Are maternity expenses covered under health insurance?
Health insurance offers financial cover for a host of medical expenses, one of which is maternity-related. Expecting a baby is a delightful experience and it brings happiness that knows no bounds! Yet it does pose some financial constraints on the parents-to-be. The expenses incurred during and immediately after pregnancy (tests and screening, hospitalization and surgery for delivery, newborn baby care etc.), when totaled can run into a substantial amount. This is where health insurance can help. It provides the expecting family additional financial support to protect from these high and rising medical expenses.
There are numerous maternity health insurance plans available that cover maternity-related expenses. However, this cover could carry certain clauses and conditions that one should be mindful of, at the time of applying for maternity-oriented health insurance plans. These are:
1) Additional cover for maternity: Many health insurance plans offer maternity benefits as an optional cover for additional premium. Such plans might not offer maternity cover by default as a basic feature. Do find out whether the chosen health policy offers maternity benefits for extra premium, and / or with any other conditions.
2) Waiting Period: Plans that cover maternity benefits specify a waiting period to be served before related medical claims can be submitted. This means that any medical expenses associated with pregnancy, that are incurred before the waiting period is over, cannot be submitted for claims. Waiting period for maternity differs across health insurance plans as well as insurance companies. It ranges from 9 months to 72 months for different health insurance plans. It would be wise to seek this information prior to purchasing the policy.
3) Sub-limits: Some insurers place a cap on maternity-related expenses that can be claimed after the waiting period is over. This cap is the maximum amount which is offered as maternity benefit in the health policy. The cap can either be a predetermined fixed amount or a percentage of the total cover i.e. Sum Insured. For example, there could be a capping placed on the amount of medical expenses that can be claimed towards a caesarean delivery (C-section). Make sure to go through the policy terms and conditions to know more about maternity sub-limits and caps.
4) Inclusions: Most people believe that all pregnancy-related expenditure for the entire 9-month term along with delivery and post-delivery costs are covered under health insurance. Whereas, the health insurance plans that do cover maternity expenses consider pre-, during- and post-hospitalization expenses only up to a certain specified period (say 30 days pre- and 60 days post-hospitalization). Specifically seek information on what is included under maternity benefits in the family floater health policy.
5) Exclusions: This would be mentioned specifically in a list of exclusions in the policy terms and conditions. In case maternity benefit is offered, there might be certain situations / conditions related to pregnancy that might be excluded from medical cover. Find out the list of exclusions in the chosen health policy.
6) Conditions: Maternity benefit might have some conditions attached in certain health insurance plans. For instance, maximum number of pregnancies in the lifetime of the insured, age limit at entry, maximum number of medically advised and lawful terminations permitted etc. Check for associated conditions in the chosen plan.
7) Baby care: pre- and post-natal expenses: Some plans may include care for the newborn such as pre-natal and post-natal expenses. These could be infant vaccinations, hospital care and related expenses. Find out whether or not these expenses are covered and up to what amount or under which conditions, if any.
8) Birth complications: Maternity benefit health plans cover treatment and expenses, should the mother and baby face any complications during birth. For instance, delivery complications, birth defects such as internal congenital diseases, medically advised termination of pregnancy etc. may be covered under maternity health insurance. It is advisable to confirm this, and to find out what are the conditions, if any.
9) Maternity as secondary benefit; health insurance as primary benefit: Health insurance is a lifelong investment to secure one’s personal and financial health. If maternity is going to be part of your life’s journey, then it should be seen as a part of health insurance too! The primary goal is to get a comprehensive health insurance plan that takes care of your medical requirements, including pregnancy-related costs. So, look for a plan that offers a lot more as basic health cover, over and above maternity.
10) Comparing various maternity-benefit health plans: Given the waiting periods that need to be served, it would be prudent to plan your health insurance well in advance before you decide to expand your family! It would be best to compare a few plans that offer additional cover for maternity expenses, before zeroing in on any one health insurance plan or scheme for you and your spouse / family.
SANA.Insure has more than a hundred health insurance plans from many insurers across different categories, including family floater plans that offer maternity benefits. We invite you to visit our health insurance portal sana.insure for quick, impartial, simple and easy access to comparative information across various health policies available in India, best suited to your needs. Our Health Insurance Buddy can help guide you along the way in choosing the right plan.
Wish you a healthy and happy life!