Maternity Health Insurance

Table of Content

1. What is a Maternity Health Insurance Plan?

2. Why Do You Need Maternity Insurance?

3. What Is Included Under Maternity Insurance Plans?

4. What Is Not Included Under Maternity Insurance Plans?

5. When to Purchase Maternity Health Insurance?

6. Features of Maternity Health Insurance

7. Benefits of Maternity Health Insurance

8. What Factors Should You Consider While Buying a Maternity Health Insurance Policy?

9. Who Can Benefit from Maternity Health Insurance Coverage?

10. Eligibility Criteria for Maternity Health Insurance

11. Documents Required to Claim Maternity Insurance

12. Claim Process to Avail Maternity Health Insurance Policy

13. A Buying Guide for Maternity Health Insurance Plans

14. Things You Must Know Before Buying a Maternity Health Insurance Policy

15. How long is the waiting period for maternity benefits?

16. How is the Cost of Maternity Health Insurance Calculated?

17. Summary

18. FAQ's on Maternity Health Insurance

What is a Maternity Health Insurance Plan?

Maternity insurance plans are designed to cover the medical expenses that are related specifically to pregnancy and childbirth. These plans with health insurance for women usually include the costs incurred by the insured during delivery, as well as prenatal and postnatal care. However, some maternity insurance plans may also cover newborn care.

It is important to note that when you are opting for a maternity insurance policy, you must note its waiting period. Most of these plans have long waiting periods ranging anywhere from 9 months to 4 years, depending upon the insurance company and plan you choose. Hence, choosing the right plan is important to help ease your financial burden during this critical life event. It ensures that both mother and baby receive the best possible care as you enter parenthood.

Why Do You Need Maternity Insurance?

Before you apply for maternity insurance, you must have a clear idea of why it is a necessary requirement. The details are provided below:

• Money Support

Maternity expenses can be overwhelming, from pre-natal care and hospitalisation to post-natal care. Without insurance, these costs become a burden on couples, especially if the delivery is done in a private hospital that charges exorbitantly high. Maternity insurance goes a long way in relieving this burden by covering medical bills, doctor's fees, and maternity-related complications. It lets you get excellent healthcare without draining one's money.

Besides this, many policies have the added benefit of covering C-section deliveries, which can be significantly costlier than regular ones. If one opts for maternity insurance early enough, one will have assured financial support for one of life's most significant moments, minus the worry of unexpected medical expenses.

• Total Care

Maternity insurance goes beyond covering hospital bills; it ensures complete medical care during pregnancy. Such care includes regular health check-ups, ultrasounds, medication, and consultation, all of which are indispensable for a healthy pregnancy. Some of the policies include pre and post-natal care, thus ensuring both the mother and baby get the requisite medical attention.

Such cover ensures that the expectant mother is not worried about the expenses incurred for medical treatment in childbirth. Given the ever-increasing cost of healthcare, maternity insurance ensures that you have nothing to worry about regarding the quality of medical facilities that might be needed, making the journey to motherhood less hassle and stressful.

• Care for Your Baby

Many maternity plans automatically extend coverage to newborns, covering vaccinations, post-natal care, and rare medical complications. A few plans also offer NICU (Neonatal Intensive Care Unit )coverage in premature birth or congenital disorders, assuring the baby gets immediate and proper medical care.

And this is one of those essential things; medication costs may rise unexpectedly for babies and newborns. With a good maternity plan, parents can ensure that their infants receive the best medical care starting from delivery without worrying about monetary considerations. This not only secures the infant's health but also provides peace of mind to the parents.

• Support for Family Planning

Health insurance for maternity is of prime importance as it aids family planning by enabling couples to prepare financially for parenthood. Early planning is critical since many insurance policies have a waiting period before maternity benefits can be claimed. It also promotes sensible financial management so medical bills do not destroy savings or other goals of genuine interest.

