Maternity Insurance

While the anxiety about parenthood will take days to settle, one thing you don't need to worry as much are the hospitalization expenses if you have adequate maternity cover. While there are numerous other factors that the couple should consider before and after conceiving to ensure a safe and healthy pregnancy, one cannot overlook the cost involved. With high-end hospitals spreading their web across the country, the cost of a normal delivery clubbed with the hospitalization in a decent hospital in any metro city could range anywhere between Rs.60,000 to Rs.2 Lakhs. These shocking figures only suggest a need for proper planning of finances towards the expenses that will incur. Hence, a Maternity cover offered by several Health Insurance companies is one modern approach to tackle these costs.

What is Maternity Health Insurance?

The benefits of such a coverage include financial protection during pregnancy, pre and post-natal care for the new born, pre and post hospitalization expenditures, ambulance charges, and delivery costs, irrespective of whether it is a Caesarean or a normal delivery. The new born baby is also covered by the maternity health insurance plan till a certain period.

Features of Maternity Health Insurance Plans

Comprehensive coverage – An effective maternity health insurance policy covers the expenses incurred for delivery, pre and post hospitalization, as well as charges for ambulance services, medicines hospital room rent and doctors’ consultation fees.

Pre and post-natal care for the new born – Maternity health insurance not only covers the mother, but also financially protects the new born, in case he/she is diagnosed with critical illnesses.

Hospitalization coverage – Pre and post hospitalization expenditures related to pregnancy for a certain span of time before and after hospitalization, as mentioned in the maternity health insurance policy document.

Cashless facility – Maternity health insurance plans of leading insurance companies offer the cashless facility at their network of authorized hospitals across India.

Claim-free bonus – Discount on the premium for the next year, in case the policyholder does not raise claims in a certain policy year. Quick and streamlined online application – Maternity health insurance plans offer individuals the convenience of online application at the click of a few buttons.

Tax savings - Tax benefits as per Section 80D of the Income Tax Act, 1961, is applicable on maternity health insurance policies. Waiting period – Expenses related to maternity are usually covered by maternity health insurance plans after 9 months to six consecutive policy years.

Flexibility to select your sum insured – Individuals can choose the sum insured that they want to receive as maternity expenses, when the need arises, at the time of purchasing a maternity health insurance policy.

Benefits of Maternity Health Insurance

  • Outpatient services like hospital room rent, medicines and doctors’ consultation fees, and treatments like lab studies, gestational diabetes screenings, etc.

  • Inpatient services like doctors’ fees, pre and post hospitalization, etc.

  • Pre and post-natal care for the new born

Eligibility for Maternity Health Insurance

Any individual who meets the eligibility criteria, as set by an insurance company, can purchase a maternity health insurance plan from that insurer.

Why Do You Need Maternity Insurance

As a responsible parent, you must prepare suitably for the cost related to pregnancy and the delivery of the baby. With the medical costs soaring high, one has to be well prepared for all expected and unexpected expenses. And this is why you should consider a Maternity cover in your health insurance plan

Covers Your Maternity Expenses: Most regular-joe medical health insurance policies does not cover maternity costs and thus are of no use when the time comes for the baby’s delivery.

Safeguard Against the Rising Healthcare Costs: With healthcare inflation about 15-18% each year, the cost of hospitalization will be more than twice within the next five years.

Also Read: Why You Should Opt for Higher Health Insurance Coverage?

Who Can Purchase Maternity Health Insurance?

Anyone who fits the eligibility criteria laid down by an insurance company is eligible for buying a maternity health insurance plan of that company.

Does Regular Health Insurance Policies Provide Maternity Cover

Yes, they do. But this goes against the principle of insurance. You don't insure an event that is most likely to occur. You insure an event that only has a rare possibility of occurrence. See the difference? However, most insurers still promote this cover for a couple of reasons:

Reason 1 - It is a great marketing ploy, as the brochure reads 'MATERNITY COVER INCLUDED.'

Reason 2 - It helps cushion the maternity expenses for 'loyal' customers

What Does Maternity Cover Include

Includes expenses for hospitalization and the costs for the delivery of the baby (normal or caesarean) Covers costs that are related to pre and post hospitalization, as well as pre & post-natal care Covers the new-born baby as well, up to a particular time limit Includes the ambulance charges for ferrying the to-be mom to the nearest network hospital of your choice

So Let's Quickly Decode Maternity Insurance

So should you opt for the health insurance plan that features to cover maternity expenses? Well, it's not as black & white as it seems. There is a CATCH.

WAITING PERIOD

All maternity covers come with very stringent waiting period ranging from 36 to 72 months of continuous renewals. So, if you are planning a baby in the immediate future, this benefit is as useful as a discount coupon for a hardware store in Honolulu. However, some innovative maternity focussed health insurance plans such as "Joy" from Religare Health Insurance comes with an extremely low waiting period of just nine months.

