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Maternity Health Insurance

What is Maternity Insurance Plan

Maternity or pregnancy is a crucial phase in a woman’s life. When pregnant, women have to cope with a lot of emotions, and undergo many physical and hormonal changes. While there is the wonder of creation of a new life, there is also uncertainty of the future, and a fear of inadequate finances to handle childcare expenses.

To embrace parenthood; therefore, you must prepare well in advance. Looking after a child can be expensive, and it does require a robust financial backup and emotional stability that can help to meet the requirements of the growing baby.

From hospitalization expenses to delivery costs, medical tests and medicines – having a well-constructed maternity insurance plan can help you handle the rising medical expenses effectively so that you can enjoy, what is perhaps one of the happiest moments of your life, without any stress.

What is Maternity Insurance?

Maternity insurance is essentially a plan designed to cover the health and maternity care expenses of expecting mothers and their new-born.

You can also opt for maternity insurance, as an additional rider with your existing health insurance plan. Maternity insurance covers expenses for both caesarean and normal delivery. Also, maternity insurance benefits may include both pre- and post-hospitalisation treatment costs, including consultation fees, surgeon fees, anaesthetist.

Therefore, you need to thoroughly understand the inclusions and exclusions of a maternity insurance policy before opting for it.

Why Do You Need Maternity Insurance?

As a would-be parent, you must prepare yourself for the additional expenses relating to the pregnancy and the delivery of your child. In its 2013 circular, the IRDAI’s Circular on Standardized Definitions describes maternity insurance as a financial backup to cover any hospitalization and medical treatment expenses. Nowadays, medical expenses are increasing day by day. Therefore, you need to prepare your finances, well in advance so that when the time comes, you could deal with any expected and unexpected expenses of the child.

Augmenting your existing health insurance plan with maternity coverage will allow you to:

1. Safeguard yourself and your family against the increasing healthcare costs

2. Cover Your Maternity-related Hospitalisation Expenses – maternity insurance helps cover up to 30 days before childbirth while providing coverage against post-hospitalization expenses for up to 60 days.

3. Coverage Against Pre- and Post-Natal Expenses – maternity insurance covers medical expenses relating to both Caesarean and normal delivery along with post-delivery complications for the mother.

4. New-born Cover – protection under maternity insurance is also extended to new-borns (from Day 1 to day 90 day), in case they are diagnosed with some life-threatening or congenital ailment.

Maternity Health Insurance Eligibility Criteria

Amidst all the happiness and joyfulness that pregnancy and motherhood brings, there is always an impending possibility of large medical bills. Pregnant women require constant medical attention and care, ranging from monthly tests to hospital bills.

The eligibility criteria to purchase maternity health insurance varies from one insurer to another. The minimum age at which you can buy maternity insurance is 18 years, while the maximum age is 45 years. Also, maternity insurance comes with a waiting period, of between 9 months to 6 consecutive policy years. After the completion of the waiting period, you can avail the policy benefits.

Maternity & New-born Cover with Health Insurance

A health insurance plan with maternity and new-born cover ideally provides financial assistance to take care of pre-natal and post-natal expenses, Caesarean delivery, delivery expenses, post-birth care, and vaccination.

In India, the maternity and new-born cover is usually available as an add-on or additional rider under a primary health insurance policy. Some firms offer maternity insurance benefit with a sub-limit up to ₹50,000, along with their group health insurance plan. The maternity and new-born add-on covers pre and post hospitalisation, nursing and room charges and doctor consultation fees.

Features of a Maternity Insurance Plan

At times when you have little or no financial backup at your disposal, necessary expenses such as maternity costs can burn a large hole in your pocket. To avoid such instances you need to invest in a maternity insurance plan, well before you even plan for a child. To help you make up your mind, here are some key features of a maternity insurance plan:

Comprehensive Coverage – Having an effective maternity health insurance policy enables you to cover the expenses incurred for pre and post hospitalization and delivery along with miscellaneous charges such as those for medicines hospital room rent, ambulance services, and doctors’ consultation fees.

Pre and Post-Natal Care for Your Newborn – Maternity insurance plan not only covers the mother but also provide for the treatment expenses of the newborn, in case he or she is diagnosed with a congenital health condition.

Cashless Facility – Maternity insurance plans from leading insurance companies offer cashless payment of treatment in their network of authorised hospitals pan-India.

Claim-Free Bonus – In case you do not raise claims in a given policy year, you are eligible to receive discounts on the premium for the subsequent year.

