Maternity Health Insurance
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Maternity Health Insurance

The importance of having health insurance plan cannot be stressed enough. However, health insurance needs to be flexible and change with age and circumstances, Hence one must regularly update their health insurance portfolio.

A single individual in his 20s might be in a sweet spot with a comprehensive health insurance plan, but the same person in their 30s with a life partner and a baby on the way, might need to rethink their insurance plan. Think maternity insurance plans.

What are maternity insurance plans?

Maternity insurance is specially designed to provide coverage for maternity expenses. Maternity insurance is not a stand alone insurance plan. It is a part of a comprehensive health insurance plan. Quite often, maternity insurance has to be bought as an add on as it is not a part of a plan unless opted for.

Maternity Insurance Plan

Top maternity insurance plans

Plan

Features

Care Joy Maternity Health Insurance

  • Coverage for newborn baby
  • Policy tenure: 3 years
  • Rs.3 lakh -to Rs. 5 lakh
  • Higher sum insured increase for each claim-free year
  • Entry age: 18 years to 45 years
  • New born baby cover: 1 day
  • Waiting period: 9 months

HDFC Ergo Family Easy Health

  • Coverage for up to 2 deliveries
  • Newborn baby coverage
  • Vaccination expenses included
  • Rs 30,000 for normal delivery and Rs 50,000 for C-section
  • Waiting period: 3 years

Bharti AXA Smart Super Health Insurance with Maternity Cover

  • Coverage up to 2 deliveries
  • 2 terminations covered
  • Waiting period: 9 months
  • Available with family floater 3-year plan
  • Coverage for newborn baby for first 90 days

Universal Sompo Health Insurance with Maternity Cover

  • Coverage up to 2 deliveries
  • 2 terminations also covered
  • Waiting period: 3 years

Why should one opt for a maternity health insurance plan?

When people think about health insurance, rarely do they think about maternity expenses. Maternity expenses can cost a considerable amount of money, depending on the hospital, city, and complications if any. Here are some reasons why maternity Mediclaim plans are good to have:

Rising costs of maternity: Medical inflation is skyrocketing. Maternity expenses, too, have increased manifold. The bigger the hospital, more expensive will be the costs. Maternity insurance plan can help meet the high costs of maternity hospitalization.

Coverage for maternity and newborn baby: Health insurance with maternity benefits offers coverage for maternity as well as newborn baby. Buying maternity insurance is the best way to insure a newborn baby as these plans provide coverage to newborn babies from day one.

Stress-free maternity: Married people have a lot of expenses. With family planning, their expenses can increase significantly. The average maternity expenses start at Rs.1 lakh. Such an amount can cause financial worries if one hasn’t planned and prepared to meet the expenses. Health insurance with maternity cover helps couples have a stress-free experience.

Helps in family planning: Having the support of a maternity health plan can help couples well in family planning. For many couples who have financial responsibilities, bringing a child into the world can be a huge decision that might require planning. A maternity policy can help ease that cost considerably as it provides coverage.

Coverage against medically necessary terminations: At times, childbirth and maternity can end up in grave complications. During such times, doctors may prescribe medical termination of pregnancy (MTP). The costs of such MTP procedures are also covered by these maternity insurance plans.

Steps to buy a maternity health insurance plan in India

A maternity health insurance plan is not a standalone plan and cannot be bought separately. It can be bought as an add-on to an existing health insurance plan. Here are the key steps to buying a maternity Mediclaim policy.

  • Determine your maternity medical needs
  • Maternity plans have a long waiting period so plan in advance
  • Calculate your desired sum assured
  • Compare different maternity insurance plans
  • Look for details such as sub-limits, co-payment, and extra premium costs
  • Check the coverage included in maternity cover
  • Use the online aggregator to calculate the maternity insurance premium and to compare across policies

Key features of maternity insurance

Waiting period: Most maternity insurance plans have a waiting period of a few months to a few years. Policyholders must consider the waiting period at the time of buying maternity Mediclaim.

Limits on maternity spend: Maternity insurance plans have limits on certain claims. These are pre defined and specified in the policy. for example room rent limit.

Coverage: Maternity insurance plans provide a wide range of coverage: in-patient, pre- and post-hospitalization, day-care, ambulance charges, room rent, prenatal and postnatal expenses, and newborn baby cover.

Newborn coverage: Most maternity health insurance plans offer coverage for newborn babies from day 1 to a few months. The entry age for newborn baby cover might differ from one plan to another.

In-patient care: Health insurance with maternity cover provides coverage for in-patient care. In-patient treatments are those where the policyholder has to stay overnight in the hospital.

Day-care treatment: Certain maternity related treatments might not require the policyholder to get admitted to the hospital. These day-care treatments are covered by maternity Mediclaim.

Normal delivery: Maternity Mediclaim plans offer coverage for normal deliveries. However, some policies might have clauses that limit coverage for complications, but most maternity plans cover both kinds of deliveries

C-section delivery: C-section is a more common and preferred way for deliveries these days and the good news is that maternity insurance plans offer coverage for it.

Cashless hospitalization: Maternity Mediclaim plans offer cashless reimbursement facilities, which means the policyholder does not have to pay to the hospital in advance. Instead the insurer pays directly to the hospital.

Eligibility for maternity insurance plan

Maternity insurance plans have an age eligibility of 18 years to 45 years, being the minimum and maximum entry age, respectively. The eligibility of newborn babies to be covered under maternity plans is one day to 24 years.

