Medical insurance for women: How to buy a plan that will actually help in your time of need

Between the boob smooshing, involuntary nakedness and cold, clammy accoutrements being manoeuvred into your privates, a visit to the gynaecologist is probably as awkward as an experience can get. Then you discover that your mediclaim doesn’t cover the innumerable procedures dotting your pregnancy journey, or the treatments required to treat infertility.

“I’m desperate to have babies, desperate. Not being covered by insurance is having a serious impact on whether I can afford to grow my family,” says Delhi-based Vibhuti Shah, 36, who’s been battling infertility for years.

Medical insurance for women should ideally differ from men, because sedentary lifestyles, stress, the pandemic and the pressures of the modern world affect us differently. Insurance companies, however, offer one-size-for-all plans that cater to both genders, even though their risks are completely different. And to complicate the issue further, the 2018 National Family Health Survey found that only 20% of women aged 15-49 are covered by health insurance or a health scheme.

“Heart disease kills more women. They’re more likely to show signs of depression or anxiety, or get a stroke or osteoarthritis. Some STDs are more serious for women than men,” says Dr Vidya Jha, a Mumbai-based general practitioner, explaining the need for tailoring medical insurance for women.

They also have to deal with pregnancy and reproduction-related disorders. “My son passed away in my womb at 20 weeks. The doctor had to induce labour, and it led to severe complications. The mental and emotional trauma left scars that are yet to heal, and it put a big dent in our wallet,” says Tanvi Srivastava, 32, Lucknow-based homemaker.

Opting for medical insurance for women can help address gender-specific health issues, or those that might affect women more severely than men.

Questions you might have when buying medical insurance for women

What will my mediclaim cover?

Insurance covers specific illnesses. It does not typically cover procedures done out of choice. Chances are an abortion, IVF course and PCOS or PCOD treatment will not be covered by your general insurance plan. Some do offer in-built pregnancy cover, but it is not always extensive.

Dr MS Kamath, LLM in Consumer Laws and a senior medico-legal consultant, explains that insurance companies work on the principle that only a small percentage of people will actually experience the condition they’ve been insured against, like a heart attack. “That’s why it excludes the very old or those with pre-existing diseases, since their chances for a claim are substantially higher. That’s also why policies which include these two categories have higher premiums,” he adds.

There are a few plans, however, that cover critical illnesses which are more likely to affect women, such as cancers affecting the breast, cervix, fallopian tubes, and other organs. “But most companies will not renew your policy post a claim. You will be given a one-time payment, and become ineligible to continue with the plan,” says Tarun Sinha, an independent insurance agent.

How can I get medical insurance for women with the best cover?

While the options are currently limited, there are a few ways to address the issue.

Opt for a specialised plan: Some insurance plans are specially curated to cover illnesses that women are prone to.

Bajaj Allianz women-specific critical illness insurance plan assures a guaranteed sum to the insured in the case of breast, vaginal, cervical, ovarian, fallopian tube, or uterine/endometrial cancer, and paralysis and burns.

HDFC women cancer plus plan covers cancer treatment, and major illnesses or autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus with lupus nephritis.

“Be aware that insurers can decide to continue or discontinue a product at any point in time on the basis of its claim ratio. They may also increase the premium to let you remain insured,” says Sinha. “If you have a pre-existing illness, the insurer may refuse to issue a policy. So understand the terms and conditions before you sign up.”

Understand your company policy: If you are employed, and covered by a group insurance policy, it probably covers illnesses that affect women. Your HR executive or official insurance liaison could help decode that for you.

Start a fund: Keep an emergency fund ready for medical expenses and procedures that your general insurance plan does not cover. Get an estimate on what it could cost you and start saving up by starting an SIP or even a recurring deposit.

Get maternity insurance: Care Joy maternity health insurance plan has two variants under which maternity expenses, hospitalisation, newborn baby birth defects, pre-delivery, post-delivery and vaccination charges are covered depending on the plan you choose.

Go for preventive health checkups: Routine tests done as per your gynaec’s recommendation can ensure that you are ready for any curveball life throws at you. Here are 5 to get you started.

Sure, you’ve got 99 problems. Armed with the right information, you can now also get medical insurance to cover some of them.