• Maternity Health Insurance – An Overview

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    What is Maternity Health Insurance?

    Motherhood is one of the most joyous periods of one’s life. But in order to truly enjoy this special phase, it is vital that you are financially prepared for the birth of your newborn. Rising healthcare costs and inflation have made maternity expenses shoot through the roof. Thus, it is imperative that you purchase a maternity insurance policy to cover your maternity-related expenses.

    A maternity health insurance policy will cover the hospitalisation and delivery costs of the new-born (be it a normal delivery or a Caesarean), pre- and post-hospitalisation expenses, and pre- and post-natal care of the new-born. In addition, the newborn is also provided a health cover for a certain period of time after his/her birth. Maternity insurance plans also cover ambulance charges, in most cases, in case the to-be mother needs to be taken to the hospital by an ambulance.

    Key Features of Maternity Health Insurance Plans

    Features Description
    Inclusions In general, most maternity insurance plans cover the following, up to the limits specified by the insurer:
    • Hospitalisation expenses (including cost of drugs, room rent charges, specialist fees, etc.)
    • Pre- and post-hospitalisation expenses
    • Delivery expenses and New-Born Cover
    • Ambulance charges
    • Pre- and post-natal expenses
    Note: Certain maternity insurance plans also provide additional coverage for specific day-care procedures and other treatments.
    Exclusions
    • Pre-existing diseases within the 48-month waiting period
    • Illnesses/diseases contracted during the first 30 days
    • Non-allopathic treatment costs
    • Hospitalisation expenses as a result of a self-inflicted injury
    • Hospitalisation expenses arising as a result of drug/alcohol use
    • Treatment of congenital diseases
    • Cost of contact lenses/spectacles/dental treatment
    • Aesthetic treatments
    • Expenses arising as a result of treating AIDS/HIV
    • In-vitro fertilisation (IVF) or infertility treatment costs
    Waiting Period Most maternity health insurance plans will only cover your maternity-related expenses after a period of 2 – 6 continuous policy years. Group health insurance plans, on the other hand, usually cover maternity-related expenses after a period of 9 months.
    Sum Insured You will have to choose the sum insured amount at the time of purchasing your policy. You can choose an optimum sum insured amount, which falls within the insurer’s pre-defined limits. Your premium rates will be linked to the sum insured. Thus, if you opt for a high sum insured, you will have to pay a high premium.
    Premium A health insurance policy which provides coverage for maternity expenses will be more expensive than a regular health insurance policy. The premium rates will vary on the basis of the sum insured, age at entry, risk factors, location, and number of employees (if it is a group policy).

    *Note: Specific features and coverage limits will vary from plan to plan.

    Benefits of maternity insurance 

    Maternity insurance helps you and your spouse to be able to focus on only your health and that of the newborn during the pregnancy, delivery, and post-delivery phase without getting stressed about the bills. Depending on the plan that you choose, any medical treatment that is required for the newborn too will be covered. This ensures that your child gets the best treatment available without any financial constraints.  

    With rising healthcare costs, having a maternity health insurance ensures that you can plan your family and provide the best healthcare without any financial constraints. You will also benefit from tax deductions on the premiums that you pay towards your health insurance plan. 

    Who can purchase Maternity Health Insurance?

    A maternity health insurance plan can be purchased by any individual who meets the insurer’s eligibility criteria. Health insurance plans with a maternity benefit may also be a part of your group health insurance policy.

    When should you purchase Maternity Health Insurance?

    Ideally, you should purchase a maternity health insurance plan well before you are pregnant. Most health insurance providers provide maternity health insurance plans to policy buyers with a waiting period of 2 – 6 years. Since health insurance providers will not offer maternity health insurance plans to women who are already pregnant, it is vital that you purchase a maternity health insurance plan well in advance, keeping the waiting period in mind, in order to enjoy complete coverage during this period of your life.

    Documents required to apply for maternity health insurance 

    This may vary from insurer to insurer, but some common documents that may be required are the following: 

    • Proof address: Driving licence, electricity bill, ration card, etc. 
    • Proof of identity: Driving licence, electricity bill, ration card, etc. 
    • Proof of age: Birth certificate, Aadhaar card, passport, driving license. 
    • For policyholders who are above 45 years of age, medical examination reports. 
    • Passport-size photographs. 

    Claim Process

    While the claim process may vary from insurer to insurer, the general claim process that you will have to follow as a policyholder is listed below.