Apart from that, some extensive health insurance policies give benefits for infertility treatments and can be very useful for couples who may need medical assistance in conceiving. With maternity coverage incorporated into your financial planning, parenthood becomes a venture filled with little stress, allowing one to concentrate on the health needs of the new mother and child.

What Is Included Under Maternity Insurance Plans?

Listed below are the following benefits which are included in maternity insurance plans:

• Expenses associated with pregnancy complications
• Coverage for C-section delivery
• New- born's vaccination expenses
• New-born child expenses
• Coverage for delivery cost
• Reimbursement for in-patient hospitalisation expenses
• Coverage for pre or post-natal care expenses
• Stem cell preservation expenses
• Coverage for medically demanded pregnancy termination costs

What Is Not Included Under Maternity Insurance Plans?

Listed below are the following benefits which are typically not included in maternity insurance plans:

• Expenses incurred on pre-delivery consultation and medical tests
• Expenses related to ectopic pregnancy
• Coverage for post-hospitalisation expenses
• Cash benefits from hospital
• Coverage for regular medical check-ups
• Coverage for pre-hospitalisation expenses
• Coverage in case of surrogacy

When to Purchase Maternity Health Insurance?

A maternity insurance policy is not something that you can purchase at any time. So here are the scenarios that will help you get an idea of when getting such an insurance policy will be better for you:

• Plan Your Family Early

Getting maternity health insurance early is a smart idea if you are considering starting a family. Most policies have a waiting time of 9 to 36 months before the claims can be made. Buying insurance in advance guarantees that you will not face any delays when the actual time comes for coverage needs. Early planning would also allow you to compare plans and choose the best coverage while preventing a last-minute financial burden for pregnancy, hospitalisation, and post-natal care.

• Security from the Financial Point of View

Maternity expenses can be overwhelming, from doctor consultations to hospital stays and delivery costs. These expenses, unsupported by any insurance, can drain a considerable part of your hard-earned savings.

However, a maternity health insurance plan will provide you with financial security so that you get the right kind of medical treatment without fretting over the high costs. This peace of mind now allows you to concentrate on your journey into motherhood, safe in the knowledge that most of your medical expenses, prenatal to post-natal care-will be catered for under your policy.

• Complications covered

As you go through the pregnancy process, your health might take an unexpected turn for the worse and lead to excessive uncompensated medical costs and prolonged hospital stays. Complications such as gestational diabetes, premature birth, or emergency C-sections can significantly increase the amount on your medical bills. A maternity health insurance plan is essential in ensuring that complications are covered so that financial pressure is reduced in a critical moment when stress is high.

In addition, newborn coverage is provided in some policies, clearly showing that the mother and baby are in the hands of necessary medical treatment in case of emergencies. Having this would mean your health and finances are covered.

• Maternity Cost Support

Maternity health insurance covers essential costs like pre-natal check-ups, hospitalisation, delivery charges, and post-natal care. Some plans even cover vaccinations and medical examinations for newborns. Such expenses can add up quickly, and their non-coverage can trigger a financial botch-up.

Having a maternity health policy reduces the chance of compromising the standard of care. You can walk into any hospital providing suitable patient treatment standards and undertake a safe and hassle-free pregnancy and childbirth experience.

• Elimination of Workplace Gaps

The period during which maternity leave is taken has relatively low remuneration, or there is no paid maternity benefit in some situations. In the meantime, it can create significant gaps in your pockets since medical costs are rising. Maternity health insurance helps to bridge these tiny economic gaping holes by covering hospital bills, consultations with doctors, and hospital care for newborns, dues that can considerably relieve anxiety during these years.

If the health plan provided by your employer does not cover maternity expenses entirely, then a fully independent maternity policy would keep you ready and steady, thus supporting fewer hopes in an employer's offer of maternity benefits.

