Maternity health insurance, maternity insurance, or health insurance with maternity cover refers to the coverage provided to the expecting mother and her newborn. As bringing new life into the world 

is a magical experience, the mother should not be constantly worrying about the expenses incurred. Whether it is the hospitalization expenses or the expenses incurred after the birth of her child, a maternity insurance plan offers the best of the financial support she needs during such a crucial time.

Why is maternity insurance important?

Maternity insurance is one of the types of health insurance and it enables the policyholder to be in control of their finances while also safeguarding their future. The maternity benefits of having an insurance policy are as follows.

Provides financial security

With the ever-increasing medical expenses in the country, it is difficult to pay for every single expense out-of-pocket every single time while saving enough for future expenses. With a maternity insurance policy, the policyholder gets financial security as a range of expenses is covered as detailed in the insurance plan. These include hospitalization charges, pre-natal, and post-natal expenses, and so on. With an insurance plan in place, the costs are easier to manage.

Protects from financial hardship before childbirth

Most maternity insurance policies in India provide cover for a month before the policyholder is due to give birth. During these times, the expenses incurred include hospitalization fees, medicines, and other charges that can add up quickly. With a cover in place, the financial burden is much lesser as the insurance provider covers all these costs even before the child is delivered safely to the hospital.

Covers expenses incurred due to complications

Every pregnancy journey is unique and so are the associated complications that may arise during childbirth. These complications may come up after the birth of the child as well. Maternity insurance covers these unexpected expenses that are incurred at any stage ensuring the new mother is safe and so is the baby.

Protection for the newborn

All children do not have smooth sailing when they enter the world. Some children may have complications from the moment they are born. Health insurance with maternity cover covers the expenses of the infant up to a certain period. This period is generally up to 90 days. In case the child is born with a congenital disease, the insurer pays the associated expenses.

Covers both normal and C-section delivery

Maternity cover insurance covers the expenses of a normal or a C-section delivery. While most women prefer natural birth, not all women can give birth that way. This is why insurance providers cover the expenses incurred in either type of delivery so that all costs are taken care of and the new mother and child are safe.

What things are covered /included in maternity insurance?

Maternity insurance is a type of health insurance that focuses on the well-being of the new mother and the child. It includes a vast range of expenses that are associated with childbirth. The expenses that come along with pregnancy and childbirth are quite high and with medical inflation at an all-time high, it becomes difficult to manage it all with ease. With pregnancy health insurance in place, the policyholder can easily cover a range of vital expenses that will occur.

The following are the inclusions of the maternity health insurance policy.

  • It provides cover for delivery (whether it happens by C-section or if it is a normal delivery).
  • It covers the pre-natal and post-natal expenses that are incurred which can be significant if paid out-of-pocket.
  • It covers up to 30 days of hospitalization and related fees before the policyholder is due to give birth and also covers up to 60 days of hospitalization after birth.
  • It covers expenses incurred due to complications that arise during childbirth.
  • It covers expenses incurred after the child is born for up to 90 days.
  • It covers any special care required for the baby such as ventilator care.

People who benefit by availing of insurance for pregnancy

Maternity insurance does not apply to everybody such as single people who wish to remain single forever with no plans of ever getting married. It is also not for people who wish to get married but choose not to have any children either due to their choice or due to some health concern. Buying health insurance with maternity cover is best for the following people.

  • People who recently got married and are planning to have children in the coming two to three years and are less than 40 years old.
  • People who are married and already have one child but are planning to have another child in the next two years.
  • People who are yet to be married but are likely to get married soon within a span of one year and are planning to have a child within the next two to three years.
  • People who are married even though they do not have a child yet and are not planning to have one anytime, want protection in case of a pregnancy.

When should you opt for maternity coverage?

You should think about health insurance for pregnancy once you know you are going to be married within a year or right after you get married. If you want to expand your family in the coming two years, it is best to purchase a maternity insurance policy. As there is a waiting period in insurance for pregnancy policies. It is best to get maternity coverage sooner rather than later to avail yourself of all the benefits that come with the plan.

Required documents to raise a maternity claim

When the time comes to raise a maternity claim, some documents are required to be filed and submitted to the insurance provider. Note that the type and number of documents required can differ from insurer to insurer as some may need more documents while others may require fewer documents than the ones mentioned below. The following are some such documents that must be submitted.

  • ID proof (Aadhaar card, PAN card, driver’s license, passport, voting ID, etc.)
  • Duly filled and signed claim form
  • Health insurance plan
  • Discharge summary
  • Prescriptions (for medications and other items)
  • Pre-authorization form (if a cashless claim is a plan feature)

What are add-on covers in maternity insurance?

The maternity insurance plan is already an add-on to a normal health insurance plan or it can be purchased as a standalone policy. Even though it is generally more expensive because a claim is more likely to be made when compared to health insurance, it is recommended for everyone who is planning to have a family soon. All costs are not included in the maternity insurance plan so it is best to purchase the most comprehensive insurance policy for maximum coverage.

