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9 Important Questions Related to Maternity Insurance Policy

A health insurance policy also has maternity benefits. These benefits cover expenses related to childbirth. Pre and post hospitalisation expenses are covered as well. Most health insurance policies have an integrated maternity benefit clause. Some health insurance policies don’t have this, yet they may provide add-on riders for this.

Having considered the importance of maternity insurance in India, we’ve listed below some important questions followed by their relevant answers to understand this policy better. Here you go:

Q. no. 1: What is the Maternity Benefit of a Health Insurance Policy?

A health insurance policy with maternity benefit is a regular policy in which expenses arising due to pregnancy of the policyholder, or the dependent of the policyholder is covered. If the policyholder is a man who wants to enrol his pregnant wife into the policy, he cannot do it when the policy is in force. Only at the next renewal date, he can include his wife in the policy. Even then, there is a waiting period before claiming maternity benefits. Even the best medical insurance policy can have a waiting period that could be a minimum of 36 to 48 months. So it is advisable for anyone wanting to get their dependents covered for maternity, to add them at the start of the policy period.

Q. no. 2: Can Maternity Benefit be Taken by Live-in Couples or Unmarried Couples?

As per rules, maternity health insurance policy benefits can only be taken by those who have an insurable interest between them. So, a man may not be eligible to cover his live-in partner for maternity. However, the live-in partner can avail personal maternity insurance for herself. Similarly, a to-be-married couple cannot claim maternity insurance.

Q. no. 3: Are There Maternity Covers for Single Women?

In the case of a live-in couple, if the woman decides to take maternity insurance, then there are not many insurers providing maternity insurance for single women. However, there are a few insurance policies that do provide maternity insurance to single mothers or unmarried mothers. The woman can avail all the benefits of the maternity cover after the initial waiting period irrespective of her marital status.

Q. no. 4: What is the maternity benefit component in group health insurance policies?

Employers provide group health insurance schemes to their employees. These insurance schemes have special maternity benefits for female employees. Not only do these insurance plans come with a subsidised or lower premium, they are also from renowned insurers. Another strong feature of these policies is that most of them do not have waiting periods. A female employee of a company can be insured by the company on a particular date, and can claim maternity benefits within a week, as there is no waiting period.

Therefore, it is advisable to check with one’s employer about such health insurance policy schemes. Insurance companies generally provide a lot of discounts and free benefits to corporates. So, even if an employer does not have maternity insurance for its female employees, it can consider starting having a tie-up with an insurance company for this purpose. Often, this can be a strong proposition to attract women to the organisation, as such a company is considered to be women-employee friendly.

Q. no. 5: What is Covered Under a Pregnancy and Childbirth Insurance Plan?

The list of coverage includes the following:

  • Generally, 30 days before hospitalisation and 60 days after hospitalisation expenses are covered. But this could extend to 60 and 120 days depending on the insurer. Some insurers give more extensions for a higher cost of the premium
  • It provides coverage for normal delivery and C-section delivery. Normal deliveries cost lesser than C-section deliveries. There could be special clauses related to both types of deliveries which could vary by insurer. Therefore, it is essential to inspect the insurance terms and conditions carefully before purchasing the policy.
  • All hospitalisation expenses are covered in a maternity health insurance policy. It includes rent of the room, ICU charges, Operation Theatre charges, anaesthetist expenses, medical practitioner’s fee, equipment charge, and nursing charges.
  • Expenses associated with the care and treatment of the newborn are covered.
  • Emergency evacuation and ambulance expenses. In-ambulance treatment expenses etc. are covered.
  • Cashless treatment cover that includes check-ups at network hospitals.
  • In case of emergency situations during pre or post-hospitalisation, the insured may require daycare treatments. The maternity insurance health plan covers any expenses arising out of this.
  • Expenses arising out of medicine or vaccination expenses of a newborn are covered.

Q. no. 6: What is not Covered under a Maternity Insurance Plan?

Ans: Pre-existing diseases that affect pregnancy directly is not covered in a maternity health insurance policy. The underwriter may determine the premium value of the maternity insurance based on the severity of the pre-existing disease and its impact on the pregnancy.

  • Congenital diseases
  • Costs arising due to infertility treatments
  • Medicine costs that are not prescribed by a medical practitioner don’t fall under the purview of coverage.