LIMITS ON MATERNITY SPEND

Both group and individual policies that offer maternity as an add-on cover have a restraint on the coverage amount, either by way of a flat figure or linked to the overall sum assured. Very few policies cover it for more than Rs.50,000. As the actual cost for the delivery goes upwards of Rs.1 Lakh, especially in metro cities, one might require shelling out a good chunk from his pocket.

COVERAGE

The policy wordings of the plan gives a real clarity on what and how of the coverage. Check if the plan also offers other benefits such as cover for the newborn from day one, coverage for termination of pregnancy, associated pregnancy complications & pre and post-natal expense. Similarly, keep an eye on the sub-limits, whether the plan covers both types of deliveries and other exclusions/special conditions, etc.

Some Holistic Insights On Funding Maternity Expense

If you believe in planning finances and want the best the medical attention for you/your spouse and your baby, it makes absolute sense to plan your medical expense related to maternity.

OK, now that we've briefly reviewed what maternity health insurance plans are all about, following are some pointers on how one should plan for this expense in a holistic manner:

Do not be in a hurry to purchase a health policy only because it offers a maternity cover. Maternity cover can be just one of the “pluses” but cannot be the sole criterion for buying a health cover. Evaluate the policy for all other valuable benefits and choose the best.

Since there is a sub-limit for maternity related expenses that does not match the actual costs, it is likely that the insurance policy will fund only up to 20%-30% of the cover. Hence, you should target a dedicated fund for the whole of the expense, without considering the insurance claim. This arrangement will provide a complete peace of mind. If you get a maximum maternity claim payout, that will be an icing on the cake.

Employer's group health insurance plans have better conditions on the maternity cover. As these plans have fewer limitations compared to individual plans, claiming them is much easier and favorable. Hence, in case you happen to incur an expense, first, try to claim from the group policy without recourse to your individual one. This measure will also help you preserve the no claim bonus of your own policy.

So Mommy and Daddy-To-Be, Here’s What You Need To Do…

If you are keen on a high-end private room in a decent hospital, you can expect to get a claim payout up to 20%-30% of your maternity costs. Hence, it’s wise not to rely entirely only on health insurance maternity benefit to tackle the delivery and hospital related expenses. Check the waiting period in your policy or the one you plan to buy, to know if and when you can claim. When it comes to the spending limit, it is not very different across insurance products available today.

Likewise, don't decide your basic health insurance plan purely basis the Maternity Cover. It's a valuable feature only after a particular period and for a limited amount; not something you should primarily seek.

Bringing a whole new life into this world is certainly no cake-walk. Plan well and ins ure adequately to make this experience a real cherishable one. Call Coverfox.com if you have any questions or need help in choosing the best plan to safeguard your financial future.

Faqs on Maternity Health Insurance

If I am already pregnant, can I be covered for maternity?

As most insurers count pregnancy as a pre-existing condition, they will not accept your application if you are already pregnant unless you are entering a group policy.

What if my baby is born with a birth deformity?

If your baby is born with an abnormality, deformity, disease, illness or injury, it is termed as a congenital condition. The coverage for such deformity purely depends on the insurance company and varies from all to none to partial.

Is my baby covered right from the birth?

Some insurers do cover the newborn baby from day one until they are 90 days old. From day 91, they can be added to the parent's policy by paying the additional premium. And some don't at all. However, this decision entirely rests with the underwriting team of the insurance company.

My daughter is getting married soon, and I wish to gift her a health insurance plan. What other benefits should I consider along with Maternity cover?

Congratulation on such a thoughtful gesture! Apart from Maternity cover, you can consider a plan that offers other valuable benefits as a cover for critical illness, hospital cash, room-rent waiver, etc. Also, find a plan that has fewer restrictions on sub-limits. Call Coverfox.com to assist you with the best deal!

How do I claim the Maternity cover?

As in all health policies, you must intimate the insurance company about the pregnancy if your plan includes the Maternity. And when you get hospitalized for the delivery of the baby, you must raise a claim with the insurance company. The sooner, the better.

Are maternity expenses covered under the health insurance policy?

Motherhood is a gift every woman wants to nurture. Sadly, the expenses arising right from the delivery to pre and post hospitalization as well as the new-born care are exorbitant these days.

Health Insurance is a type of mediclaim that strives to offer insurance coverage to reduce your medical and surgical expenses. Maternity expenses are also covered under a health insurance policy.

Most insurers consider pregnancy as a pre-existing condition. So, it definitely comes with a waiting period clause. Additionally, if you are already pregnant, an individual health insurance cover will not cover maternity expenses. A group health insurance plan may however cover maternity even if you are pregnant while entering the plan.

