Health Insurance With Maternity Cover

Parenthood is one of the most special experiences of one’s life, particularly for women. During pregnancy, the female body undergoes both physical as well as hormonal changes which can have an everlasting impact on their overall well-being. Becoming a parent is one of the most beautiful experiences in life, but it comes with a significant responsibility, especially for expectant mothers. The journey of pregnancy brings immense joy and anticipation, yet it also involves numerous medical expenses that can create financial stress. In such times, having a maternity insurance policy becomes essential to ensure that the focus remains on the well-being of both the mother and the newborn. This blog will help you understand everything you need to know about maternity insurance, including its benefits, features, and eligibility criteria, so you can make an informed decision for your family’s health. There is apprehension when it comes to pregnancy, and maternity health insurance is the safest bet at such times. Let us understand all that you need to know about maternity insurance plans.

What is a maternity health insurance policy?

Maternity health insurance covers all expenses associated with childbirth for expecting mothers as well as newborns. One can avail of maternity insurance coverage as a standalone policy or add it to your existing family health insurance plan. This additional coverage to your existing plan can be in the form of additional riders or add-ons. Some employers also extend the facility to avail maternity coverage under group insurance policies.

Why should you opt for maternity insurance cover?

No one would want to compromise on the health facilities at any time. So, why hold back when it comes to welcoming a new life into this world? With a maternity insurance cover, you can ensure you get the best medical facilities, both for the mother as well as the new-born. Moreover, standardised medical treatments are no longer easily affordable and can break your bank. Having a pregnancy insurance policy ensures you get access to state-of-the-art medical procedures and can also take care of unforeseen complications. Medical professionals, too, charge hefty fees for consultation and surgery, if required. This can be an unexpected blow to your saving that otherwise can be used for your child’s future. A maternity insurance policy covers the fees paid to professionals like a gynaecologist, an anaesthetist, a paediatrician, and more. A maternity insurance cover also includes the cost of childbirth, and pre-natal as well as post-natal expenses. Some family health plans with maternity benefits offer coverage for the newborn as early as 90 days after birth.

Key Features of Maternity Insurance Plans

Maternity insurance is a specialised type of coverage designed to manage the expenses related to pregnancy and childbirth. The following are the key features that one should look for while selecting a policy:

1. Comprehensive Coverage

Maternity insurance covers expenses related to prenatal care, hospitalisation for delivery (normal or caesarean), and postnatal care. Some plans also include coverage for newborn baby care up to a specified period.

2. Inclusion of Medical Tests and Medications

Regular health check-ups and prescribed medications are crucial during pregnancy. A good policy will cover the cost of these necessities.

3. Cashless Hospitalisation

Many insurance companies offer cashless hospitalisation at network hospitals, making it easier for the insured to get treatment without immediate out-of-pocket expenses.

4. No-claim Bonus

Some plans offer a no-claim bonus, which can enhance the coverage if no claims are made during a specified period.

Benefits of Having Maternity Health Insurance

The financial implications of childbirth can be overwhelming. Here's why investing in maternity insurance is beneficial:

• It reduces the financial burden by covering medical expenses associated with pregnancy, thereby allowing families to focus on the health of the mother and baby.
• Provides access to quality healthcare services without worrying about the costs.
• Covers prenatal and postnatal care, ensuring comprehensive support throughout the pregnancy journey.

Key Factors to Consider when Buying Maternity Health Insurance

These are some important factors to consider when buying maternity insurance -

Coverage

When shortlisting pregnancy insurance, check for the coverage it offers. Many maternity plans extend their cover to provide health check-up facilities, any pregnancy-related medical tests, hospitalisation at the time of birth, along with unforeseen emergencies that need to be addressed. *

Waiting Period

There is usually a clause pertaining to the waiting period in health insurance and maternity insurance policies. This means any treatment or check-up shall be included under the insurance cover only after completing a pre-specified duration. Thus, it is advisable to buy maternity health insurance in advance. *

Clauses

One must carefully read through all the policy terms to understand the fine print. This helps in avoiding cases of rejected claims and to compare the various features of each policy before zeroing down. *

Claims process

You do not want to be rushing here and there to gather dozens of documents or explain the situation to your insurance agent for hours during the peak pregnancy period. Hence, an easy claim-raising and settlement process is essential.  *

Does Regular Health Insurance Plans Cover Pregnancy?

You may be wondering whether your regular health insurance plan already covers pregnancy and related medical issues. Now, whether your regular health plan covers pregnancy or not is mostly dependent on the insurer and the product you choose. In most cases, maternity coverage is provided as a part of top-up health insurance plans. It may not be available as a part of the standard health insurance package. You could also opt for maternity insurance coverage by opting for a relevant add-on. There may be limits to the maternity expense coverage under the health insurance plan. For instance, if the sum assured of your regular health insurance policy 3 lakhs to Rs 7.5 lakhs, then the maternity coverage may be limited to Rs 15,000 for normal delivery and Rs 25,000 for caesarean delivery Furthermore, the waiting period for maternity cover may be different from that of the regular health plan. Thus, one should have a thorough understanding of the same before opting for this cover.

Eligibility Criteria for Maternity Insurance

The eligibility for a maternity insurance policy generally depends on the terms set by the insurer. Most policies are available to women between the ages of 18 and 45 years. It is advisable to review the specific criteria of each policy before purchasing.

Waiting Periods for Maternity Insurance

One crucial aspect of maternity insurance is the waiting period. This refers to the duration one must wait before being eligible to claim the benefits. Typically, the waiting period ranges from 9 months to 4 years, depending on the policy. Therefore, it is recommended to plan and purchase maternity cover well in advance to avoid last-minute exclusions and ensure that you are covered when needed.