Hassle-free Online Application – You can easily purchase a maternity insurance plan online by filling out an application form in just a few clicks.

Tax Savings – Maternity insurance plans offer comprehensive tax-saving benefits under Section 80D of the Income Tax Act, 1961. These tax deductions are applicable on the premium paid on the policy.

Advantages of Maternity Insurance Plan

The benefits of maternity insurance are plenty. First, you can prepare financially, well in advance before starting a family. Since maternity care, hospitalization, and taking care of the new-born requires considerable investment, you need to have a maternity insurance plan in place, to augment your savings. Here are a few advantages that maternity insurance provides, as you prepare for the next important milestone in life, i.e. becoming a parent:

  • You have a financial backup with exclusive benefits.
  • Maternity benefits from day 1, for your new-born baby.
  • Preparation for both mother and child against any complications.

Inclusions in Maternity Insurance

With a maternity insurance cover in your health insurance policy, you do not have to worry about the various expenses when choosing the nursing home or hospital for delivery. In other words, maternity insurance provides you protection against any unforeseen situations, so that you can get the best possible doctors to attend to you or your spouse and your newborn baby.

Here is the list of expenses covered under a maternity insurance plan –

  • Maternity insurance provides coverage against delivery expenses for both caesarean and normal delivery.
  • You receive comprehensive coverage against pre- and post-natal expenses.
  • A maternity insurance plan includes coverage for the new-born baby for miscellaneous expenses such as ventilator care and vaccinations during his or her first year.
  • You have financial backup to take care of expenses 30 days before hospitalization, along with 60 days of post-hospitalization care.

Exclusions in Maternity Insurance

Maternity insurance also has a few limitations. Firstly, the amount of coverage or the sum insured under the policy may not be sufficient to cover maternity expenses. Maternity insurance coverage under most health insurance plans could vary between Rs 20,000 to Rs 70,000, which might be inadequate to cover delivery costs.

Secondly, though it is possible that your claim may not be declined after you have bought the policy, there might be situations when the insurance company could refuse to pay the claim such as in the case of a late pregnancy (for ages 35 and above).

Typically, the below-mentioned expenses are excluded from a maternity insurance plan –

  • Doctor’s visit for regular health check-ups.
  • Consultation, diagnostic tests, and follow-ups during nine months of pregnancy.
  • Treatment costs for premature termination of pregnancy, within 12 weeks of conceiving.
  • Medical expenses of ectopic pregnancy.
  • In-vitro fertilization.
  • Late pregnancies above 45 years of age.

When to Purchase Maternity Health Insurance?

With a maternity insurance plan, you can rest assured that lack of finances will not hinder your happiness of being a parent.

These plans usually have a waiting period of up to 3 to 4 years. Therefore, you get ample time to plan towards starting a family. In other words, it is essential that you purchase health insurance with maternity insurance cover as early as possible, instead of waiting till you are pregnant.

Ideally, you should seek maternity insurance coverage before conceiving as some insurance companies may consider the pregnancy as pre-existing and deny paying the claim. At the same time, you need to ensure that you opt for the best possible maternity cover. You can do so by comparing available plans and choosing the one that offers maximum benefits at a cost-effective premium.

It would help if you also considered the following factors while choosing the maternity insurance cover:

  • Coverage and Sub-limits: Most insurance companies offer limited maternity coverage, ranging between Rs 15,000 to Rs 50,000, with a few offering coverages as high as Rs. 1 lakh. Thus, you must choose coverage that aligns with your requirements.
  • Waiting Periods: Typically, maternity insurance plans have long waiting periods. Thus, it would help if you went with an insurer that offers the minimum waiting period.
  • Pre Post Hospitalization Expenses: You must choose a maternity policy, which offers comprehensive coverage against both pre- and post-hospitalisation expenses such as in-patient hospitalisation expenses and vaccination cover.

Documents Required to Apply for Maternity Health Insurance

Some common documents required to apply for maternity health insurance are as follows:

Identity Proof:

  • Aadhaar card
  • Voting ID
  • PAN card
  • Driving license
  • Passport
  • Electricity bill, etc.

Address Proof:

  • PAN card
  • Aadhaar card
  • Voting ID
  • Passport
  • Ration card
  • Driving license

Age Proof:

  • PAN card
  • Aadhaar card
  • Birth certificate
  • Driving license
  • Passport

Medical Examination Reports : In some cases, the insurer may ask for medical reports, especially if the policyholder is above 45 years of age.

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