However, the below factors come into picture, when you plan your maternity under a health insurance policy:

Waiting period and extra premium Well, it goes without saying that every health insurance policy comes with a waiting period. Once you ask the insurer to add maternity in your health insurance policy, you will have to adhere to the waiting period of 2 years. This waiting period however depends on one insurer to another. At times, this may be as long as 4-6 years. Besides, health insurance along with a benefit of maternity comes at a higher price than normal. This is because insurance companies treat maternity as a high risk cover. The claim ratio is mostly higher for this type of cover unlike other expenses covered under a health insurance policy. For example, Ajay a newly married 30 year was advised to buy a family floater plan that covered maternity too. Happily he wished to opt for the same since he was planning to start a family in 2 years. Sadly, the insurance agent explained that the plan had a waiting period of 4 years. Ajay then planned to opt out of the maternity cover since it was incurring a heavy

The exclusion list Buying a health insurance with a maternity cover doesn't necessarily cover all the medical expenses. For example, pre and post hospitalization expenses may not cover ultrasound charges or all your visits to the gynaecologist. Besides, fertility treatments like IVF, IUI etc. also are not covered. Abortions also frame a part of the exclusion list. Complications arising in the pregnancy leading to medical termination of pregnancy is covered by a very few insurers. So, it is advisable not to buy a health insurance policy only to cover maternity benefits. This is because, you continue paying a higher amount of premium till the time you renew your health insurance plan. There are also high possibilities of certain expenses not getting covered due to the cap on charges. You may still buy special maternity plans from a health insurance company that covers cost for pre and post hospitalization, cost of the delivery that includes both normal and c-section, covers the new-born baby as well as the ambulance charges.

Can I Buy Pregnancy Insurance Policy After Getting Pregnant?

Yes, you can purchase a maternity health insurance while you are pregnant. However, the expenditures incurred for the current pregnancy will not be covered by the policy. If your employer has offered you a group health insurance policy, check whether it covers maternity expenses.

What is excluded under a maternity health insurance policy?

The following are not covered by maternity health insurance plans:

  • Medical tests undertaken during pregnancy
  • Doctors’ fees during routine check-ups as a part of post-natal care
  • Expenses related to purchase of necessary vitamins and supplements for the mother or the new born

When is the best time to purchase a maternity health insurance policy?

It is essential for you to purchase a maternity health insurance plan way before you are pregnant or planning a baby. This is because such plans are generally accompanied by a waiting period that varies between 9 months and 6 years. It implies that you would be eligible for availing the benefits of the plan only after the completion of the waiting period that is applicable to the maternity health insurance policy that you have purchased. Therefore, you may be able to buy a maternity insurance, but not be able to avail the benefits of the plan due to the waiting period.

What is the premium I have to pay for a maternity health insurance plan?

The premium that you have to pay on your maternity health insurance plan depends on certain parameters like the sum insured opted by you, your age, location, etc. The premium that you will be eligible for varies between insurance companies.

What is the waiting period for maternity health insurance policies

The waiting period usually varies between 9 months and 6 years, and differs from one insurance company to the other. You can avail the benefits of your maternity health insurance plan only after the completion of the waiting period, as mentioned in your policy document.

I will not be covered by my maternity insurance because I had purchased it during my first pregnancy. Will I be able to avail the benefits during a second pregnancy?

In your case, your on-going pregnancy will not be covered because you are yet to complete your waiting period. Your second pregnancy will be covered by your maternity health insurance plan, only if you have served the waiting period by that time.

What does a maternity health insurance plan cover?

Below are the benefits offered by maternity health insurance:

  • Inpatient services like doctors’ fees, pre and post hospitalization, etc.
  • Outpatient services like hospital room rent, medicines and doctors’ consultation fees, and treatments like lab studies, gestational diabetes screenings, etc.
  • Pre and post-natal care for the new born

What is the waiting period for maternity insurance policy?

Maternity health insurance plans are accompanied by a waiting period that varies between insurance companies, and usually ranges from 9 months to 6 years. You can avail the benefits of your maternity health insurance plans only after the completion of consecutive policy years.

Does health insurance cover pregnancy?

Yes, there are certain health insurance policies that cover maternity-related expenses.

Which health insurance plans cover maternity?

The following are some leading health insurance plans that cover maternity-related expenses:

  • Religare Joy Today/Tomorrow Plan: This maternity insurance plan offers the flexibility of selecting between two sum insured options – Rs.3 lakh and Rs.5 lakh. This is accompanied by a waiting period of 9 months/2 years.
  • HDFC ERGO Health Suraksha Gold: The sum insured options applicable is based on the type of the plan - individual or family floater. A waiting period of 4 years is applicable on this maternity health insurance policy.
  • Star Wedding Gift Insurance Plan: This maternity health insurance plan is offered on the basis of a floater with a policy term of 1 or 2 years.

Does maternity insurance plan cover caesarean delivery?

Yes, maternity health insurance policies cover expenses incurred for delivery of a new born, irrespective of whether it is a C-section or a normal delivery.

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