Features of Maternity Health Insurance

Following is a list of features to consider while purchasing your maternity or pregnancy insurance:

• Day Care Treatment

Day care treatments include treatments and medical procedures that call for less than a full day of hospitalisation. Maternity health insurance will cover such treatments. The therapy may be diagnostic tests, minor surgeries, or treatments related to complications that may arise during pregnancy. This way, whilst the expectant mother may get proper medical care when required, she is spared the expense of a day-long hospital stay for a minor procedure.

• Ambulance Cover

Maternity insurance also covers ambulance transportation costs incurred during medical emergencies during pregnancy and childbirth. An ambulance service is available for quick transfer to a hospital for normal delivery or an emergency C-section, allowing for good medical attention without additional costs or concerns. Coverage limits may differ based on the insurer's discretion.

• Cashless Treatment

Offers cashless hospitalisation at network hospitals to eliminate any upfront payment on maternity insurance. The bill for any medical treatment is cleared through a direct settlement with the hospital, which eases the burden for the family.

Among hospitalisation treatments, this increasingly takes precedence during labour and delivery, enabling expectant mothers to forget about worrying about money matters and focus on their health instead of worrying about the rigmarole of reimbursement processes.

• Hospitalisation Cover

Maternity health insurance covers a range of hospitalisation expenses, including room rent, doctor's consultation, anaesthesia fees, and operating theatre charges. Both normal and C-section deliveries are covered, so financial cushioning is assured in childbirth. This also includes treatment costs incurred due to complications during pregnancy or after delivery.

• Waiting Period

Maternity insurance policies do not take effect for a waiting period of 9 to 36 months. A longer waiting period means expecting medical costs to occur only after the waiting period. This might require planning since maternity costs would not be covered immediately. The waiting period varies by insurers; hence, early policy adoption would help protect one financially in subsequent pregnancies.

• Pre-Hospitalisation Expenses

Insured maternity has a pre-hospitalisation period of up to 30 days, covering prenatal check-ups, diagnostic tests, ultrasounds, medications, and doctor visits. These expenditures tend to be substantial during pregnancy; hence, this coverage helps relieve the financial burden of expecting parents.

• Post-Hospitalisation Expenses

After childbirth, the mother and newborn incur further medical expenses. Post-hospitalisation expenses, including follow-up doctor visits, medications, and required tests, shall be covered under maternity insurance for up to 60-90 days after delivery. This allows for proper post-natal care, and such aid shall reduce out-of-pocket expenses at this crucial recovery time after child delivery.

• Newborn Cover

Most maternity health insurance plans give away coverage for a newborn from birth. This may cover a range of treatments for congenital diseases, vaccinations, and any health complications arising from the very first hours of birth. While some plans cover this for a limited period, few covering as little as 90 days of seeing the newborn must be added to a family floater plan.

• Medical Treatments & Vaccination Expenses

Maternity insurance typically covers essential vaccinations, such as BCG, polio, and hepatitis. This safety net may also cover other medical treatments for any health complications for the newborn. This feature will put to rest any worries that a newborn less than one-month-old might incur some other complication and will make the first round of medical care affordable for many young parents.

Benefits of Maternity Health Insurance

• Financial Assistance:

Maternity Health Insurance covers the cost incurred in a Caesarean or a normal delivery. Moreover, there can be several medical treatments for pre-natal and post-natal care which are all covered under the policy.

• Newborn Cover

It offers coverage for newborn babies from day one for a total of 90 days. This includes expenses due to medical emergencies along with all the vaccinations.

• Delivery Expenses

Obtaining a mediclaim plan with maternity benefits also covers pre-and post-natal expenses, delivery expenses, and ambulance charges. Any delivery type is included, whether it is a normal or Caesarean delivery.

• Ambulance Charges:

In case of an emergency, maternity insurance plans typically cover ambulance charges, ensuring that you get to the hospital without worrying about the cost. This is a crucial benefit, especially in situations where every second counts.

• Cashless Facility:

A maternity insurance policy often provides a cashless facility at network hospitals. This means that you don’t have to worry about making upfront payments. The insurance takes care of it directly, allowing you to focus on your health and recovery.

