Maternity Health Insurance Guide

While the excitement of parenthood may require some time to subside, if you have adequate maternity insurance, you won't have to stress about the associated costs. Couples should consider several other things before and after the baby is delivered. The best insurance plan for pregnancy will also cover the newborn child up to a specific time. Financial protection during pregnancy, pre- and post-natal care, pre- and post-hospitalisation costs, ambulance fees, and delivery costs, regardless of whether you have a normal delivery or a caesarean section, are all advantages of maternity insurance. Therefore, one of the best ways to deal with such costs is to purchase maternity insurance, which many health insurance companies provide.

What is maternity insurance?

Maternity insurance is a specialised health insurance plan that is designed to cover expenses related to pregnancy and childbirth. This includes costs associated with both normal and caesarean deliveries, prenatal and postnatal care, and sometimes extends to cover the newborn's medical needs for a specified period.

What is pregnancy insurance so important?

The following list includes maternity insurance benefits in India:

• Acting as a Financial Backup:

Maternity insurance is a safety net for the family’s finances by covering the expenses related to normal and caesarean birth. You need not worry regarding the payment of treatment. Some plans include pre- and post-hospitalisation expenses, paying all associated costs up to 30 days before admission and related expenses up to 60 days after admission.

• Expensive delivery in an intimate setting:

People today prefer private clinics because they want high-quality healthcare. Caesarean delivery may cost an additional Rs 50,000 to Rs 1 lakh in a private hospital, while a normal birth may cost Rs 50,000 to Rs 70,000. Your insurer provides all these costs.

• Coverage for the newborn from Day 1:

Typically, health insurance begins to cover infants once they’re at least 90 days old. A maternity insurance policy, however, starts to pay benefits as soon as the child is delivered. In addition, some plans will pay for the newborn's immunisations until the end of the policy year.

• Prepares the couple for complications:

A newborn requires an incubator for a specified time for complications like premature birth. The price of such treatment can reach Rs 10,000 per day. However, if you have a good maternity insurance plan covering most expenses, you can find respite from the financial pressure.

Features of maternity health insurance

The benefits of purchasing pregnancy insurance online include the following:

• Cashless hospitalisation:

Leading insurance companies offer maternity plans to provide cashless hospitalisation services at hospitals nationwide. At network clinics, you can access medical services without paying for them.

• Claim-free Bonus:

If you do not make a claim during a policy year, some insurance companies will reduce the insurance payment for the following year or increase the amount covered at the same premium. Moreover, insurance companies provide an online application facility to make the process straightforward for policyholders.

• Choice of the covered amount:

Policyholders can choose the insured amount. When purchasing a maternity insurance policy, they can select the desired amount insured.

• Tax benefit:

Section 80D of the Income Tax Act of 1961 allows policyholders to receive tax benefits for insurance premiums paid for pregnancy coverage.

When you are ready to become a parent, maternity insurance coverage is an excellent addition to your healthcare plan. Growing medical inflation and the possibility of unpredictably high hospitalisation costs typically make it challenging to pay for medical expenses and can interfere with parenting pleasure. Therefore, buying maternity insurance is advised for an economically secure pregnancy. You can purchase these insurance policies online, as the process is seamless and easy.

Key benefits of maternity health insurance

The key benefits of maternity health insurance are-

• Financial Security: Reduces the financial burden of maternity-related medical expenses.
• Quality Healthcare: Facilitates access to better medical facilities and services.
• Comprehensive Coverage: Encompasses a wide range of maternity-related expenses, ensuring holistic care.

What is covered under a maternity insurance plan?

Inclusions are circumstances in which an insurer will accept a maternity benefit claim. The coverage extends to both the woman and the newborn child's related costs and those associated with delivery and childbirth. The following are the standard benefits of maternity health insurance:

1. Support for both pre- and post-hospitalisation

• Delivery and Labour Costs:

The maternity add-on insurance covers all birth-related expenses. However, the insurance may only cover a certain number of pregnancies due to the coverage limit.