Q. no. 7: How is Maternity Insurance Premium Calculated?

Although maternity insurance plan premiums are higher, when included within a health insurance, the relative benefits of a maternity coverage plan are higher. The best medical insurance policy can be chosen based on its cost to benefits ratio. When bought as a standalone policy, the insurance premium could be higher than other types of insurance policies. It is recommended to take group health insurance plans provided by employers as the premiums of such plans are affordable.

Premium is calculated on standalone maternity insurance plans based on factors such as the age of the insured, pre-existing diseases, previous medical history etc. The insurer determines if there will be any complications during childbirth, and based on this, the insurance premium is calculated.

For a high-level overview of a probable insurance premium of a maternity health insurance policy, it is a good idea to use the premium calculator. However, the final calculation of premium is based on an analysis of medical records by the insurance company overseers.

Q. no. 8: What are the benefits of a maternity insurance scheme?

The benefits offered under a maternity insurance policy are:

Coverage Benefits

During pregnancy, the most important phases are not just the hospitalisation phase. The pre-hospitalisation and post-hospitalisation phases are equally important. The pre-hospitalisation phase is important because it readies the woman’s body for childbirth. Pre-natal tests are conducted during this phase. Medical procedures, nutritional advice and constant monitoring/checkups are part of this phase. All of these incur expenses.

Likewise, in post-hospitalisation, only a healthy mother can provide good health for her child. Without good health, the child would be malnourished and under-cared. Post-hospitalization also involves regular periodic visits to the doctor, vaccinations for the child, nutritional advice and may also include daycare treatments.

It is essential to choose the best medical insurance policy that has adequate pre and post hospitalisation coverage. Because as much as a mother is vulnerable during childbirth, so is she after childbirth. Her body undergoes through a series of changes. It is a phase of recuperation and should be ably supported by expert medical guidance from qualified medical practitioners.

Since all of these incur costs, a maternity health insurance policy that offers comprehensive coverage for all aspects of motherhood can ease the financial burden on the insured or their pregnant dependent.

Additional Benefits

A general insurance plan with maternity benefits may not cover complications arising out of childbirth. This is where special maternity plans covering childbirth complications come in handy. Special maternity plans with add-on riders to cover any eventuality or critical condition arising during childbirth can ease any financial burden associated with complicated or expensive procedures. So it is a good idea to choose a standalone maternity insurance policy if the intent is to get covered for all eventualities or complications during childbirth.

Coverage for Newborn

Health insurance policies with integrated maternity benefits may have coverage benefits post hospitalisation only up to few months. But special maternity plans have coverage not only post hospitalisation, but cover the new born up to a certain age. The plan could cover all costs associated with rearing the child, including the food, medicine and nutrition expenses.

Q. no. 9: How to Choose a Good Maternity Insurance Plan?

In order to select the right maternity cover, always compare health insurance plans with maternity benefits. Make a comparison based on the pros and cons, premium amount, extent of coverage, network hospital list, claim process, duration of pre and post hospitalisation coverage, in-patient expenses and so on.

Check for government-sponsored health insurance policy schemes as well. Incumbent governments provide many schemes for women to help them during motherhood. Check these schemes, and apply for them. They usually come at subsidised premiums and are very affordable.

Wrapping it Up!

We hope the aforementioned questions have cleared a lot of your doubts regarding the maternity cover. With this let’s prepare for a beautiful phase of your life without worrying much about the savings. Happy parenting!

FAQs

  • Q. When is the best time to take maternity insurance?

    Ans: The best time to take maternity insurance is right after marriage. If this is not possible, then taking maternity insurance at least 2 years before a projected pregnancy is a good idea. This is because maternity insurance plans have waiting periods. The waiting period could start from 3 years to 5 years.

  • Q. Do all health plans have maternity benefits?

    Ans: Not all plans have maternity benefits. Few plans do, few don’t. For the one’s that do, the maternity benefits provided are standard. For the ones that don’t, add-on riders could be available to cover maternity benefits. The best medical insurance policy offers both facilities, the facility to include or exclude the benefit.

  • Q. Does maternity insurance cover artificial insemination and IVF?

    Ans: Infertility treatments may not be covered by the maternity insurance but could be covered by health insurance with maternity benefits. Generally, health insurance plans have a broad set of categories for coverage that includes emergency services, outpatient services, pediatric services, prescription drugs, maternity costs, and newborn care. What doesn’t come under these categories is infertility treatments. Therefore, this information has to be checked with the insurance provider of the health insurance policy with maternity benefits.

Written By: Paisawiki - Updated: 18 November 2020

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