP healthcare was the first to bite the bullet and withdraw caesarean section cover from its policy. Other insurers quickly followed suit and caesareans are no longer covered in most PMI plans.
However, BUPA does not cover elective procedures but continues to offer cover for caesareans deemed medically necessary. The insurer individually authorises all caesareans required before they are carried out or if an emergency procedure is carried out and there would not be time, an assessment is carried out within 48 hours of delivery.
"It is necessary to understand all the information as to why caesareans are carried out because there is a grey area surrounding elective and medical procedures. By carrying out medical assessments we are trying to get a picture of why women may require a caesarean section," says Dr Natalie-Jane Macdonald, medical director at BUPA.
Common trends
One of the common trends in PMI policies is maternity cash bonuses paid out on the birth of each child. This is not a feature of BUPA's policies, but many other providers offer this benefit.
Norwich Union Healthcare pays a maternity cash benefit of £100 per child on its Fair & Square and Medios policies. WPA's Flexible Health policy has an additional cash plan option, where if you pay higher premiums, you get certain cash benefits. This includes maternity and paternity benefit, which pays out £150 per child on level one and £300 per child on level two.
BCWA policies also have a maternity cash benefit of £100 per birth, provided the mother has been enrolled as a member of the scheme for more than 12 months.
The value of these depends on each individual, but insurers say they are more of a token gesture on the birth of a child. However, Cox questions the value of this feature. "Some of the cash maternity benefits seem so small in relation to the magnitude of having a child," he says.
There are a number of important factors to take into consideration when choosing to have a child in the private sector. As pregnancy and normal childbirth are generally excluded from PMI policies, it is imperative that female clients do not think they are covered when they are not. Similarly, understanding what maternity benefits are available is also important as these can vary widely between providers and clearly identifying exactly what is available to the client is crucial.
COVER notes
&149; Normal pregnancy and childbirth are generally excluded from most PMI plans.
&149; Most providers cover complications of childbirth such as ectopic pregnancies.
&149; A 10-24 month qualifying period is usually required before any maternity benefits can be claimed.