What is Covered in Maternity Insurance Coverage?

A comprehensive maternity insurance policy usually covers the following:

1. Prenatal and Postnatal Expenses

Regular check-ups, ultrasounds, and medications before and after delivery are included in the coverage.

2. Delivery Costs

Whether it's a normal delivery or a caesarean section, the insurance covers the cost of delivery.

3. Newborn Baby Cover

Some plans extend coverage for the newborn for a specified period, covering expenses related to congenital diseases and necessary vaccinations.

4. Emergency Complications

Unforeseen complications that may arise during childbirth are also covered.

What is not covered in maternity insurance coverage?

It is also crucial to know what elements may not be covered under your maternity health insurance coverage. Here are a few:

Pre-existing conditions that could affect pregnancy

If you suffer from a health condition that could have a negative impact on your pregnancy, then it may not be covered under maternity coverage. However, this depends upon the insurer’s terms and conditions. *

Infertility expenses

If you or your partner seek treatments related to infertility, then the charges for the same may not be covered. *

Congenital diseases

Medical conditions that a newborn may have inherited or may occur in them before their birth may not be covered. *

Unprescribed medicines

You may be taking vitamins and supplements to aid your health. However, if they are not mandated by the doctors, they are not covered under maternity insurance. *

Is pregnancy termed as a pre-existing condition when buying maternity insurance?

Most insurers consider pregnancy as a pre-existing condition and are excluded from the coverage of your policy. You may rarely find a maternity cover without a waiting period, and thus you must plan and accordingly opt for one. To conclude, putting off buying a maternity cover is not advisable as it attracts a waiting period to it. It would be best if you buy health insurance as early as possible so that the stipulated terms are fulfilled, and your child and the mother enjoy complete medical attention at the time of delivery without worrying about the finances.

Tax Benefits of Maternity Insurance

Investing in a maternity insurance policy not only safeguards the health of the mother and child but also offers tax benefits under Section 80D of the Income Tax Act, 1961. Premiums paid for maternity insurance are eligible for a tax deduction of up to ₹25,000 per year for individuals below 60 years and ₹50,000 for senior citizens. If the insurance policy is for parents, additional deductions can be claimed, thereby making it a financially wise decision.

How to Choose the Best Maternity Health Insurance Plan

Selecting the best health insurance plans for pregnancy can be challenging due to the various options available. Here’s how to make the right choice:

1. Compare Plans

Look at different policies to compare the coverage offered, premium rates, waiting periods, and exclusions.

2. Check Network Hospitals

Ensure the insurer has a wide network of hospitals, including those where you plan to deliver.

3. Understand Sub-limits

Many plans have sub-limits on coverage for normal and caesarean deliveries. Be aware of these limits to avoid surprises during claims.

4. Review Additional Benefits

Some policies offer additional benefits such as coverage for vaccination and congenital conditions. Choose a plan that provides the most comprehensive coverage.

How to Claim Maternity Insurance

The process of claiming maternity insurance is straightforward if you follow these steps:

1. Pre-authorisation

Inform the insurance provider in advance about the expected delivery date and hospital details for a smooth claim process.

2. Submit Documents

Post-delivery, submit necessary documents like the discharge summary, medical bills, and claim form to the insurer.

3. Cashless Claims

For cashless hospitalisation, ensure that the hospital is within the insurer’s network and get pre-authorisation from the insurance company.

4. Reimbursement Claims

In case the hospital is not in the network, pay the bills upfront and submit them to the insurer for reimbursement.

When to Purchase a Maternity Cover?

The best time to purchase pregnancy insurance is before planning a family. Since most maternity insurance policies come with a waiting period of 9 months to 4 years, it is wise to buy the cover as early as possible. This ensures that you can claim the benefits when you need them without any delays due to the waiting period.

FAQs

1. Can you get maternity insurance if already pregnant?

Most insurance providers do not offer maternity insurance if the woman is already pregnant, as it is considered a pre-existing condition. It is recommended to buy a maternity cover well in advance.

2. How can I buy/take maternity coverage?

You can purchase maternity insurance by comparing plans online, selecting the one that suits your needs, and applying directly through the insurer’s website. Companies like Bajaj Allianz General Insurance Company provide a seamless online process.

3. What is covered under maternity insurance?

Maternity insurance covers expenses related to prenatal and postnatal care, delivery costs, and sometimes, newborn care for a specified period. Additional coverages may include vaccinations and treatment of congenital diseases.

4. How is maternity insurance premium calculated?

The premium for maternity insurance is calculated based on factors like the policyholder’s age, sum assured, coverage details, and the selected insurance provider.

5. What happens if a child is born with any complications?

If a newborn is diagnosed with any complications at birth, some maternity insurance plans cover the cost of treatment up to a certain period, depending on the policy terms.

6. What is the minimum and maximum sum assured under pregnancy insurance?

The sum assured under pregnancy insurance varies widely, ranging from ₹50,000 to ₹5,00,000, depending on the insurer and the type of plan chosen.

7. Does maternity insurance cover newborns too?

Yes, most maternity insurance plans include newborn coverage. The extent of coverage for a newborn in terms of tenure and compensation limits can be found in the terms and conditions of the maternity health insurance plan documents. *

8. What is the usual waiting period for maternity insurance coverage?

The waiting period for maternity coverage differs from product to product. In some cases, it may be 72 months while some plans may allow claims under this coverage after a period of 12 months only. * Standard T&C apply. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.