Maternity insurance claim process

Maternity Mediclaim claim process is simple and easy. Upon getting hospitalized for the maternity treatment, the policyholder must intimate the insurance company. Here’s the process to follow:

Cashless claim

Cashless claim is an agreement between the insurer and the network hospitals to allow policyholders maternity treatments without any payments from the policyholder. In this type of claim, the insurer pays directly to the hospital. The policyholder does not have to make the payment and then receive it back as reimbursement from the insurance company. This process, typically, follows these steps:The typical process followed is as under…

  1. Get treatment at a hospital which is part of the network of the insurance policy
  2. Submit a health insurance policy claim form at the hospital
  3. The insurance company sends an approval to the hospital or raises a query in case of missing information

Reimbursement claim

In this type of claim, the policyholder has to make the payment to the hospital, which is then reimbursed by the insurer upon following the reimbursement process, as under:

  1. The policyholder is required to fill a claim form and submit to the insurer along with the medical and hospital bills
  2. The insurer then investigates and verifies all the documents
  3. If the claim is approved, the insurance company sends an approval letter. In case of rejection, a rejection letter along with the reasons is shared with the policyholder.

Inclusions & Exclusions of Maternity Insurance Plans

The inclusions and exclusions of a maternity insurance plan differ from insurer to insurer. However, these are among the most common maternity insurance inclusions and exclusions.

Inclusions:

  • Maternity health insurance plans cover child delivery expenses. It covers both normal and C-section delivery.
  • Health insurance plans with maternity cover include newborn baby cover. Newborn babies as young as one day can be included in the insurance.
  • Infertility expenses covered: Many couples might require treatment for infertility. These expenses are included in maternity Mediclaim plans.
  • Medical terminations of pregnancy (MTP) covered: At times, pregnancies get complicated and need to be terminated. Health insurance plans with maternity coverage include cover for such cases.
  • 200% sum insured for second delivery: Many health insurance plans that offer maternity insurance add-on offer 200% sum insured for the second child delivery.

Exclusions:

  • Non-allopathic treatments might not be included in maternity insurance. However, it depends on the insurance company.
  • Maternity complications arising out of self-inflicted injury are not included.
  • Expenses arising out of or attributable to alcohol or drug use/misuse/abuse leading to maternity complications are not included.
  • Tests and treatment relating to infertility and in-vitro fertilisation.
  • Expenses related to the purchase of vitamins and tonics are not included.

Faqs

What is maternity insurance and how does it work?

Maternity insurance plans are add-on coverage that can be purchased in addition to an existing health insurance plan. Maternity insurance can be purchased for individuals or as part of a family-floater plan. They are not standalone plans.

Maternity insurance is specially designed to provide coverage for maternity expenses. From childbirth to newborn baby coverage to medically necessary terminations, there are a wide range of expenses covered in maternity plans.

Maternity plans work just like other health insurance plans. Upon getting hospitalized, the policyholder has to intimate the insurance company, submit bills

When should I buy a maternity health insurance plan?

Most maternity health insurance plans have a waiting period of a few months to a few years. Hence, those who are planning to have a child must buy the maternity add-on cover much in advance so as to make the most of the plans benefits. Typically, there is a 9 month
to 2 years waiting period, depending on the insurance company. Policyholders must consider this factor when buying a plan as well as planning a child.

Can I get a maternity plan while I am pregnant?

Yes, you can get a maternity plan even while you are pregnant but it might not be of use for that pregnancy. It can be used for your second pregnancy. Most maternity health insurance plans have a waiting period of a few months to a few years. Hence, those who are planning to have a child must buy the maternity add-on cover much in advance so as to make the most of the plans benefits. Most maternity Mediclaim plans offer coverage for up to 2 children.

Who is eligible to buy a maternity insurance plan?

Maternity insurance plans have an age eligibility of 18 years to 45 years . These are the minimum and maximum entry age, respectively. The eligibility of newborn babies to be covered under maternity plans is one day to 24 years.

How will a maternity plan benefit my newborn?

Most maternity health insurance plans offer coverage for newborn babies from day 1 up to a few months. The entry age for newborn baby cover might differ from plan to plan. Maternity plans offer coverage to children up to the age of 24 years, hence it is beneficial for the child as the child can get coverage for many years.

What is the waiting period for maternity health insurance policies?

Most maternity insurance plans have a waiting period of a few months to a few years. Policyholders must consider the waiting period at the time of buying maternity Mediclaim.

What happens when a child is born with deformity?

Different health insurance plans might have different clauses in the case when a child is born with deformities. It is advisable to check the specific clauses and coverage offered by different maternity insurance plans.

What is the minimum sum insured under maternity Mediclaim plans?

The minimum sum insured amount for a maternity plan depends on the health insurance company. However, most insurance companies provide sum insured starting at Rs.20,000. Maternity plans are add-ons and hence they could even have co-payment clauses.

Is pregnancy termination covered under maternity health insurance?

At times, childbirth and maternity can have grave complications. During such times, doctors may prescribe medical termination of pregnancy (MTP).The costs of these termination procedures are covered by maternity insurance plans.

Is the second child covered under health insurance with maternity coverage?

Many health insurance plans provide maternity coverage for just one child, while many offer coverage for the second child, as well.

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