A maternity health insurance cover is usually bought as a rider with the basic health insurance policy. It provides coverage for delivery expenses– both normal and cesarean. It reimburses for pre and post-hospitalization expenses, child delivery expenses, and in-hospitalization expenses along with the newborn baby cover.
Maternity policy provides coverage for various maternity related expenses. A few insurance providers have formulated standalone maternity health insurance policies. As per your insurance needs, you can choose a standalone maternity plan or can include it as a rider or add-on to your existing health insurance policy by paying the extra premium.
What is the Need to Buy Maternity Health Insurance Policy?
There is no better feeling in the world than being a mother. Motherhood is the perfect time to rejoice in the little things around you and embrace the new change your baby brings in your life. Don’t let the anxieties and worries associated with hospitalization expenses and other financial responsibilities ruin this new journey of motherhood. Safeguard yourself and your child with an adequate insurance that covers pregnancy.
It’s important that you take the utmost care of your health and stay in a positive environment to avoid any complications in the future. These precautions are necessary if you want to ensure a safe and healthy pregnancy. But, a steep rise in hospitalization charges, including delivery and maternity expenses, can raise a distressing financial concern. A normal delivery at a decent hospital in metro cities can easily stretch from Rs. 70,000 to Rs. 2 Lakhs. Amid this rise in maternity costs, couples should seek a financial support in the form of a maternity insurance policy.
Couples who are planning to have a baby in the near future should fully understand the benefits, limitations, and premium of maternity insurance policies. Doing so can help them to analyze the requirement of medical funds later.
Nowadays, you can get maternity cover on the group health policy provided by your employer. It is advisable that you check with your employer for the provision of maternity benefits in the group policy. However, most of the corporate group insurance policies provide maternity cover as an add-on benefit, with a sub-limit of not more than Rs. 50,000.
Key Features of Maternity Insurance Policy
The key features of the insurance policy are:
- Pre and post hospitalization cover: Most of the maternity insurance plans provide the feature of pre and post hospitalization. In pre-hospitalization, the expenses of check-ups to medicines before the hospitalization are taken care of by the insurance provider. And the post-hospitalization takes care of the child after delivery. Generally, 30-60 days of pre-hospitalization and 60-90 days of post-hospitalization are considered under this feature.
- Post and prenatal expenses: The childcare expenses including the consultation from doctor and expenses of medicines even the incubation and checkups are covered.
- In-patient hospitalization and cost of delivery: The insurance policy covers the hospitalization costs for delivery.
- Newborn health cover: Some maternity insurance policies cover new-born babies against defects that require special care.
- Covers vaccination: Vaccinations that are made mandatory by Government are also covered in some maternity plans. Most of the plans cover vaccination for the first year only whereas some plans extend to 12 years.
Best Health Insurance Plans with Maternity Cover
|Health Insurance Plan with Maternity Cover
||Key Features &Benefits
|Max Bupa Heartbeat Family First Plan
- Maternity cover for up to 2 deliveries
- Cover for newborn starts with the birth
- Cashless approval within 4 hours in 3500 network hospitals
- Tax benefit U/S 80 D
- Newborn vaccination expenses cover for the 1st year
- Birth control & Assisted reproduction
- Hereditary conditions
- OPD Treatment
- 2 years for maternity benefits (if the insured has been covered under the policy for 2 consecutive years)
|Religare Joy Health Insurance Plan
- Room charges for single A/C room
- New-born baby cover
- Pre & post-natal expenses
- Ambulance charges up to Rs. 1000 on every claim
- Daycare treatment provided
- Tax saving benefits
- Cashless treatment
- Congenital disease
- Cost of spectacles, dental treatment, and contact lenses
- The medical expenses incurred for AIDS treatment
- Any OPD treatment
- Medical expenses arising because of alcohol/drug use
- 9 months under Joy Today
- 24 months under Joy Tomorrow
|Apollo Munich Easy Health for Young Family Plan
- Provides coverage to the dependent child after 3 months from birth, if both the parents are covered under the plan
- pre & post maternity expenses
- Medical expenses for inpatient treatment under Homeopathy, Ayurveda, Unani, and Sidha
- Tax benefit U/s 80 D
- 7.5% discount on purchasing a 2-year plan
- Pre-existing diseases will be covered after 3 years
- Weight control treatments
- Lifelong with 30 days grace period
|HDFC ERGO Health Suraksha Gold Plan
- No entry age limit
- Cashless service available at 4800+ network hospitals
- No sub-limit on Ayush cover
- Newborn baby cover
- Tax saving benefits
- 10% discount on purchasing a 2-year plan
- 10% discount on family cover
- Treatment within initial 30 days of the policy( except accidental cover)
- Preventive care and vaccination
- For initial 48 months, pre-existing diseases will not be covered
- 4 years from the commencement of policy
|Royal Sundaram Lifeline ‘Elite’ Health Insurance Plan
- Worldwide emergency hospitalization (except US & Canada)
- 7.5% discount on purchasing a 2-year plan
- 12% discount on purchasing a 3-year plan
- Maternity Benefit up to 2 deliveries (if both husband and wife are covered)
- Newborn baby cover with vaccination in 1st year
- OPD Treatment up to Rs.10,000
- Emergency ambulance cover up to Rs.10, 000.
