How Health Insurance Views 3 Pregnancy Trimesters & Post Natal Complications

Modern Indian women are career-oriented, striving to outperform their male counterparts. Women now prefer to conceive at a later stage, when it is not likely to impact their professional growth.  They are also more aware of and accountable for financial security; hence they postpone child rearing until they have built a sufficient corpus to fund all expenses.

As a result, there is a shift in the average age of first-time mothers; some even after the age of 35. Opting for late motherhood is a personal choice; however, it is important to be cognisant of related risks from a point of view of health and increased expenditure. Post 30 the body's natural fertility declines with each passing year, and the probability of complications increases. However, significant improvement in healthcare and technology have eased the pressure off more mature couples planning late pregnancies, albeit at a higher cost.

Insurers offer a variety of maternity health insurance plans. They consider certain factors to calculate the premium and issue a policy. Familiarising yourself with these terms will help you in finalizing the most suitable health plan for your family.

1) Age: The premium increases with the age of the mother to be. More mature women tend to have health and birth complications (acquired BP, miscarriage etc.) as they grow older, and that translates to higher risk and cost for the insurance company.

2) Coverage: This would comprise sum assured, exclusions and upper limit of maternity expenses permitted. Your health policy premium is calculated according to the sum assured (maximum annual value of health insurance) you require. The upper limit on medical expenses overall or for different categories is determined by the insurer, either as a specified amount or as a percentage of sum assured.

3) Pre-existing conditions: Most companies consider pregnancy itself as a 'pre-existing' condition if you plan to buy a policy while you are pregnant. Infertility, hypertension, epilepsy are other examples of health abnormalities that some insurance companies don't/might not cover.

4) What is typically covered: Insurers typically cover hospital costs such as room rent, in-patient medicines, surgeon and anaesthesiologist fees, surgical procedure (whether normal or caesarean); for up to 30 days prior to and 60 days after delivery on an average. Even in case of family floater plans, some companies cover these as additional features.

5) Postnatal Care: Postpartum care for newborns like vaccinations, incubation etc., or any other in-hospital treatment for the mother is usually covered for up to 60 or 90 days. However, some external congenital conditions or birth defects (Down's syndrome, cleft palate, spina bifida etc.) would not be covered.

6) What is typically not covered: Usual exclusions that are not considered by the insurer could be out-patient treatment, pre-existing diseases, home treatments.

7) Pre-natal Care: Antenatal care includes scheduled visits to your gynaecologist or obstetrician to monitor progress of pregnancy, prescription of prenatal vitamins and supplements, screenings for amniocentesis, gestational diabetes, ultrasound, etc. Coverage for such kinds of medical intervention during all 3 trimesters is dependent on insurance companies. By and large these are excluded, unless they require hospitalization.

8) Claims: The claims process could be different for each company - in cashless hospitalization the insurer deals directly with the hospital, whereas in reimbursement cases you have to clear all the medical bills (again, this could be in part or in full, according to your chosen plan) and submit them along with the claims form to the insurer.

NOTE:  Maternity health plans differ across insurance companies with various combinations of policy features. The factors mentioned are indicators of what to look for and not all-encompassing. Do check on policy features of the specific plan you choose.

For easy access to comprehensive and comparative information on top maternity insurance plans we recommend logging on to Sana.Insure. All you have to do is key in some specifics, and a Sana Expert will immediately get in touch with you to guide you along the way.

Wish you a healthy and happy life!