    • Claim Intimation: Before you raise a claim, you will first have to intimate the insurer of the upcoming claim. In case of a planned hospitalisation, the insurer will have to be intimated at least 48 hours before the intended date of hospitalisation. In case it is an emergency hospitalisation, the insurer will have to be intimated within 24 hours of being hospitalised. You can intimate the insurer of the claim though the helpline number/email ID, provided on the insurer’s website.
    • Cashless Claim: If you are opting for cashless treatment at a network hospital, you will have to follow the steps mentioned below to request for pre-authorisation.
    • Fill-up the pre-authorisation request form that is available at the hospital registration desk/TPA desk and have the same sent to the insurer.
    • Upon receiving this form, the insurance firm’s claim management team, will either approve, reject, or send a query to the hospital.
    • If you pre-authorisation has been approved, you can avail cashless treatment at the hospital.
    • Reimbursement Claim: If you have undergone treatment at a non-network hospital, you will have to pay for the treatment/hospitalisation in full and then raise a reimbursement claim. In order to raise a reimbursement claim, you will have to follow the steps mentioned below.
    • Fill-up the original claim form, sign it, and submit it along with all the supporting documents to the insurer.
    • Post this, the insurer’s claim management team will send you an approval letter if the claim has been approved, respond with a query, or reject the claim and communicate the reason to you.
    • If approved, the claim settlement will be one within a period of few days.

    Documents required for maternity health insurance claims process 

    • Original policy document of maternity health insurance 
    • Proof of pregnancy 
    • If you are going to be hospitalised at a network hospital, your cashless health card 
    • KYC documents 

    Top 7 maternity insurance plans 

    You can choose from a wide range of maternity insurance plans from reliable insurance firms. These are some of the popular plans: 

    1. Religare Joy Maternity Insurance Plan 
    2. This is a maternity and newborn insurance coverage plan that covers both hospitalisation and post-hospitalisation expenses.  

      • There are 6000+ hospitals that are part of the network hospital list where you can get cashless hospitalisation. 
      • The waiting period for maternity-related claims is a short 9 months. 
      • The policy tenure is 3 years.  
      • This plan includes coverage for the newborn. 
      • You are also covered for a private AC single room, in-patient care, and daycare treatment. 
      • The maximum entry age is 45 years.  
      • The sum insured is Rs.3 lakh (and Rs.30,000 for newborn) and Rs.5 lakh (Rs.50,000 for newborn). 
    3. Star Wedding Gift Insurance Plan 
    4. This plan is from Star Health Insurance and provides coverage for both mother and child. Coverage is provided for: 

      • Delivery expenses. 
      • Pre- and postnatal expenses. 
      • Hospitalisation expenses for the treatment of any congenital diseases for the baby. 
      • Lump-sum payment for a baby with cerebral palsy or Down’s Syndrome. 
      • Coverage for post-delivery complications 
      • Coverage for tests to detect any congenital abnormalities in the fetus. 
      • There are two options for the sum assured – Rs.3 lakh and Rs.5 lakh. 
      • The maximum age of entry is 40 years. 
      • It is renewable up to 45 years of age. 
    5. HDFC Ergo Health Suraksha Insurance Gold 
    6. With this plan, you get coverage for mother and child. There is no sub-limit on room rent so you need not compromise on your comfort for the sake of insurance. Some of the features are: 

      • Coverage for pre- and post-delivery expenses for both cesarean and normal deliveries. 
      • Coverage for any medical expenses of the child that occurs within 90 days of birth.  
      • Coverage for 144 daycare procedures.  
      • You can choose a sum insured from a wide range of options to suit your budget and requirements.  
      • There is no entry age restriction; however, premiums are lower at younger ages. 
      • There is lifelong renewability. 
    7. Max Bupa Heartbeat Family Floater Health Insurance 
    8. The Max Bupa Heartbeat Family Floater Health Insurance plan is available in two variants, Gold and Platinum. Some features are: 

      • Sum insured options start from Rs.5 lakh and goes up to Rs.1 crore. 
      • There is a waiting period of 2 years for maternity benefit. 
      • The gold plan offers coverage for up to two deliveries. 
      • There is also coverage for the newborn baby from birth till the policy year without any additional premium. 
      • If the baby is added under the policy the following year, expenses for vaccinations are also covered. 
      • Renewability for life. 
    9. Royal Sundaram Family Plus Health Insurance Plan 
    10. This plan offers maternity benefit coverage and newborn cover. Some features are: 

