guide to maternity coverage

An unbiased guide to maternity coverage in health insurance

Maternity coverage helps in payment of the hospital costs during the pregnancy of the insured including childbirth. Health insurance basic plans cover maternity charges, but it is limited only up to the delivery of the baby. The coverage provided under regular health insurance is not so vast and thus limited in scope. 

Indian Reforms

In 2014, under the Affordable Care Act, it was made compulsory that maternity cover be made mandatorily available among the top 10 essentials of health benefits. Individuals, families, and small group plans shall also include maternity coverage. The costs shall cover pregnancy, labor, delivery and newborn baby care. 

Maternity health insurance 

Going through tremendous pressure is asking too much of a pregnant woman. During such times, the family tries to support her and be there for her. In such times, unloading financial liabilities upon them is actually being unfair. To feel a little relaxed and de-stressed, a new product was launched; maternity health insurance. 

The product helps you get a sense of financial protection during pregnancy. It covers all expenses that may be incurred during the entire phase of pregnancy. Having maternity health insurance is important as you need not worry about a whole lot of routine things when you are carrying the baby inside you. 

Features of Maternity Health Insurance 

  1. Premium: The premium for such policies is higher as they have a near-100% claim settlement ratio. Other factors that decide the cost of maternity health policy are age, risk profile, and if any existing health condition, may it be disease or critical illness. 
  1. Claim: The claim process is easy and flexible. Filing of cashless and reimbursement claims are possible and also simple. 
  1. Coverage: Maternity health insurance covers pre- and post-hospitalization expenses along with ambulance services, consultation fees, and room rent. The policy also includes maternity cover and secures the newborn up to a specific period. The delivery through normal or cesarean section is also under coverage. 
  1. Tax benefit: Availing tax benefit of Rs.50,000 is possible under Section 80D of the Income Tax act, 1961, through annual premium payments.
  1. Cashless facility: Through this method, the insurer will directly pay the hospital bill without the insured being an intermediate party, thus causing no additional stress. The usage of this facility is possible only if the hospital the insured had taken admission was within the network of hospitals of the insurance company. 
  1. Cover for newborn: The newborn baby will be receiving coverage for a minimum of 90 days or more as this is pre-decided among the parties vis-à-vis insurer and insured.
  1. Claim-free bonus: This is valid from the date of purchase of such a plan till the date of pregnancy / delivery. The gap between these periods can help you extract a no-claim bonus; assuming no claim was made in the past year or for a longer time frame. 
  1. Natal care: Natal means taking up preventive healthcare options through check-ups, scans, and more. Maternity insurance plans cover 30 days of pre-natal pregnancy tests and 60 days after the delivery. Maternity health insurance covers all this. 
  1. Waiting period: The waiting period for purchasing differs from one company to another. It starts from 9 months to 6 years. 
  1. Vaccination costs: The vaccination given to the newborn baby is under the coverage of the policy for a period of one year. 

What is the right time to buy a Maternity Health Insurance?

Earlier, the better. Following class of people tend to purchase a maternity insurance plan.

  1. Newly Married couples. 
  2. Couples planning for a child in the next 2-3 years. The decision should be ideally made sooner, considering the waiting period that needs to be served. 
  3. Couples planning a second kid. 

All this helps the future parents to be financially stable, enjoy a valuable investment, and be all set for parenthood. 

Here is a quick question that needs to be addressed – If we have health insurance covering maternity costs, why purchase a separate policy? 

During pregnancy, there is a possibility that one might undergo complications that will then lead to higher medical costs. Insurance cover supports all the additional expenses incurred before and after the delivery of the newborn. Your health insurance covers maternity costs only up to a minimal delivery cost and hospitalization money. 

Pre-hospitalization, post-hospitalization, prenatal, post-natal, doctor consultation fees, vaccination and cover for the newborn can add up to quite a bit.  

To cover all these costs in advance for the future will help you experience the beautiful process of motherhood and not cause any unnecessary additional stress. 

Difference between a health insurance covering maternity benefits and maternity health insurance

Health Insurance including maternity coverItemsMaternity Health Insurance
Maternity cover is one of the benefits that is included in your health insurance package. MeaningMaternity Health insurance is an entire plan introduced for covering pregnancy-related expenses. 
Health insurance only covers delivery expenses and hospitalization costs. CoverageMaternity health insurance covers pre and post-hospitalization, prenatal and postnatal expenses along with vaccination of the new born baby up to one year. 
Looking at maternity in focus mode, the scope of providing financial security is narrow. ScopeThe broad scope is given by maternity health insurance and thus guaranteeing future security. 
For including maternity cover, a waiting period does not need to be specifically served. The waiting period for a basic health insurance needs to be fulfilled in 0-90 days; varies based on detection of pre-existing diseases. Waiting PeriodThe ideal age of purchasing a maternity health insurance is 25 years of age. As the waiting period can differ from a period of 9 months up to 6 years. Keeping a buffer never hurts. 
Health insurance is a whole policy on its own and is not an add-on. Add onOn purchase of maternity health insurance, the insured has an option to add it to their health insurance or can keep it separate. The decision is in your hands. 
Health insurance provides tax benefit of up to INR 25,000 to INR 50,000. The exemption amount depends on the age of the insured. Tax BenefitTax benefit of up to INR 60,000 can be enjoyed under maternity health insurance. 
The motive of health insurance to cover and secure the life of a person from all perspectives. MotiveMaternity health insurance has the motive of covering all pregnancy related expenses. 

Cost of Maternity Health Insurance

  1. While purchasing maternity insurance, you should select and compare many plans before choosing a final one as the cost-benefit analysis differs from one company to another. 
  1. The premium payable is higher than that of health insurance. The reason for the same is maternity insurance provides almost 100% claim settlement ratio. 
  1. Medical costs are increasing every-day, and the expense that will be spent on pregnancy-related prices will also rise. So, purchasing a plan today to beat future inflation and protect your parenthood experience is known to be wise. 
  1. The last point that one should keep in mind is that the older you get, the premium payable for purchasing maternity insurance keeps increasing. 

Guide to Maternity Coverage

Can one get maternity insurance if already pregnant?

As maternity cover is one of the top 10 essential health benefits covered by health insurance, coverage is given. Maternity costs can be claimable under health insurance only if you have served the waiting period, and your plan is active. Maternity insurance has a waiting period of 9 months up to 6 years. If you are already pregnant and want coverage for the kid, it is impossible to purchase maternity insurance in such a short time. It is like purchasing marine insurance when the ship is sinking. The halt period needs to be fulfilled. Although, one can buy maternity insurance that will cover their next child if the couple is planning one shortly.

If you are under your parents' insurance but find out you're pregnant, what are your maternity insurance options?

An insurance plan purchased by your parents will cover you for maternity costs based on the amount of the plan you have purchased. The amount of premium payable or the amount of the entire policy plays a vital role in deciding if the child can get maternity coverage under their parent's plan. Example: If X has insurance coverage of Rs.5 lakhs. If the daughter of X is pregnant, due to such a low coverage plan, the insurance company has the authority to reject the claim. On the other hand, if Z has a policy of Rs.50 lakhs, the daughter of Z will be receiving coverage for maternity expenses too.

Which health insurance company covers maternity?

As per the guidelines under the Affordable Act, 2014, providing maternity cover is one of the top 10 health essential benefits. In case you are already pregnant, then, the policy will not provide you with coverage. Pregnancy is considered a pre-existing condition for health insurance. But, if you look at the factor in general, then, maternity cover is provided by health insurance. The plan covers- pregnancy, labor, delivery, and newborn care. Coverage is mandatory for these minimal maternity expenses.

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