What is Maternity Cover in Health Insurance?

What is Maternity Cover in Health Insurance?

The birth of a child is a pivotal event in the lives of parents and one needs to plan for it in advance. One way to plan for the various expenses related to the medical needs of a newborn child is to purchase a health insurance plan with maternity coverage.

However, such coverage often comes with an additional cost that adds to the health insurance premium of plans that do not offer this benefit. Read on to know the details of how maternity coverage in health insurance works, its key inclusions and exclusions as well as key pointers on how you can choose the most suitable plan. 

What is Maternity Coverage in Health Insurance?

Maternity coverage often known as maternity health insurance policy is a type of health insurance plan offered specifically to women. Often provided as a rider to standard health insurance and mediclaim policies, maternity coverage is designed to cover the expenses of childbirth.

While the extent of cover may vary from one insurer to another, this type of insurance policy covers a wide range of pregnancy-related expenses. Typically, the coverage ranges from prenatal care during later stages of pregnancy, costs associated with normal/caesarian deliveries to any pregnancy-related complications.

Some insurance companies also cover a wide range of pre- and post-natal expenses under their maternity health insurance policies. However, these policies typically do not cover pre-existing diseases affecting pregnancy, congenital diseases, or treatment expenses related to infertility.

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Eligibility Criteria for Availing a Maternity Health Insurance Policy

In India, maternity benefits of health insurance are primarily offered as an add-on benefit of health insurance policies and only women can avail this type of cover. So, most insurers allow individuals to avail this plan if they fall within the 18 years to 45 years age group. It is also important to remember that this add-on cover does not extend beyond the age of 45 years.      

Additionally, health insurance companies may choose not to provide maternity coverage in the case of women who fall into common exclusion criteria like having congenital disorders or those with diseases that impact the ability to conceive. What’s more, there is often a waiting period of 9 months or longer, that varies from one insurer to another, before you are eligible to claim the maternity benefits of your health plan.  

The generic eligibility criteria for maternity health plans is not exhaustive. You need to go through the documentation provided by the insurer to determine if you are eligible for availing this type of health plan. 

Benefits of having Maternity Health Insurance

A pregnancy insurance policy allows you to enjoy benefits, including and pre and post-natal expenses, hospitalization expenses for childbirth and even medical termination of pregnancy for various health reasons. Considering the rise in medical costs, it makes sense to prepare ahead of time for such planned and emergency expenses by availing a maternity health plan. Let’s discuss the benefits that one can avail of by having maternity insurance policy.

You can avail cashless medical facilities of the best hospitals that come under your health insurance plan. 

Get access to skilled gynecologists and other staff for a better health experience without having to pay out of pocket or with minimal out-of-pocket expenses

The premium paid for availing maternity insurance offers you tax benefits under Section 80D of the Income Tax Act, 1961.

Maternity cover minimizes your child birth related hospitalization charges, including room rent and other expenses so that there is minimal impact on your monthly budget.

What is Covered Under Health Insurance with Maternity Benefits?

Health insurance with maternity cover is an add-on benefit that enhances the mediclaim cover provided to women. Eligible women can opt for either a health insurance plan for self or a family floater health insurance covering the maternity expenses. Key inclusions of a health insurance with maternity cover benefits include the following:

1. Maternity-related Hospitalization- Pre-hospitalization expenses are covered up to 30 days before delivery for the expecting mother. Additionally, this health policy add-on can also cover up to 60 days post-hospitalization expenses for the mother and new-born child.

2. Coverage for pre- and post-natal Expenses- Pregnancy insurance can also cover expenses related to normal and cesarean delivery and also additional expenses occurring due to post-delivery complications.

3. Hospitalization Costs- Hospitalization expenses that are covered under maternity cover include a wide range of charges for pregnancy-related expenses. These can include room charges, surgeon and nurse charges, anesthetist consultation charges, medical practitioner charges, emergency ambulance fees, etc. The list can vary to some extent from one insurer to another.

4. The Newborn Baby Cover: The cover of a maternity insurance plan is also extended to infants in most cases for up to 90 days from the day of birth. This usually includes expenses incurred for treatment of infants diagnosed with a congenital disorders and other complications post-birth.  

5. Vaccination Cover: Maternity benefits ride of health plans also cover expenses related to vaccination charges for the newborn that need to be completed within 1 year of birth. The list of vaccines whose costs may be covered by the insurer include BCG, measles, typhoid, OPV, etc. The complete list will be available in the documentation provided by the insurer.

The above list of inclusions under maternity benefits plan is designed to provide an idea of the benefits that may be available. You may be eligible for additional benefits in lieu of that are specific to the maternity benefits plan purchased by you.   

Common Exclusions of Maternity Insurance Policy

Maternity insurance policies do have certain exclusions that you need to keep in mind when purchasing the plan as well as when filing a claim with the health insurance provider. Have a look at the key exclusions that are applicable to a maternity insurance policy.

Expenditure on supplements such as tonics and vitamins mentioned in the plan

Diagnostic tests and doctor’s consultation charges incurred during the pregnancy

Treatment costs related to infertility treatment

Costs related to harvesting and storing stem cells including if it is done as a preventive measure  

Any pregnancy-related costs occurring during the waiting period

The above list is for illustrative purposes only, there can be additional exclusions that are applicable based on the specific maternity health policy you have opted for. 

Key Factors to Consider when Buying Maternity Health Insurance 

Here are the factors that you need to consider when buying maternity health insurance:

Certain aspects might be considered while buying maternity health insurance; as a policyholder, you should understand all the factors to get the best deal and never regret it later. Look at all the aspects that must be considered while buying a health insurance policy.

Always compare the insurance companies and their plans before you finalize them.

Comparing allows you to figure out the best among the rest.

Know the waiting period beforehand to claim the benefit.

Understand the exclusions well.

Know the coverage that would suit your needs and requirements.

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Frequently Asked Questions (FAQs)

Q1- If someone is already pregnant, can they get maternity insurance covered?

Most companies count pregnancy as a pre-existing condition; therefore, you will not get coverage under the plan if you are already pregnant.

Q2- What happens if a child is born with any complications?

Maternity plans cover treatment costs up to the sun insured for a newborn with birth complications like critical illness, injury and various other congenital conditions. This cover typically lasts for a limited period usually up to 90 days after birth.

Q3- What is the minimum and maximum sum assured under pregnancy insurance?

The sum assured offered by these plans can differ from companies and it impacts the insurance premium payable for the add-on. Additionally, there may be sub-limits that are applicable to specific policies. Therefore, you have to go through the policy document provided by the insurer to known the sum assured under a specific maternity benefits health policy.

Q4- What is waiting period in health insurance policy?

It is the time period an insured must wait for before the health insurance coverage comes into effect after the policy is purchased. In case of maternity benefits, this waiting period is usually 9 months, after which you can claim benefits. However, some insurers can have a longer waiting period, so you have to check the individual policy details.

Q5- Are diagnostic tests and regular checkups covered in the maternity cover?

No, these tests and checkups are all common exclusions under a maternity health benefits plan.