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October 8, 2024
Finance

Unbiased Guide to Maternity Coverage in Health Insurance

Every mother deserves a healthy pregnancy, stress-free and an experience to cherish forever. While your near and dear ones around you do their best to make you feel comfortable, the financial implications of a pregnancy might be bothering you at the back of your mind. Pregnancy is expensive, with doctor’s fees, cost of medical tests, cost of delivery, hospitalisation expenses and so on. The good news is that health insurance does cover pregnancy in India and will cover the expenses relating to your delivery and any complications if they arise.

Maternity health insurance is a comprehensive health insurance policy that covers the following expenses relating to your pregnancy:

  • Doctor’s fees
  • Cost of medical tests
  • Hospitalisation expenses
  • Cost of delivery – both normal delivery as well as Cesarean Section (C-Sec)
  • Pre and Post Natal expenses
  • Expenses of your newborn baby
  • Expenses incurred in case of complications in pregnancy
  • Cost of vaccines for your newborn baby
  • Stem cell preservation (at least assistance)
  • Expenses related to medical termination of pregnancy, if so required.

Health insurance is a great support in helping you access quality healthcare facilities as it ensures that the health insurance company takes over the financial burden. This provides significant relief, especially in the context of the high medical trend rate and medical inflation, in India at 14 per cent in 2022 -23, the highest in Asia and higher than the global average. Institutions providing quality maternity care have become very expensive, and the cost of a C-sec delivery has gone upto Rs Two lacs in the best facilities in the metropolitan cities. Luckily, the best health insurance in India covers the expenses.

As per the Insurance Regulatory and Development Authority of India (IRDAI), maternity expenses include the following:

  • Medical expenses during hospitalisation for delivery – including C-Sec and complicated deliveries
  • Legal, medical termination of pregnancy – subject to a maximum of two deliveries and terminations during the entire lifetime of the person who has been insured
  • Medical expenses, both pre-natal and post-natal, incurred either during a delivery or termination.

Health insurance plans for families provided to employees of certain companies as part of their group mediclaim policies include the advantages of maternity cover. This benefit is available for women employees and also the wives or partners of the male employees, where the company offers spouse medical insurance facilities. This is a great support, but the coverage under such employer-provided group Mediclaim policy is often capped at a limit between Rs  25,00 to Rs 1,00,000 and may be subject to waiting periods.

As of now, there are no exclusive policies covering only maternity benefits. You need to buy a health insurance policy that includes maternity coverage or buy the same as an optional add-on cover. Do consider buying affordable health protection plans along with your policy.

A maternity health insurance plan has certain exclusions. The expenses relating to the following are usually excluded:

  • Ectopic pregnancy
  • Regular check-up
  • Surrogacy
  • Hospital cash benefit.

Pro Tip: Please note that even the best health insurance policy that provides maternity cover benefits usually has a waiting period ranging from nine months to six years.

Before buying a policy with maternity coverage in health insurance for a family, you need to check on the following points:

  • Waiting period for maternity coverage
  • Reimbursement of pre and post-hospitalisation expenses and the number of days in both instances
  • The number of children and pregnancies the policy covers
  • The coverage the policy provides for your newborn baby
  • Cashless hospitals in the network hospital list
  • Sublimits for different treatments
  • Eligibility criteria, if any
  • Coverage in case of legal, medical termination of pregnancy
  • Additional benefits offered by the policy
  • Inclusions and exclusions in the policy
  • Discounts are applicable for online payment or prior payment for multiple years of premium.

As you welcome your bundle of joy into the world do ensure that you have already purchased your maternity health insurance policy. Do your proper research and comparisons before you buy your policy for an amazing and ever-lasting experience free of the associated financial worries.

References

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