What are the exclusions of maternity insurance?

Maternity insurance coverage does not include everything and has its own set of limitations. For example, maternity policies provide financial aid up to a certain point, and in some cases that is not sufficient in the case of complications during childbirth and so on. If the policyholder had a complicated birth due to which extra costs were incurred, the insured person will need to pay those out-of-pocket.

The following are some of the common exclusions of health insurance with maternity coverage.

  • Visits to the doctor for routine health check-ups (even when the policyholder is aware that she is not pregnant).
  • Visiting the doctor for diagnostic tests, consultation, and follow-ups during the pregnancy period.
  • In-vitro fertilization.
  • Supplements and other medications prescribed to the expecting mother.
  • Medical expenses incurred due to ectopic pregnancy (a pregnancy where the fetus develops outside the uterus).
  • Pregnancies that occur after 40 years of age (in some cases this can be pregnancies after the age of 40 even if it is the first pregnancy of the policyholder).
  • Premature termination of pregnancy and associated costs when the termination occurs within 12 weeks of conceiving.

Usually, the third child is excluded from being covered in maternity insurance, unless specified otherwise. Any maternity claim filed during the waiting period, will not be liable for expense coverage. It is a must for the waiting period to be over for the claims to be accepted by the insurance provider. When purchasing a maternity insurance policy, make sure you read the pregnancy insurance coverage and the exclusions.

Save tax with maternity insurance

The policyholder can avail of tax benefits on purchasing maternity cover insurance. It is a part of health insurance. The insured person can get an exemption of up to Rs. 25,000 (during a financial year) according to the Income Tax Act, 1961 on purchasing a pregnancy health insurance plan. The specific income tax deductions are specified in Section 80D. The insured person can also get Mediclaim for pregnancy deductions on the income tax.

Read More: Tax Benefits in Health Insurance

The income tax deduction is calculated based on the premium paid for the health insurance that covers pregnancy. There is a limit on how much you can save on income tax based on the insurance policies purchased. The total income tax deduction can be higher if the policyholder purchases a health insurance plan for their parents and other dependents. As the income tax rules change constantly it is best to refer to the latest income tax rules.

What should you consider before buying a maternity insurance policy?

Many maternity insurance plans exist but you want to choose one that is the best for you. Here is a list of factors to consider before purchasing a policy.

Age

Before purchasing a maternity insurance plan, ensure that you are eligible for it. Some insurance providers have plans that enable women who are up to 45 years old to purchase the maternity policy while others only cover women who are 35 years old or below.

Waiting period

Every maternity plan comes with a waiting period and the maternity claim can be made only after the waiting period. Some insurance providers offer a waiting period of 9 months while for others it can be a year or more.

Sum insured

The sum insured and the expenses covered must be checked to ensure you have the best coverage needed. You may need to spend from your pocket if certain expenses are not included in the maternity insurance.

Key Takeaways

It is advisable to take health insurance with maternity coverage to cover the sky-high maternity costs in India. Having maternity coverage saves you from spending out-of-pocket, enables you to save on tax, and ensures you get timely treatment. It also covers the infant up to a period thereby ensuring the best for the new mother and baby. When purchasing this type of insurance, make sure you know the waiting period, sum insured, eligibility, features, and cover.

FAQs

1. Do maternity insurance plans come with no waiting period?

No, because in India every health insurance with maternity coverage comes with a waiting period. While some policies have short waiting periods, others have much longer waiting periods.

2. Can I get maternity insurance plans if I’m already pregnant?

Getting a policy for pregnancy insurance after pregnancy is not possible because the pregnancy is considered a pre-existing condition. If you need a pregnancy insurance policy, it must be purchased well in advance.

3. What should I consider before buying a maternity insurance policy?

When purchasing pregnancy cover health insurance, make sure you consider the sum insured, maternity benefits, waiting period, and cashless settlement option.

4. Is third childbirth covered under maternity insurance plans?

In India, you will find that most maternity health insurance policies come with a cover for a maximum of two children. But some maternity plans do come with a cover for the third child.

5. How can I buy/take maternity coverage?

An insurance policy for pregnancy can be purchased as an add-on to your existing health insurance plan. You can buy it from reputable insurance providers such as Policy Bazaar.

6. What is the cost of maternity expenses in India?

The cost of maternity expenses including pre and post-natal expenses can easily range from a few thousand to a few lakhs.

7. How do I claim my ESI amount for maternity benefits?

You can claim your ESI amount for maternity benefits by going to the ESIC Online Maternity Benefit Claim Portal which makes claiming maternity benefits simpler, faster, and easier.

8. What is the limit of maternity insurance in India?

Generally, the insurance that covers pregnancy will start from around Rs. 15,000 and go up to a lakh or more depending on the specific health insurance with the maternity cover plan chosen.

9. Is a newborn baby covered under health insurance?

Yes, a newborn baby is covered under the pregnancy insurance plan up to 90 days after s/he is born. Once these 90 days are over, the policyholder must ensure the baby is listed in the base plan.

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