• Hospitalisation Coverage:

Hospitalisation costs, whether before or after delivery, can add up quickly. Maternity health insurance covers these expenses, ensuring that both you and your baby receive the necessary medical care without the stress of high hospital bills.

• Simple and Fast Online Application Process:

Applying for pregnancy insurance has never been easier. Many providers offer a simple and fast online application process, making it convenient to secure the best maternity insurance plans without the hassle of paperwork or lengthy procedures.

• No Claim Bonus:

If you don’t make any claims during the policy period, some maternity insurance plans offer a no-claim bonus. This benefit can reduce your premium in the following year or provide additional coverage, making your maternity insurance policy even more valuable.

• Tax Benefit:

Another advantage of maternity health insurance is the tax benefits it offers. Premiums paid towards pregnancy insurance are often eligible for tax deductions under Section 80D of the Income Tax Act², providing financial relief beyond just medical expenses.

What Factors Should You Consider While Buying a Maternity Health Insurance Policy?

Here are some of the factors which one must consider while buying a maternity health insurance policy:

• To choose the best plan, look for one that offers financial coverage on various other medical expenses and not just hospitalisation coverage.
• Before purchasing a policy, consider checking the premium discounts it offers.
• Go through the list of network hospitals for cashless treatments, to ensure that you can get admitted to a network hospital during an emergency.
• It is essential to carefully go through the terms and conditions of a maternity health insurance policy to understand its waiting period, sub-limits, inclusion and exclusions.
• Compare the chosen maternity cover policy with other policies and choose the one with maximum benefits at an affordable cost.
• Consider checking some of the must-have benefits such as new-age treatments, new-born baby cover, daycare procedures etc., before finalising a maternity health insurance policy.
• Also, consider checking the claim filing procedure of the policy, and finalise the same only if it is quick and hassle-free.

Who Can Benefit from Maternity Health Insurance Coverage?

Any individual who satisfies the following parameters may want to avail maternity health insurance coverage and derive perks from the same:

• Any woman of age below 40 years and married can benefit from the plan.
• Any woman can benefit from the plan if the maternity cover is bought along with health insurance.
• Any woman can avail the benefit of the cover for up to 2 deliveries.

Consider availing the maternity insurance at least 2 years before starting a family as there are waiting periods with this kind of coverage, which can range from 9 months to a maximum of 6 years.

Eligibility Criteria for Maternity Health Insurance

Here are a few eligibility criteria to keep in mind while purchasing your maternity insurance policy:

• Age Criteria

Most maternity health insurance plans set limits on the age of persons directly eligible to be covered. The limit typically ranges between 18 and 45. However, some companies may allow coverage beyond the limit but at an additional premium.

It is always advisable to buy maternity insurance early to finish the waiting period before pregnancy. Young policyholders can benefit from lower premiums, better coverage, and maximum options, thereby ensuring financial safety against the expenses incurred during childbirth.

• Waiting Period

This is a period after getting maternity insurance, during which benefits cannot be claimed. The period generally runs from 9 months to 3 years. Maternity insurance offers no immediate assistance to newlyweds until they have waited the designated waiting time after buying the policy.

Therefore, it is highly advised to purchase the policy long before planning to expect a child so that sharp spikes in medical bills during delivery do not cripple you financially. Certain companies provide policies with shorter waiting periods at higher premiums. So, always try to compare all the options before making your selection.

• Pre-existing Health Issues

Pre-existing health issues like diabetes, hypertension, or thyroid disorders might affect eligibility for maternity health insurance. Some insurers impose longer waiting periods according to certain pre-existing conditions. A few health complications during the pregnancy phase incur additional premium payments or exclusions for forecasted pregnancy complications.

Dishonesty in disclosing any health problems while purchasing a maternity policy may lead to hassling claim settlements. One must check the clauses about the insurer's pre-existing conditions when deciding on the right plan for oneself, which assures sufficient coverage without unforeseen limitations on pregnancy.

