Published September 29, 2023

Pregnancy Insurance Claim — 5 Real Cases I Have Handled For New Parent Clients

min read

Navigating a pregnancy insurance claim can be painfully complex for new parents.

Up to now, I have personally assisted dozens of my clients in the claims process by submitting their claims on their behalf, managing the details, and successfully collecting payouts from insurance companies.

It is my job, as a licensed financial planner who sold them an insurance, to help ensure a smooth journey during a stressful time — financially and, even more so, mentally.

Because, seriously, the stress of having a child hospitalised is no joke!

From premature deliveries to neonatal jaundice to tiny collapsed lung😢, I'll highlight a handful of real cases out of the many that I have handled.

With these stories, I hope to help you make an informed decision about getting a maternity insurance and the coverage that suits your needs best.

Pregnancy insurance statistics among my clients

To start, these are the stats on my pregnancy insurance clients and claims that I think you may find interesting:

  • 15% of pregnancy insurance purchase applications get rejected,
    • 46% of which is due to undisclosed diabetes (aka GDM or gestational diabetes mellitus)
    • 30% due to more than one previous miscarriage and/or abortion
    • 15% due to a COVID-19 diagnosis during pregnancy
    • 9% due to other miscellaneous health issues, e.g. ovarian cysts, uterine fibroids, candidiasis, etc
  • 39% of clients file a claim in their first policy year
  • 100% of claims successfully get a payout
    This is NOT typical! My clients and I have been quite lucky!

A couple quick advices would be:

  1. If you've decided to get a pregnancy insurance, get it approved before your glucose test (usually takes place around week 24-28 of your pregnancy, check with your gynae).

  2. Always disclose your full, honest health history. If your agent advises you to lie to manipulate your application, run the other direction!

    Your insurance may become void and future claims be rejected once you get found out — it is rarely worth the trouble to lie to your insurer.

Pregnancy insurance real cases

1. Double Joy: Twin Pregnancy Insurance Policies That Surpassed Expectations

Diagnosis/condition: Premature twin delivery with jaundice
Pregnancy insurance claim payout: RM13,000
Time-to-payout: 12 days
Cumulative Premiums Paid: RM2,000
Insurance Company: Prudential

My client conceived twins and purchased two pregnancy insurance policies. The premature delivery led to 6 days in the NICU and then 5 days in the NHDU for both babies. And both required phototherapy treatments for jaundice.

An NHDU is a neonatal high dependency unit, where babies with less severe conditions than NICU babies go.

The total costs for NICU, NHDU and jaundice treatments amounted to about RM7,300.

Prudential paid out RM13,000 (!!), leaving plenty of excess for my client's other baby expenses!


The duration from the day of the claim submission and day of payout

Cumulative premiums paid:
The total premiums that a client has paid before a claim is submitted.

2. Emergency Caesarean Section and Respiratory Distress

Diagnosis/condition: Meconium aspiration syndrome with neonatal jaundice
Insurance claim payout: RM1,500
Time-to-payout: 13 days
Cumulative premiums paid: RM832
Insurance company: Great Eastern

The baby faced respiratory distress during birth so he was then placed in NHDU (neonatal high dependency unit) for 5 days with concurrent phototherapy treatment for jaundice.

The NHDU costs amounted to RM1,000; Great Eastern paid out RM1,500.

However, as the baby's total serum bilirubin level (TSB level) for jaundice did not meet Great Eastern's benchmark level (250 μmol/L), the jaundice claim was denied.

3. A Goodwill Gesture by Great Eastern: Neonatal Jaundice Claim

Diagnosis/condition: Neonatal jaundice
Insurance claim payout: RM1,000
Time-to-payout: 36 days
Cumulative premiums paid: RM742
Insurance company: Great Eastern

The client brought their jaundiced baby to a medical facility that did not have a lab room to conduct a blood test to find out the baby's jaundice level.

Instead, the paediatrician used a Transcutaneous Bilimetry (TcB) test, which did not meet the insurer's claims requirement.

(All insurance companies in Malaysia require blood test results for jaundice claims!)

However, considering the TcB level was high, Great Eastern chose to pay the full jaundice claim payout — RM1,000 — out of goodwill.

4. Spontaneous Pneumothorax: Managing the Unexpected

Diagnosis/condition: Spontaneous pneumothorax, small holes in the heart and neonatal jaundice
Insurance claim payout: RM2,200
Time-to-payout: 18 days
Cumulative premiums paid: RM1,254
Insurance company: Great Eastern

The baby experienced neonatal jaundice, small holes in the heart chambers, and respiratory distress as a result of a collapsed left lung.

The baby boy needed to be ventilated, leading to an NICU and incubation claim.

1 day of stay in the NICU and 3 days in an NHDU amounted to RM1,220.

Similar to a few case studies above, the TSB level also did not meet Great Eastern's requirement, hence the jaundice claim was not paid.

However, the parents of this little fighter still received a RM2,200 payout to cover part of their total hospital costs.

5. Government Hospital Claim: Meconium and A Foot Abnormality

Diagnosis/condition: Meconium aspiration syndrome with bilateral positional CTEV
Insurance claim payout: RM2,500
Time-to-payout: 134 days (longer than usual due to slow responses from the government hospital)
Cumulative premiums paid: RM1,640
Insurance company: Great Eastern

This case involved meconium aspiration syndrome as well and bilateral positional congenital talipes equinovarus (AKA Clubfeet, a common foot abnormality where the feet point downward and inward), requiring treatments and a NICU stay of 5 days.

The total government hospital bill was only RM51.

And my client subsequently received a RM2,500 payout.

One thing to note when you are dealing with a government hospital regarding an insurance claim is that the process will not be fast!

In this case, it took us around 4 months to secure the payout.

The importance of pregnancy insurance: Your safety net as a new parent

Getting a pregnancy insurance is a proactive step towards safeguarding your family's future.

As seen from the real-life cases above, unpredictable things can happen!

Complications can arise that might lead to unexpected medical costs.

Whether it's a premature birth of your baby, neonatal jaundice or a more dire medical condition...

The right pregnancy insurance policy can ensure that both the mother and the newborn receive the necessary care and treatment without putting undue strain on the family's finances.

How we can help

At Simply Better Finances, we understand the importance of a tailored approach to pregnancy insurance.

As a client, you will have access to multiple insurance options without any bias towards a particular company, e.g. AIA, Prudential, Great Eastern, Manulife, etc.

Together, we can find the plan that best suits your unique needs and circumstances, providing you the assurance that you and your baby are in good hands.

Investing in pregnancy insurance is not just a financial decision; it's a commitment to the well-being of your growing family.

Contact us today to explore the right coverage for your peace of mind.

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