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Becoming a mother is a special feeling and experience for every woman. Right from when you realise that you are pregnant, you may feel that it is the beginning of a new phase of life, which also marks the beginning of new expenses.In such a situation, you must be wise with your financial planning to have sufficient back-up when needed. To manage the maternity-related expenses well, you must buy a health insurance policy with maternity cover.
What Is Maternity Health Insurance?
Maternity insurance is a rider or add-on that is offered on a main health insurance policy chosen by you. A maternity health insurance basically covers expenses related to delivery be it normal or caesarean. This rider is offered by insurance companies with an aim to reduce the burden of expenses on your pocket during pregnancy.Nowadays many corporates add the rider of maternity health insurance in the health insurance policy they provide to their employees with a sub-limit of not exceeding ₹50,000. Along with both pre and post hospitalization costs, a maternity health insurance policy covers other related expenses like surgeon fees, doctor consultation fees, anaesthetist consultation fees, nursing and room charges.
How Maternity Insurance Cover Can be Beneficial for You
A health insurance policy with maternity cover provides compensation for the medical expenses incurred during pregnancy. From maternity-related hospitalisation expenses to covering the newborn baby, good maternity insurance can help you deal with all kinds of expenses without any hassles and disturbing your savings.
Eligibility for buying maternal insurance
- The minimum age requirement for purchasing maternity insurance is 18 years, while the maximum age limit is 45 years.
- Maternity insurance policies typically have a waiting period ranging from 9 months to 4 years, during which time policy benefits cannot be utilized. Policyholders can only access the benefits of the policy after the waiting period has ended.
What Does Maternity Insurance Cover?
- A health plan with maternity cover usually covers pre-hospitalisation expenses , including routine medical check-ups, doctor consulting fees, tests, etc. These expenses can take a significant amount, but with robust insurance, you can take care of the costs with ease.
- One of the most important phases of pregnancy is delivery; during the stage, the woman needs special medical attention. Depending on the plan you choose, it will cover the full delivery charges, bed charges, etc. In some cases, if the newborn needs intensive care, the insurance may cover that too.
- Post-natal or the post-delivery phase, too, requires special medical attention for both the mother and the newborn. Maternity insurance can help you cover the expenses related to child-care, medications, and doctor consultation fees.
- The importance of vaccination for the newborn cannot be undermined. The doctors administer mandatory vaccination to the newborn through different stages. Some insurance policies cover the vaccination for 12 months, whereas other plans may offer coverage until 12 years. So, make sure that you know the exact coverage limit for vaccination in your policy.
Types of maternity insurance policies
Maternity insurance comes in two types:
- Add-on maternity insurance: This type of insurance is an add-on to your existing health insurance policy and covers your maternity expenses. As the name suggests, it is an additional benefit that you can opt for.
- Standalone maternity insurance: If your health insurance policy does not cover maternity expenses, you can opt for a standalone maternity insurance policy. It is a separate policy that provides coverage specifically for maternity-related expenses.
Final Word
With the benefits mentioned above, it is evident that health plans with maternity cover are useful to cover pregnancy-related expenses. There is no right time to buy maternity insurance, but experts suggest that it is best to purchase insurance at the time of marriage so that you are well-prepared for the time when you are ready to welcome the baby.
FAQS - FREQUENTLY ASKED QUESTIONS
Can an already pregnant lady buy maternity insurance ?
No, a maternity insurance plan usually has a mandatory waiting period of 2-4 years before you can file a medical claim. Therefore, pregnant women cannot purchase maternity insurance. However, they can purchase it for their second child.
What maternity items are covered by insurance ?
Maternity insurance typically covers expenses related to pregnancy and childbirth, starting from one month before the delivery date and extending up to three months after delivery.
Maternity insurance typically includes coverage for expenses related to hospitalization, including room charges, nursing fees, and doctor fees. Additional miscellaneous hospital charges, such as surgeon fees, may also be covered under some plans. Additionally, some policies may offer coverage for ambulance services.
What is not covered in maternity insurance ?
There are several items that may not be included in maternity insurance coverage, including
Pre-existing diseases or medical conditions that affect pregnancy, which may require additional coverage or a higher premium.
Congenital diseases or birth defects that are present at birth.
Treatment expenses related to infertility, which may require a separate insurance policy or coverage option.
Medicine costs that are not directly related to the treatment of pregnancy and childbirth.
Frequent doctor's check-ups or consultation fees that are not deemed medically necessary.
How to claim maternity insurance ?
To claim maternity insurance, follow these steps:
Contact your insurance company via their website or toll-free number after hospitalization and provide the necessary details and documents.
The insurance company will contact the hospital to verify your claim and request any additional documentation needed.
If the hospital is in the insurance company's network, they will pay the amount directly to the hospital. If not, your cashless insurance claim may be rejected, and you will need to pay the hospital expenses upfront and then submit a claim for reimbursement with proper documentation and bills.
Once the claim is approved, the insurance company will reimburse you for the eligible expenses covered under your policy.
What is the waiting period for pregnancy health insurance ?
The waiting period for maternity health insurance can vary depending on the insurance provider and policy. Typically, the waiting period for maternity coverage is between 24 to 36 months, which means that you need to wait for that period before making a claim for any pregnancy-related expenses. However, there are some insurance providers who offer policies with shorter waiting periods, such as 9 months, which can be beneficial for those who are planning to start a family in the near future.
Can husband and wife both claim maternity insurance ?
It is possible to claim insurance from two different policies to cover medical expenses. This is known as 'coordination of benefits'. In case the medical expenses exceed the coverage amount of one policy, you can claim the remaining amount from the second policy.
For instance, let's say you have two health insurance policies covering you and your wife, with one policy providing coverage up to Rs. 30,000 and the other policy providing coverage up to Rs. 20,000. If you have medical expenses worth Rs. 50,000, you can claim Rs. 30,000 from the first policy and the remaining Rs. 20,000 from the second policy. However, you cannot claim more than the actual medical expenses incurred, which in this case is Rs. 50,000, even if you have multiple policies covering the same expenses
Which is better for maternity cashless or reimbursement policy ?
Opting for a cashless maternity policy can be advantageous as it eliminates the need for you to pay upfront and then seek reimbursement. It is particularly beneficial if the hospital you plan to deliver in is included in your insurer's network, allowing you to easily make cashless claims.
What are the Indian government schemes for pregnant ladies ?
There are various government schemes available for pregnant women in India, such as the Pradhan Mantri Matru Vandana Yojana (PMMVY), which provides financial assistance of Rs. 5,000 to pregnant women for their first live birth. The Janani Suraksha Yojana (JSY) is another scheme that provides benefits to women who give birth in a government hospital or accredited private hospital. They receive Rs. 1,400 in rural areas and Rs. 1,000 in urban areas.
Additionally, various state governments offer their own schemes for pregnant women, which may differ from state to state.
Is pregnancy covered in Ayushman card ?
Yes, pregnancy-related medical expenses are covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) or Ayushman card, which provides coverage for medical treatment up to Rs. 5 lakhs per family per year.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
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