So you’re pregnant and looking for maternity insurance. Now what?

One of the most common questions CCW Global receives in relation to health insurance is whether a woman can obtain maternity insurance if she is already pregnant.

Given that the costs of having a baby through Hong Kong’s private medical system can easily exceed HK$150,000 (US$19,350) there is obvious concern about maternity insurance for many families in the city. This is not to disparage the government run hospitals and clinics, like the Queen Mary, where the cost of having a baby can be as low as HK$45,000 (US$5,800). However, there are issues with the public facilities that are not experienced at private institutions, like the Matilda or Sanatorium hospitals, which leads many families to choose the convenience, comfort, and price tag of a birth at a private hospital.

With the cost of giving birth at a private hospital in Hong Kong being extremely high, and the average premium associated with maternity insurance ranging from US$5,000 to US$10,000 per year, being able to take out an insurance plan covering the costs of maternity medical treatment and the actual delivery would be a bargain.

Unfortunately this is where the situation becomes complicated.

Is pregnancy really a pre-existing condition?

At this point it is worth taking a look at the definition of insurance. For reference, insurance is defined as the equitable exchange of risk between two parties for a predetermined fee.

Under the definition of insurance its immediately apparent that in order for a contract of insurance to be placed we need two things:

1) A Risk. In the case of health insurance the risk is your exposure to the costs of healthcare should you fall sick or suffer an accident.

2) A Fee. This is the premium that you pay to the insurer in return for your coverage; this may be higher or lower based on your specific risk of requiring healthcare.

The critical factor here is risk. In order for insurance to be practiced it is only risks that can be covered – not facts. For example, a home which is currently on fire would likely not be accepted for coverage under a fire insurance policy. This is due to the fact that there is no risk, no potential of fire. The home is currently on fire, this is a fact. Consequently, there can be no equitable exchange of risk in relation to the home being on fire and no insurance can be placed on the property.

Humans are not inanimate objects, healthcare and medicine are often more complicated with far more moving parts than a fire – with conditions that can change. As such, and in order to simplify their operations, many insurers will simply exclude any medical conditions of which the policy holder is aware or of which they have received treatment for prior to the commencement of an insurance policy.

However, becoming pregnant is not a condition that lasts forever. In 9 months, the mother gives birth and is no longer pregnant. So, does joining an insurance plan if you are already pregnant mean that maternity is now excluded indefinitely? No, it does not, but nor does it mean that the pregnancy you joined the policy with will be covered.

In order to deal with this specific situation insurance companies will place a waiting period on your policy in relation to all maternity coverage benefits.

What are waiting periods?

We did say this was a complicated subject!

Waiting Periods are special clauses that apply to certain benefits on health insurance policies. Maternity is one such benefit that is always tied to a waiting period.

A waiting period is the length of time that must elapse before a specific policy benefit is able to be covered under the health insurance policy. The length of the waiting period, and the benefits which are attached to a waiting period, will vary between insurance companies but the concept remains the same.

For a majority of Hong Kong and International health insurance plans the waiting period in relation to maternity coverage is normally between 12 and 24 months from the start of the plan. This means that, depending on the policy you purchase, you will have to wait at least 10 months from the moment your plan is active before you are able to receive any coverage for maternity treatment or childbirth costs under the policy.

This over simplifies the case slightly, as there are actually two different types of maternity waiting period that can be commonly found under Health insurance products offered in Hong Kong.

1) From the start of the plan. The waiting period starts the minute the plan is purchased and is completed after a specified date.

2) Until conception. The policyholder must wait a specific length of time until they can conceive a child if that pregnancy is to be covered under the policy.

While a waiting period that is applied on a “conception” basis is obviously more restrictive than one which commences with the start of the plan, under both types of waiting period the policyholder/mother will have to wait before receiving coverage for the pregnancy under the plan.

With the length of both types of waiting period exceeding 9 months this obviously precludes anyone who is already pregnant from receiving coverage under a health insurance policy, if said policy is taken out after the conception date.

Is there really no coverage available if I’m already pregnant?

If you’re already pregnant and looking for help with the costs of your delivery, prenatal, and post-natal treatment from a maternity insurance policy then the chances of this happening are extremely low to non-existent. Waiting periods are placed on insurance to ensure that individuals are enrolled on the policy for a sufficient length of time to ensure that they are not attempting to disrupt the equitable nature of the insurance contract.

However, while the costs of the delivery and checkups for your pregnancy may not be able to receive coverage under the policy, obtaining a maternity insurance plan (even if you are already pregnant) can ensure that your child is born with health insurance protection and is able to access high quality, comprehensive healthcare from the moment of their birth.

While this is not able to assist with the prohibitive costs associated with giving birth at one of Hong Kong’s premier private maternity hospitals, it does ensure that your child is protected against the cost of treatment for any congenital birth conditions, if the baby is born prematurely, and is able to access lifelong guaranteed health insurance as soon as they are born no matter what the state of their health may be like.

Newborn child coverage is normally offered in one of two ways:

1) A Free benefit: the child is provided free health insurance for a specified length of time after which an application must be made to formally enroll them on the insurance.

2) Born into the Plan: the child is born into the parent’s health insurance policy and an appropriate premium paid. The child is covered as per usual up to the plan limits.

Having a child born into an existing medical insurance policy is the more expensive option, but ensures that they are fully covered from the moment of birth. There is no gap in coverage, and any medical conditions which were present at the time of birth will be covered fully as long as the child remains on the health insurance plan.

A free benefit requires a reapplication for insurance once the coverage has expired. This runs the risk of any medical conditions which have presented at birth being excluded from coverage as pre-existing when the insurer underwrites the infant as part of the application from continuing coverage.

Maternity Insurance is complicated. CCW Global can help

Maternity coverage is one of the more complicated aspects of health insurance, and its important because it directly impacts your future, your plans, and your dreams for your family. Not every situation is the same, and there is a tremendous amount of choice available to you for maternity insurance protection, even if you’re already pregnant.

For more information or to receive a free quotation simply complete the short form at the top of this page. Alternatively, you can Contact Us to speak directly to one of our expert Hong Kong Insurance Brokers and discuss your specific needs.