• Policyholder Information

Maternity health insurance is mainly offered to women under an individual or family health scheme. A few insurers also offer maternity rider³ that can be added to an existing policy. Depending on the terms of the policy, a spouse and newborn may also be covered by the insurance. Providing exact details about income, age, employment, and medical history will help insurers assess eligibility and offer the most appropriate coverage options.

• Payment of Premiums

Maternity health insurance premiums depend on the age of the insured, policy coverage, waiting period, and conditions of the insurer. Lower waiting periods or more considerable sums insured tend to command higher premiums.

Employers sometimes provide insurance benefits for maternity insurance, delivery, hospitalisation, or newborn care as part of corporate health insurance. Weighing the policy's benefits, like hospitalisation, delivery, and newborn care, against premiums ensures that the policy is affordable and provides excellent value in the future.

Documents Required to Claim Maternity Insurance

Listed below are the documents required to raise a claim for maternity insurance:

• Pre-authorisation form/insurance claim form (duly filled)
• Policy documents
• Hospital discharge details
• Original medical treatment bills/reports bills/receipts
• Doctor’s prescriptions and other consultation bills
• Recent passport-size photo
• KYC documents

Claim Process to Avail Maternity Health Insurance Policy

Cashless Claim

Step 1: The first step begins with initial intimation; in case of cashless hospitalisation reach out to your insurer within the first 24 hours.

Step 2: Then, you will have to fill out a pre-authorisation form to seek the insurer’s approval.

Step 3: The insurer will verify your request and approve or reject it as per stated norms.

Step 4: The approved claim will then be settled with the hospital directly.

Reimbursement Claim

Step 1: Pay the hospital bill and preserve all prescriptions and payment receipts.

Step 2: Register a maternity health insurance claim under the reimbursement category.

Step 3: In this step, you need to submit all required documents such as the payment receipts and medical bills, diagnostic reports, prescription and other relevant documents backing your claim.

Step 4: Your request will then be forwarded to the insurance company; upon successful verification, it will be approved or rejected by your insurer.

A Buying Guide for Maternity Health Insurance Plans

Here is the step-by-step guide helping you to purchase maternity health insurance coverage:

Step 1: To start with, firstly login to your HDFC life account. If it is your first time, consider signing up.

Step 2: Then click on options similar to ‘Apply Now’ or ‘Get Quote’ to get into the application process.

Step 3: Now, fill up the application form. Here, you are required to enter some of the basic details such as name, contact number, date of birth, gender, etc., and proceed.

Step 4: Select the policy type and the amount of premium you are opting for.

Step 5: Then, you have to enter some additional details such as your height, weight, residential address, nominee details, etc.

Step 6: You will be directed toward an interface where you will have to answer some basic questions regarding your previous and current health conditions.

Step 7: Next, you will have to confirm the above-entered details and proceed to the payment gateway.

Step 8: Pay the amount using your desired mode of payment.

Step 9: Upon successful payment, your transaction becomes complete and you will receive your policy documents in your email.

Things You Must Know Before Buying a Maternity Health Insurance Policy

Listed below are some of the key points which you must note before buying a maternity health insurance policy:

• Newborn Cover: It covers all sorts of medical expenses incurred for a newborn baby for 90 days. It also includes all sorts of vaccinations required in the initial months.
• Abortion or Termination: Some insurance providers offer coverage for abortion or termination up to two times.
• Waiting Period: Typically maternity health covers come with a waiting period ranging from 9 months to 6 years. Hence, consider checking the waiting period of the policy before finalising the same.
• Number of Children Covered: Also consider checking the number of newborns that the plan is covering. Most insurers cover expenses for up to 2 children.
  
  Parenthood is one of the most anticipated moments in a person’s life. However, massive medical bills can cause worries and deplete your savings for the child’s future. Hence, maternity health insurance plans are recommended to ensure peace of mind and the best treatment options for the mother and newborn child.