• C-Section:

Your insurer will cover all costs if the doctor recommends a C-section for the mother's or the child's health.

• Hospitalisation and Room Rent:

All hospitalisation costs and room rent incurred while receiving medical care are covered by your health insurance policy with maternity benefits. This also includes the cost of natural and c-section births and pregnancy termination in a life-threatening, medically essential scenario.

• Newborn baby coverage:

Up to 90 days after birth, a newborn will receive coverage at no extra expense. The infant must be added to the basic plan as an insured individual after 90 days.

• Vaccination coverage:

A newborn infant needs to receive vaccinations frequently. The maternity advantages of a medical insurance policy cover the expenses of routine vaccinations, such as:

• Measles
• BCG
• Tetanus Toxoid
• OPV+IPV-B1/OPV
• Hib
• Hepatitis B-1
• MMR-1
• Typhoid
• DTPw booster-1 or DTPa booster-1
• HPV (female child)
• Meningococcal

What is not covered under maternity insurance plan?

Maternity insurance has several exclusions too. First, one should increase the coverage or amount insured under the plan to pay maternity expenses. The typical range of coverage offered by health insurance plans with maternity benefits is between Rs 20,000 and Rs 70,000, which needs to be revised to cover delivery expenses.

Second, there may be circumstances where the insurance company chooses not to settle the claim even though you think the policy covers all expenses. For example, an insurer may reject a claim in the event of a delayed pregnancy (for women aged 35 and more). Let’s have a look over the critical exclusions that apply to maternity insurance policies:

• Spending on vitamins and tonics listed in the plan as well as other dietary supplements
• During the pregnancy, costs associated with diagnostic procedures and medical visits.
• Costs associated with treating infertility
• Price of collecting and preserving stem cells, including the possibility of doing so as a preventative step.

The list above includes some factors; additional exclusions may be relevant depending on your selected maternity health insurance plan. Maternity insurance coverage plans vary, and it would be wise to read the terms and conditions related to the exclusions before you decide on one.

Is there an option to buy maternity health insurance while you are pregnant?

Typically, insurers do not provide maternity coverage as a part of your standard healthcare plan. Insurance companies consider pregnancy and it-s related expenses as a pre-existing condition. However, you can still buy maternity coverage as an add-on with your regular healthcare insurance policy. You might be wondering why you should buy maternity insurance. You might have to wait between 9 months and six years to make a claim for expenses related to becoming a mother. Therefore, purchasing pregnancy insurance after getting pregnant is not a good plan. Instead, consider buying it much ahead in preparation to avoid having to wait.

Unfortunately, inflation has increased the expense of healthcare and will probably continue to do so in the future. This includes maternity-related costs too. Women must buy pregnancy insurance as quickly as they can afford it. By doing this, you can enjoy the arrival of your kid without worrying about expensive medical bills. You can leave that in the care of your insurance provider.

Waiting until the very last minute when attempting to conceive will only lead to unnecessary worry. So, we suggest that you invest in a comprehensive maternity insurance policy well in anticipation. This will also help you complete the waiting period and help you to receive coverage when you start planning for a family.

Is there any waiting period to avail the benefits of maternity insurance claims?

The waiting period in a maternity health insurance policy is the term after which insurance coverage is made available to the insured. Maternity insurance without a waiting period does not exist. It starts on the day it is issued, though it may differ from one insurance policy to another. The four kinds of waiting periods for maternity health insurance plans are as follows:

• Waiting Period for Maternity Coverage -

• Maternity insurance typically pays maternity costs after a period ranging from nine months to 6 years. Depending on the plan, the specific waiting period might be different. There are no maternity insurance plans with no waiting period available.

• Initial Waiting Period -

A 30-day initial waiting period is standard for all medical insurance plans encompassing maternity care. Except for medical costs associated with unintentional injuries, the insurance provider does not accept claims during this time.

• Pre-existing Diseases Waiting Period -

• Pre-existing disease waiting periods for maternity insurance policies range from two to four years. The insurance provider will not provide coverage for pre-existing conditions during this time.

