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Maternity Health Benefit Plans and its Pros and Cons

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. The high cost of maternity care and hospitalization triggered the need for looking out for maternity plans by the couples. 

What is Maternity Health Benefit Plan?

Maternity plan is usually an add-on or additional rider to the existing health insurance policy. Based on the insurer, the features vary to some extent

Majority of corporates include the maternity benefit of their employees and/or their spouses as a part of their health insurance group coverage with a specified sub-limit

Proper understanding of the maternity plan is imperative for understanding the inclusions and exclusions of the plan so that you can use the coverage efficiently.

Inclusions in the Maternity Benefit are:

Hospitalization for maternity issues in pre and post-pregnancy stages – This includes hospitalization costs from 30 days prior to delivery and up to 60 days after delivery. It has a cap of few thousands of rupees.

The cost associated with delivery procedures – Maternity benefits cover both normal and cesarean deliveries. It also covers the post-delivery complicacy.

Neonatal coverage – this covers the newborn baby for 1 to 90 days for any critical illness or congenital complications.

Exclusions from benefits are:

Doctor’s visit for Routine check-up during pregnancy and the diagnostic tests

Expenses of tonics, vitamins etc. unless part of treatment or mentioned specifically in the plan

If pregnancy gets terminated within 12 weeks of conceiving

Medical expenses of ectopic pregnancy

In-vitro fertilization

If 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 by you

When should you look for a Maternity Benefit Plan?

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. So 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.

Pros and Cons of Maternity Benefit Plan and options for you

The Maternity Benefit plans are gaining popularity among the working women of urban India, as there is a shift of average age of pregnancy from 26-27 to 32-33 years. This shift is giving rise to complicacy of maternity and adding on to the expenditure around childbearing, delivery and beyond. However, maternity benefit plan is an add-on rider to

Tthe general health insurance and there is a cap on this benefit. So, if the cost of treatment during maternity phase exceeds the cap for maternity benefit claim of your individual policy, then you have to make up the balance from your pocket. But, the benefit plan comes as a big support. However, if there is a group insurance coverage through your employer, which has the maternity benefit coverage for most of the times, that comes with a big advantage. After claiming with the employer’s plan, the residual can be claimed with your individual health insurer. In case all expenses are covered by employer’s plan, then you can enjoy the ‘No-claim’ bonus from your individual insurer. The major disadvantage of including Maternity benefit plan in the health insurance policy is the high premium. For example, if the premium of a normal health plan for a 35-year-old female for 3 Lacs is 300 to 4000 per year, then the inclusion of Maternity benefit plan hikes the premium to 8000 to 9000 per year. This added with the waiting period of few years, might not make the plan beneficial to consider. Moreover, many insurers put the age cap.

Conclusion

It is always a good idea to analyze your financial position and the clauses and features in the Maternity Benefit plan before opting for one. Planning ahead and building a corpus towards the maternity expenditure eases up the situation since the Benefit plan will not cover every expenditure. As a couple, if you take the plan early, it will help with the waiting period of the insurer. By the time you plan for your baby, the waiting period will be over.



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