- Hospitalization for observation purpose only
- Pre-existing conditions
- Hereditary Conditions
|Star Wedding Gift Insurance Plan
- Delivery expenses (both normal & caesarean).
- Newborn baby cover ( including congenital problems)
- Maximum 2 deliveries
- Post-delivery complication cover for the mother
- Pre-existing conditions
- Self-inflicted injuries
- 36 months for 1st delivery
- The second delivery can be claimed after a waiting period of 24 months
Benefits of Maternity Insurance Plan in India
The benefits that an insured gets after taking maternity plan in India are:
- Day to day checkup expenses: Since the consultation charges of doctors are as well skyrocketing these days, however having a maternity insurance policy covers you against such expenses. So keep calm and enjoy pregnancy even if you have to go to your gynecologist more frequently.
- Ultrasound charges: Going for ultrasound without an insurance plan can be expensive. However, keeping yourself away from the growth of your child while he/she is in your womb is also unjustified. If you have insurance for maternity, the cost of a sonogram or ultrasound is also covered in your complete cover.
- Covers the expenses of prescribed medicines: Some maternity plans also cover the cost of prescribed medicines. Since the medicines during pregnancy are expensive, but if you have a mediclaim for maternity, you can get the reimbursement for the same as well.
- Covers checkup of the newborn: You can get free health checkup for your newborn through your policy. Moreover, if your newborn suffers from some health issue, then it too gets covered by the policy.
When is the Right Time to Seek Maternity Coverage?
Pregnancy is a special experience, and it can be a blissful journey if you have your peace of mind. As mentioned above, with constantly increasing medical inflation, childbirth is as expensive as a couple of 24 carat gems. It involves a lot of physical, emotional and financial planning. If you do not want the financial stress to override your happiness of being blessed with a child, it is recommended that you plan well in advance. Try to research an appropriate maternity insurance plan to keep all your worries at bay and enjoy the peace of mind that is imperative for a mother-to-be.
Taking into note that most of the insurance companies don’t provide maternity benefits to women who have already conceived, you ideally need to apply for it way before you conceive. Considering the long-waiting period clause and other limitations, it is advisable to buy a maternity insurance policy at least 3 years before getting pregnant. While planning everything else, a little effort in this regard will prove to be beneficial.
Inclusions in Maternity Insurance Policy
You will get the following benefits in a pregnancy health cover. Broadly classified, almost every plan includes them, though certain coverage may vary from insurer to insurer.
- Pre & Post Hospitalization Expenses – You will get compensation for pre-hospitalization expenses up to 30 days prior to childbirth or delivery date. Post-hospitalization expenses are also covered up to 60 days.
- Hospitalization Expenses – The policy will recompense the room charges, nursing expenses, consultation fees with the medical practitioner and anesthetist and surgeon consultation charges. Under some maternity insurance plans, you get ambulance cover also.
- Delivery Including Pre & Post-Natal Expenses – All the expenses related to childbirth (both normal and caesarian delivery) are recompensed to the policyholder by the insurance company. Do not worry about any post-delivery complications (for the mother only) – they are also covered under maternity insurance.
- New Born Baby cover (Day 1-90) – God forbid, if at birth, the newborn is diagnosed with any congenital disorder or acute illness, then it will also be covered under the maternity insurance. The coverage, in this case, is valid up to the policy term.