• Waiting Period for Specific Diseases/Procedures

After a 2-year waiting period, maternity health insurance will cover certain illnesses and procedures. The insurance company's policy document includes a summary of these illnesses and procedures.

Unfortunately, there is no health insurance with maternity coverage with no waiting period. However, it is essential to buy maternity benefits to ensure a safe and stress-free childbirth experience, especially in light of the spiralling costs of medical services.

How is maternity insurance plan premium calculated?

Maternity insurance plans have a cap on the number of benefits. You may claim up to the insurance cover you selected when you bought or renewed the insurance for the premium you paid. Your insurance amount chosen will have a significant impact on your insurance premium. Maternity insurance coverage has a higher premium than a standard medical insurance plan. Insurers charge higher premiums for these policies because there is a guarantee that a policyholder will make a claim under the policy. You should conduct a thorough cost-benefit analysis of the various plans provided by multiple insurance companies before purchasing such coverage.

It's important to remember that maternity insurance costs rise as you get older. Furthermore, the cost of maternity insurance is growing day by day. Therefore, women should purchase maternity coverage today and not put off their choice to guarantee they can access an affordable policy with the most significant benefits.

It is crucial to compare different plans and pick the best one because medical insurance policy costs vary considerably from one insurance provider to another. On their website, each insurance provider offers a free premium calculator. You can use it to determine the premium for your maternity insurance coverage.

Eligibility criteria for maternity insurance plan

Eligibility generally depends on:

• Age Limit

  Insurers often set a minimum and maximum age for coverage.

• Employment Status

  Some group policies are available through employers.

• Existing Health Conditions

  Disclosure of pre-existing conditions is mandatory.

Factors to consider while buying a maternity health insurance policy

Consider the following:

• Coverage Details: Understand what is included and excluded.
• Waiting Period: Choose a plan with a waiting period that aligns with the timeline of your family planning.
• Network Hospitals: Check the availability of network hospitals offering cashless facilities.
• Premium Costs: Ensure the premium fits within your budget while providing adequate coverage.

What documents are required to apply for maternity health insurance?

Typically required documents include:

• Identity Proof

  Aadhaar card, passport, or driver's license.

• Address Proof

  Utility bills, rental agreements, or passports.

• Age Proof

  Birth certificate, PAN card, or school leaving certificate.

• Medical Reports

  Any existing medical records or reports, if applicable.

Documents required to raise a claim for maternity insurance

To ensure a smooth maternity health insurance claim process, you must submit the necessary documents as per your insurer’s requirements. Here is a list of essential documents needed to raise a claim:

1. Duly Filled Claim Form:

   This form is provided by the insurer and must be accurately completed with all required details.

2. Hospitalisation Records:

   Includes admission and discharge summaries from the hospital, mentioning the duration of stay and treatment details.

3. Medical Bills:

   Detailed invoices for all medical expenses, including delivery charges, room rent, doctor consultation fees, and medication costs.

4. Doctor’s Prescription and Reports:

   Copies of all doctor consultations, prescriptions, diagnostic tests, ultrasound reports, and treatment records related to pregnancy and delivery.

5. Payment Receipts:

   If it is a reimbursement claim, you must submit original payment receipts from the hospital to validate the expenses incurred.

6. Newborn Medical Reports (if applicable):

   If your policy covers newborn care, submit medical reports of the baby, including any treatments required after birth.

7. Policy Document and ID Proof:

   A copy of the health insurance policy, along with the insured person’s identity proof (Aadhaar, PAN card, etc.), may be required.

8. Bank Details:

   In case of a reimbursement claim, you may need to submit bank account details, including a cancelled cheque, for direct payment processing.

Additional Documents (If Applicable)

• Employer’s Certificate: If the maternity coverage is part of a corporate health policy.
• Pre-Authorization Letter: Required for cashless claims in-network hospitals.
• Neonatal Care Reports: If the newborn requires additional hospitalisation, treatment, or vaccinations.

Ensuring that all these documents are in order will help in quick claim approval and hassle-free settlement under your maternity health insurance policy.

