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Maternity Cover Health Insurance

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What is Maternity Cover Health Insurance?

The happy news of the pregnancy and imminent parenthood brings along with it the upcoming financial planning and expenditure during the entire period of pregnancy and beyond. These include maternity health care, hospitalization and child delivery, pre and post-natal cares and in some unfortunate situations, medical termination of pregnancy if required. A Maternity insurance Plan is adequate to handle all these contingencies.

Frequently Asked Questions

    You need to get your maternity insurance before you conceive since insurers generally decline to give a policy to an already pregnant person because of the ‘pre-existing’ condition of pregnancy. Moreover, almost all of the maternity benefit plans have an initial waiting period of 2 to 4 years before you can claim it. The waiting period depends on the insurer. In order to get the benefits, a planning for pregnancy well in advance is highly important. Claims for the benefit can be either cashless upon pre-authorization or reimbursement after the submission of claims forms, duly filled and signed.

    Limits on Maternity Coverage

    Generally, group and individual policies offer maternity as an add-on cover and have a restraint on the coverage amount. As the actual cost for the delivery can vary from Rs 30,000 to Rs.1.5 Lakh, especially in metro cities, one might require shelling out a good chunk from his pocket. That is why, before buying a health insurance plan or the add-on, please read the terms and conditions carefully. Many plans cover newborn from day one, termination of pregnancy, & pre post-natal expense and associated pregnancy complications. Calculate the sub-limits carefully so that you do not have to face any unexpected expenses.

    Inclusions in the Maternity Benefit are:

    1. Hospitalization during Pre and Post-Pregnancy Stages – It covers about 90 days and includes hospitalization costs from 30 days prior to 60 days after delivery. However, it has a capping and it is limited depending upon the total sum insured. Hospitalization during delivery covers the charges for hospital rooms, doctors, nurses and emergency ambulance.

    2. Delivery Procedures – Maternity health plans also cover both normal and cesarean deliveries. It also takes care of the post-delivery complicacy.

    3. Neonatal Coverage – Under most maternity plans, the newborn baby is covered for 1 to 90 days for any critical illness or congenital complications.

    Exclusions from benefits are: 

    Doctor’s visit for a routine check-up before delivery and the diagnostic tests. 

    Expenses of medicines unless part of treatment or mentioned specifically in the plan.

    Termination of pregnancy within 12 weeks of conceiving.

    Medical expenses of ectopic pregnancy.

    In-vitro fertilization.

    When the age of the insured under maternity benefit plan is above 45 years.

    The benefits have separate caps for normal and cesarean deliveries. 

    If your expenditure exceeds these limits, then the additional expenses are to be incurred.

    A practical example that you can relate to:

      Let’s take a real-life example - Sunita is a homemaker and she is bothered about her future child. To address her concerns, her husband start searching for a good insurance policy. In a family floater plan, there is a definite waiting period which is more than 2 years. This is not something that is suitable for them. They are planning for a baby within a year, so they need to take maternity specific plan. The good thing about maternity plans are that they cover a couple of more factors than a general family floater plan. Maternity Plans have a waiting period of around 1 year. Thus, a maternity plan suits their plan completely.

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