A steep rise in maternity related expenses & post-natal medical care over the last decade has lead to more couples opting for maternity insurance. Those buying maternity insurance must understand what it is and how do these policies work.
Maternity health covers are designed in such a way that they provide insurance coverage against the maternity expenses faced by people. These policies generally come with a waiting period before the cover can come into effect. Maternity insurance is a type of insurance that covers expenses related to childbirth up to a specific limit. It can be availed as an add-on rider or as a standalone policy. Maternity insurance falls under the health insurance category.
With skyrocketing healthcare costs and increasing complexities of childbirth, the delivery expenses in a decent hospital may range from Rs. 50,000 to Rs. 1,50,000. These expenses vary according to the complications involved in the birth process, i.e. from normal to caesarean delivery. In such cases, insurance for birth related expenses and medical expenses related to a new-born baby turns out to be a blessing.
What is maternity insurance?
Maternity insurance plans offer coverage against maternity-related expenses. According to a recent study, the average age of women embracing parenthood has risen to the age of 32 in India. There is a common view that women who have their first child in their early 30s may have a complicated pregnancy. Moreover, the ratio of normal to caesarean deliveries stood at 65:35 in metropolitan cities, according to a study undertaken in the recent past. Several people are, therefore, increasingly opting for a maternity cover along with health insurance plans. Generally, maternity insurance policies come with high premiums and long waiting periods.
Many health insurance policies cover maternity-related expenses in the form of add-on riders. In some cases, maternity coverage is included under the ambit of OPD related costs. In other cases, group insurance provided by the employer includes maternity insurance.
Features and benefits of maternity insurance
Following are some salient features of maternity insurance plans.
Waiting period: Most of the maternity health insurance plans come with a waiting period of 3 to 6 years. Hence, you can claim benefits only after the completion of the waiting period post-policy commencement. Group insurance plans which offer maternity cover generally don’t have a waiting period or a period of just 9 months.
Inclusions / Coverage: The coverage of maternity insurance plan varies according to the insurer. However, the general expenses which are covered are as follows:
- Hospitalisation expenses
- Pre-hospitalisation expenses for 30 days
- Post-hospitalisation expenses for 60 days (nursing expenses, room charge, anaesthetists’ charges)
- Delivery expenses
- Vaccination of the infant
- Pre and post-natal expenses (depends on the type of delivery)
- Ambulance charges
- Baby cover
- Emergency expenses are generally covered up to Rs. 50,000
Premium: A best health insurance policy with maternity cover is usually expensive as it has almost 100% claim ratio as compared to other insurance plans. Premium is typically higher than basic plans and depends upon several factors as mentioned below –
- Sum Insured
- Age profile
- Risk factor
- Number of employees (in case of group policies)
- Company location (in case of group policies)
When is the right time to seek maternity insurance?
Pregnancy is a joyous as well as a life-altering journey for people in more ways than one. With rising medical inflation and overall expenditure, maternity expenses have become costly. Lack of proper planning may burn a hole in your pocket, which may override the happiness of entering into parenthood. According to experts, one should plan well in advance, as maternity insurance plans typically come with a long waiting period.
Given that most insurance providers do not offer maternity insurance to women who are already pregnant, considering it as a pre-existing condition, women who wish to avail maternity insurance should apply for it before they conceive. A planned pregnancy is a critical aspect of maternity insurance.
What is not included in maternity health insurance?
There are certain exclusions applicable to the maternity benefit as listed below:
- Consultation fees of the doctor
- Non-allopathic treatment costs
- Regular medical check-ups
- Medicine costs
- Congenital diseases
- Pre-existing conditions or injuries diagnosed within 48 months from the date of policy commencement.
- Termination of pregnancy within 12 weeks
- Expenses due to self-inflicted injuries use of drugs or alcohol
- AIDS/HIV treatment-related expenses
- Dental treatment expenses
- In-vitro fertilisation and infertility related expenses
Some of the top maternity insurance plans
The following are some of the maternity cover offered by the top insurance companies in India.
|Company Name||Plan Name|
|Max Bupa||Heartbeat Family Floater|
|Apollo Munich||Easy Health Young Family|
|Royal Sundaram||Lifeline Elite|
|Star Health||Wedding Gift|
|HDFC ERGO||Health Suraksha Gold|
Maternity health insurance claim process
The process to make maternity insurance claim may vary from one insurance company to another. However, in most cases, the policyholder has to follow the procedure mentioned below:
- For cashless hospitalization - Intimate the insurance company about the claim prior to 48 hours to 72 hours of hospitalisation or within 48 hours of emergency hospitalization.
- Fill up the pre-authorisation form available at TPA desk, or you can also download from the website of the insurance company.
- Upon receiving the pre-authorisation claim form, the claim management team of the insurer sends a letter of approval within a stipulated time.
- If your preferred hospital is not in the network of the insurer, you can then file a reimbursement claim. As a responsible parent, it is advisable to prepare suitably for the cost related to pregnancy and the delivery of the baby. With the ever-rising medical cost, one has to be prepared in advance for all unexpected and expected expenses. And this is why you should consider a maternity insurance cover before embracing parenthood.
Recommended Link: Maternity Insurance Coverage