What is the claim process to avail of the maternity health insurance policy?

Filing a claim under a maternity health insurance policy is a straightforward process. Insurance companies offer two types of claim settlement methods: cashless claims and reimbursement claims.

● Cashless Claim Process

If you choose a hospital that is part of your insurance provider’s network, you can avail of cashless hospitalisation. Here’s how:

1. Inform the Insurer in Advance: Notify your insurance provider about your planned hospitalisation at least 48-72 hours in advance for a scheduled delivery. In case of an emergency, inform them within 24 hours of admission.
2. Provide Necessary Documents: Submit the health insurance policy details, ID proof, and maternity coverage approval form to the hospital’s insurance desk.
3. Verification and Approval: The hospital will send a pre-authorisation request to the insurance provider. Once verified, the claim is approved, and expenses are settled directly with the hospital.
4. Discharge and Final Settlement: After delivery and postnatal care, the final bill is sent to the insurer for settlement. Any non-covered expenses must be paid by the policyholder.

● Reimbursement Claim Process

If you opt for a hospital that is not in the insurer’s network, you need to pay the expenses upfront and later apply for reimbursement. Follow these steps:

1. Pay the Medical Bills: Settle all hospitalisation expenses at the time of discharge.
2. Collect Essential Documents: Gather hospital bills, receipts, discharge summaries, doctor’s prescriptions, and test reports.
3. Submit the Claim Form: Fill out the claim form provided by the insurer and attach the necessary documents.
4. Claim Processing and Approval: The insurer reviews your claim and processes reimbursement as per the policy terms. This may take a few weeks.

Things you must know before buying a maternity health insurance policy

Before purchasing a maternity health insurance policy, keep these crucial points in mind:

1. Waiting Period: Most health insurance policies with maternity benefits come with a waiting period of 9 months to 6 years. Purchase a plan that follows your timeline for family planning.
2. Coverage Limits: Maternity benefits often come with a cap on expenses. Ensure the sum insured is enough to cover hospital costs in your preferred medical facility.
3. Inclusions and Exclusions: Carefully check what is covered, such as pre-and postnatal expenses, newborn care, and delivery costs. Also, understand exclusions like IVF treatments or complications due to pre-existing conditions.
4. Network Hospitals: Opt for a policy with a wide network of hospitals that offer cashless hospitalisation to avoid out-of-pocket expenses.
5. Premium Costs: The premium for maternity insurance is higher than standard health policies due to its comprehensive benefits. Research the different plans and find the one that suits you.
6. Newborn Coverage: Some policies extend coverage for newborns, including vaccinations and congenital diseases. Check for this benefit before finalising a plan.

FAQs

1. Can I buy maternity health insurance if I am already pregnant?

Most health insurance plans do not cover existing pregnancies since it is considered a pre-existing condition. It is better to buy a maternity insurance policy as soon as you decide to start a family.

2. What is the ideal time to buy a maternity insurance policy?

It is best to buy a maternity health insurance policy before planning a pregnancy due to the waiting period requirement, which ranges from 9 months to 6 years.

3. Is newborn baby care covered under maternity health insurance?

Many policies provide coverage for newborn medical expenses, vaccinations, and congenital conditions for a limited period after birth.

4. Does maternity insurance cover C-section deliveries?

Both normal and caesarean deliveries are covered under most maternity insurance plans, subject to policy terms and conditions.

5. Can I get tax benefits on maternity health insurance?

Under Section 80D of the Income Tax Act, premiums paid for health insurance (including maternity coverage) are eligible for tax deductions.

Conclusion

A maternity health insurance policy is a crucial financial safeguard for expecting parents, ensuring access to quality healthcare without the financial stress. From prenatal check-ups to postnatal care, maternity insurance covers a broad spectrum of expenses. However, it is essential to carefully evaluate the policy’s waiting period, coverage limits, inclusions, and exclusions before purchasing. Planning and choosing the right health insurance policy will provide peace of mind and financial stability as you welcome a new life into your family.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.