Exclusions in Maternity Insurance Policy
The following expenses will not be included in the maternity insurance plan. Please check your policy documents carefully to avoid any confusion at the time of filing the claim –
- Expenses incurred on non-allopathic/homeopathic/ Ayurveda treatment
- Regular consultation fees with the gynecologists
- Regular medical check-ups/ultrasounds
- Cost of medicines
- Any type of congenital diseases
- If the pregnancy is terminated (within 12 weeks)
- Medical treatment due to self-inflicted injuries, alcohol consumption or drug abuse
- Medical expenses incurred on AIDS/HIV treatment
- Dental treatment is not covered under any policy
- Expenses incurred on In-vitro fertilization and infertility treatment
- Pre-existing diseases diagnosed within 48 months of the inception of the policy
Understanding the Waiting Period Clause in Maternity Insurance Plan
This is one of the drawbacks of a maternity insurance plan. All the maternity insurance policies follow a stringent maternity period clause, which may range from 2-6 years. That is why it is advised to plan pregnancy much in advance. We plan so much for educational expenses, travel expense, why not give some thought to the most beautiful phase of one’s life i.e. parenthood. Safeguard the mother and the newborn baby with the right maternity insurance policy.
This is a mandatory clause of a waiting period in a maternity cover. There is hardly any pregnancy insurance policy with no waiting period. But, there is some relief provided by a maternity-focused health insurance plan named as ‘Joy’ from Religare Health Insurance. The waiting period is of 9 months only. So, if you are planning to have a baby by next year, then you can consider this one. There are various plans for maternity which you can easily compare on our site.
How to Plan Your Maternity Related Medical Expenses
By now, you must have gathered some idea about a maternity cover and how it can help you at the most precious time of your life. Below-mentioned are some tips on how you can plan for this expenditure in a holistic manner –
- Completely understand your maternity insurance plan and anticipate the costs: If you are planning to get coverage under your employer’s group medical insurance policy, then understand its inclusions completely, otherwise understand your existing maternity insurance plan.
- Plan your maternity or paternity leave: Understand the paternity or maternity benefits of your company so that you can plan your maternity or paternity leave accordingly. Will your company pay you during such leave? This all gives you a picture of how will you be able to manage your finances as well as time with your kid.
- Understand your pre-baby budget: Understand your family’s current monthly budget that is without the baby and then makes a list of all your out-of-pocket expenses. Drafting this will give you a clear picture of your exact financial condition.
- Plan post-delivery expenses of your family: Even the thought of your baby gives you so much happiness, so you can imagine the level of joy that you will come across when he/she will arrive. However, a baby as well comes with some added expenses and responsibilities. From diapers to baby food to vaccination of baby everything adds something to your overall monthly budget. Therefore, it is suggested to manage your finances accordingly.
- Save something as your emergency fund: It is always good to be financially prepared for emergencies related to childcare. Since kids are prone to accidents, thus it is always wise to start saving something for such situations as an emergency fund even before your baby’s arrival.
- Choose a pediatrician from the network hospital of your insurance provider: You need to take your baby to his/her first doctor’s consultation within the first week. So, prepare yourself well for that. Talk to your family and friends regarding a good pediatrician in your area and search for the same over the internet. However, do not forget to check whether your selected doctor comes in the network list of the maternity cover that you have taken or not.
How to Request a Claim for Maternity Insurance Cover?
The claim procedure can vary from one insurance company to another. Usually, the proposer has to follow the below-mentioned process –
- Immediately intimate your insurer by sending a claim request. You need to inform your provider within 24 hours of an emergency hospitalization, while for planned hospitalization, you need to intimate within the insurer 48 hours beforehand.
- For cashless pregnancy health insurance claim process, the following process needs to be followed:
- Duly filled pre-authorization form (it is available at the TPA desk of the network hospital) or you can easily download it from the registered website of the insurance company
- Once you receive the pre-authorization form, you will receive a letter of approval from the insurance claim management team of your insurance provider
- Once it is done, you can easily file for your reimbursement claim
- Reimbursement claim process involves the following:
- Apart from other documents, you also need to fill in and submit the claim form with the details of your medical expenses and you need to attach a copy of original bills with it.
- Once you submit this form, you will receive a letter of approval from your insurance provider
Documents Required At the Time of Maternity Insurance Claim
The list of documents required in this case is mentioned below:
- Duly filled and signed claim form
- Copy of identity/health card
- Original discharge summary
- Final bills of the hospital
- All the investigation reports
- Payment receipts
- Receipt of the equipment used for any maternity process
How to Calculate the Premium of Maternity Insurance Policy?
