• 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.
    • 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.

    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.

    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.

    Top 3 Maternity Insurance Plans

    A few popular maternity insurance plans that are available include:

    • Religare Joy Tomorrow Plan: The Joy Tomorrow Plan from Religare comes with two sum insured options – Rs.3 lakh and Rs.5 lakh. The waiting period to avail maternity benefits is 24 months.
    • Star Wedding Gift Insurance Plan: This policy is available on a floater basis with a policy tenure of 1 or 2 years. The policy covers delivery expenses, regular hospitalisation, and provides a cover for the new-born.
    • HDFC ERGO Health Suraksha Gold: This policy provides a range of sum insured option on an individual sum insured basis and as a family floater. The waiting period to avail the maternity cover is 48 months.

    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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