      • Coverage for up to two deliveries if there are two adults covered under the same family floater policy. 
      • Coverage for the newborn/ 
      • Cover for newborn vaccinations in the first year.  
      • After delivery, there is also a nutritional allowance for the mother. 
      • There is no restriction on the maximum age of entry. 
      • The sum insured for the floater plan ranges from Rs.3 lakh to Rs.50 lakh. 
    11. Apollo Munich Easy Health Insurance Family Floater Plan 
    12. The exclusive and premium variants offer maternity benefit after a specific waiting period. Some of the features are: 

      • This plan offers sum insured in a range from Rs.2 lakh to Rs.50 lakh across three variants which are standard, exclusive, and premium. 
      • There is no cap on room rent. 
      • Both these variants also offer cover for the newborn on payment of an additional premium. Claims can be settled through cashless hospitalisation (in over 4000 hospitals across the country) and through reimbursement. 
    13. Manipal Cigna Prohealth Insurance 
    14. This plan comes with a ‘reduction in maternity waiting’ feature which, if chosen, will reduce the usual 48-month waiting period to a 24-month waiting period. Some features are: 

      • Coverage is provided for up to 2 deliveries of the insured person from the age of 18 to 45 years. Coverage is also provided for medical expenses of the newborn while the mother is hospitalised. Cover for newborn includes treatment for complications up to 90 days from the day of birth of the newborn. 
      • You can continue to get coverage for the baby beyond 90 days by paying the requisite premium and adding the baby into the policy. 
      • First year vaccinations are also covered. 
      • The minimum age of entry is 18 years with no maximum age of entry. 
      • You can choose from a wide range of sum insured under different plans starting at Rs.2.5 lakh and going up to Rs.50 lakh. 

    Factors to look out for in maternity health insurance 

    Waiting period: The waiting period can range from 9 months to even 72 months in the case of continuous renewals. It is important to keep the waiting period in mind when choosing a policy. If you are planning to expand your family soon, then choose a policy with a shorter waiting period and get yourself insured as soon as you get married. 

    Coverage: It is important to understand what is covered under the policy which will make a difference later, such as up to how many deliveries are covered, whether both normal and cesarean deliveries are covered, if there is newborn baby coverage, vaccination cover, etc. 

    FAQs on Maternity Health Insurance

    1. Do all insurance policies cover maternity benefits?
    2. Health insurance plans have been designed with the basic idea to provide coverage for emergency treatments or surgeries. Therefore, the maternity benefit feature is not one of the key features of regular insurance policies. It is an additional feature that can be opted for under some plans offered by a few insurance companies.

    3. Are cost of vaccinations for the newborn covered under a maternity health insurance plan?
    4. Yes, a few insurers do provide coverage for vaccinations. You should check the policy document for the inclusion of this feature in the plan you have purchased or are yet to purchase.

    5. What is the ideal time to purchase a maternity health insurance policy?
    6. Since maternity benefits cannot be availed immediately after the policy is issued, it is best to purchase a policy well in advance when you start planning to conceive.

    7. How are maternity health insurance plans priced?
    8. The premium payable towards a maternity plan is determined based on similar parameters as of those for a regular health insurance plan. The insured person’s age, coverage chosen, sum insured opted for, etc. are taken into consideration. The premium amount differs from insurer to insurer.

    9. Is there a way to get health insurance when I’m pregnant?
    10. While you can purchase a policy while you are pregnant, the expenses incurred on the on-going pregnancy will not be covered. So you could check if the health insurance plan offered by your employer covers maternity expenses or not. If it does, you can use the facility to cover maternity-related expenses.

    11. How long will I have to wait until the maternity expenses are covered?
    12. The waiting period to avail maternity benefits is decided by the insurance company and can range between 2 and 6 years.

    13. If I purchase a policy during my first pregnancy, will my second pregnancy be covered?
    14. Though your first pregnancy is not covered because you haven’t completed the waiting period mentioned, your second pregnancy will be covered, provided you have completed the waiting period by then.

    15. Will the maternity expenses be covered if I visit another country for childbirth
    16. Health insurance companies generally set a boundary within which the benefits of the product can be availed. Most companies do not provide financial protection for medical expenses incurred for any treatment outside the country.

    17. Can other members of the family be covered under a maternity health insurance plan?
    18. The maternity benefit feature is generally an added or an optional feature so if the floater option is available under the plan you’re looking at, you can cover your spouse, child, or parent under the same plan.

    19. Will all maternity-related expenses be covered under the policy?
    20. Delivery expenses, hospitalisation expenses, ambulance charges, and pre and post-hospitalisation expenses among others are covered up to the sum insured limit. A few insurance companies even provide additional coverage for certain daycare procedures. However, a few treatments such as IVF and infertility-related procedures are excluded from the policy.

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