How long is the waiting period for maternity benefits?

The maternity benefit waiting period in India is when you must wait after purchasing maternity insurance before claiming expenses. Depending on the insurer and policy, it typically ranges from 9 months to 3 years. To ensure coverage for pregnancy-related costs, it's wise to buy maternity insurance well in advance. Planning ahead helps avoid unexpected medical expenses and provides financial security when you decide to start a family.

How is the Cost of Maternity Health Insurance Calculated?

The cost of maternity health insurance is basically the price you pay to purchase health insurance that includes maternity benefits. This cost is represented by the premium you pay annually, semi-annually, or monthly to keep the policy active. 

Here are some factors that are considered while calculating the cost of your maternity health insurance:

• Age: Your age is a significant factor. Generally, the older you are, the higher the premium. This is because the risks associated with pregnancy and childbirth increase with age, making it more likely that you’ll need to use the coverage.
• Amount of Cover: The coverage you choose also impacts the cost. Higher coverage limits mean higher premiums. For example, if you opt for a more significant sum assured to cover potential pregnancy and delivery costs, you’ll pay more for the policy.
• Maternity Add-ons: Some insurance policies offer additional benefits, or "maternity add-ons," such as coverage for prenatal care, newborn care, or specific complications. Adding these to your health insurance with maternity benefits increases the overall cost of your policy.
• Medical History: Your medical history plays a crucial role. If you have pre-existing health conditions or a history of complications related to pregnancy, the insurer may charge a higher premium to account for the increased risk.
• Waiting Period: The length of the waiting period also affects the cost. Policies with shorter waiting periods typically have higher premiums because they offer quicker access to maternity benefits, which is considered a higher risk for the insurer.
• Network Hospitals: Insurers often have a network of hospitals where you get cashless treatment. If your policy covers a broader network of hospitals, especially top-tier ones, this might increase the premium due to the higher cost of care at these facilities.
• Renewal Terms: The terms of renewal can also impact the cost. Policies that offer benefits like no-claim bonuses or guaranteed renewals might come with higher premiums due to these added advantages.

Summary

Maternity health insurance covers pregnancy-related expenses, including delivery, prenatal, and postnatal care. Key factors influencing costs include age, coverage amount, medical history, and waiting period. Selecting the right plan, therefore, ensures financial security during childbirth. It also offers benefits like newborn care and tax deductions. Hence, planning in advance is crucial for optimal coverage.

FAQ's on Maternity Health Insurance

1. Can I get maternity insurance while pregnant?

Yes, you can get maternity insurance while you are pregnant but usually, maternity insurance comes with a minimum waiting period of 9 months so it does not make sense to avail them.

2. Which health insurance is best for pregnancy?

There is no such thing as the best option as it totally depends on your overall requirements as a policyholder. However, considering essential factors such as newborn care, pre and post-hospitalisation coverage, waiting period, etc., will help you make an excellent choice.

3. How to claim medical insurance for maternity?

You can claim maternity insurance either via the cashless or reimbursement method. For cashless claims, the policyholder is required to fill in a pre-authorisation form and once it is approved the bills are directly settled by the insurer. For a reimbursement claim, the medical bills have to be paid upfront and then, the policyholder can get their claims settled. 

4. What is the minimum waiting period for maternity insurance?

The minimum waiting period in maternity insurance is 9 months for most insurers.

5. Can I claim 3 maternity insurance policies?

Usually, most insurance providers offer pregnancy coverage for up to two children, hence only 2 claims are allowed on a policy.

6. Can husband and wife both claim maternity insurance in India?

Yes, both wife and husband are allowed to claim maternity health insurance in India.

7. What is the 12-month waiting period pregnancy cover?

A 12-month waiting period pregnancy cover means the policyholder can claim for the maternity insurance once the waiting period of 12 months is over.

8. Is the 3rd child covered under health insurance for pregnancy?

Usually, the majority of insurance providers offer pregnancy coverage for up to two newborn children.

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