Generally, the premiums for maternity insurance plans are higher than other health insurance policies because of the certainty of the occurrence of the event is most of the times fixed. Therefore from the perspective of an insurance provider, the claim has to happen.
This is the reason most of the health insurance providers keep the premium of the maternity insurance high. Generally, the group health insurance policies provided by employers cover maternity benefits. However, it is suggested to suggested to check the health insurance plans provided by your organization.
Points to Remember
- Pregnancy is counted as a pre-existing condition by most of the insurance companies, so if you are already pregnant, your claim will not be processed. Some group policies may entertain the application; you need to check policy terms for that matter.
- At the time of birth, if the baby is diagnosed with any congenital disorders like an abnormality, disease, acute illness, etc., the coverage for such conditions is subject to your insurance provider’s conditions and your maternity insurance policy.
- Some maternity insurance plans provide coverage to the newborn baby from day one until they are 3 months old. After that, you can get your child covered under a family floater health insurance plan. On the other hand, some health insurance plans with maternity cover do not consider it at all.
- Under any circumstances, do not forget to intimate your insurer about the pregnancy if your health insurance plan provides Maternity cover. As soon as the pregnant insured woman is hospitalization for delivery, the proposer should inform the health insurance provider. The sooner, the better!
Maternity Insurance FAQs
Q: What is ‘maternity insurance plan’?
Ans: To provide a financial cushion at the time of childbirth and throughout the pregnancy against any medical expenses, ‘maternity insurance’ is used. Most of health insurance policies do not cover maternity and maternity related expenses; therefore you need to purchase it as a rider or add-on to your health insurance policy.
Q: What is covered by a ‘maternity insurance plan’?
Ans: A maternity insurance plan covers pre and post-natal expenses, cost of Cesarean delivery, normal delivery expenses, and expenses of other pregnancy-related complications. Some plans also cover post-childbirth care and vaccination as well.
Q: Am I eligible to take maternity insurance policy if am pregnant already?
Ans: Since pregnancy is considered as a pre-existing condition, therefore most of the health insurance providers do not provide maternity insurance if you are already pregnant. However, if you are insured in a group medical plan, you can ask for shortening the waiting period.
Q: What is the meaning of ‘Waiting Period’ in maternity insurance plan?
Ans: Like other health insurance plans, maternity insurance as well as the ‘waiting period’. Basically, ‘waiting period’ is a time after which you can avail the benefits of your insurance policy. Different health insurance providers have different waiting period which varies from 2 years to 6 years. Therefore, it is better to take maternity insurance in advance.
Q: What to look in-order to purchase the most suitable ‘maternity insurance plan’?
Ans: Waiting period of the maternity policy is one of the parameters to look-in before purchasing a maternity policy. Another parameter to look-in a plan for maternity is sub-limits provided by the health insurance provider with total sum insured.
Q: Is IVF treatment covered in a maternity plan?
Ans: No, expenses of IVF treatment are not covered in any maternity plan.
Q: How can I claim my maternity cover?
Ans: If the waiting period of your maternity insurance plan is over, then you become eligible to take the benefits of maternity cover automatically. For cashless hospitalization, check the list of network hospitals of your insurance provider. Usually, maternity plans do not cover regular doctor checkups and cost of health tonics and vitamins. For more information about the inclusions of your maternity plan, you should check your policy.
Q: Is my newborn baby covered in the maternity insurance plan?
Ans: The newborn babies also go through a few routine checkups such as a test of hearing, vaccination, inoculations, etc. Some insurance providers do cover these tests and some do not.
Q: Is C-Section covered in a maternity plan?
Ans: A maternity insurance plan covers the whole childbirth processes that include both c-section and normal delivery.
Q: What if my baby is born with some defects?
Ans: It entirely depends upon your maternity insurance policy and health insurance provider to cover various defects of the newborn baby. Some cover all, some partial, whereas some cover none of the defects.
Q: Is there any age limit to get maternity cover?
Ans: Most of the maternity insurance providers do not cover women over the age of 44.
Q: Do all the pregnancy tests related covered in my plan?
Ans: Some maternity insurance policies do not cover the quad / triple test, DNA analysis, amniocentesis for women below the age of 35 years.