Everything to Know about Maternity Cover

The joy of welcoming a new child is a momentous occasion for any family. However, planning for pregnancy can also involve significant financial considerations. As childbirth involves medical expenses, a common question arises: Does health insurance cover maternity costs? And if so, to what extent? Let’s delve into these answers and explore the maternity features and benefits of health insurance in this article.

Understanding Maternity Cover

Maternity cover health insurance specifically addresses pregnancy-related expenses. Often, maternity coverage is comprehensive, encompassing pre-natal care, delivery itself, and even newborn costs. This extensive coverage offers peace of mind for both mother and baby, while safeguarding the family’s financial stability.

What does maternity coverage include?

Let’s explore the inclusions in maternity plans in detail:

• Pre-natal care

This includes the costs of doctor consultations, regular checkups, and counselling.

• Delivery and childbirth

Maternity health insurance plans in India cover expenses for natural and C-section deliveries- room charges, surgeon fees, anaesthetist fees, and other hospital-related expenses during childbirth. Every expense related to the newborn right after the birth is also included (such as vaccinations and other medically necessary services). These expenses can add up to anywhere from ₹ 50 thousand to more than ₹ 1 lakh. 

• Post-natal care

This includes doctor consultations, ultrasounds, routine checkups, and other pregnancy-related medical services.

Why should you get health insurance with maternity coverage?

India has made significant strides in reducing maternal and neonatal mortality rates. Health insurance for women with maternity coverage empowers expecting parents to contribute to this progress by ensuring access to quality pre- and post-natal care. With coverage, you can choose the best healthcare services for your newborn, from pregnancy to delivery. This financial security fosters peace of mind during this special time.

Factors Affecting Maternity Coverage

Here are some of the factors that affect coverage in maternity health insurance for women:

• Pre-existing conditions

Pre-existing conditions that could impact pregnancy are typically excluded. Purchasing maternity coverage before conception ensures you’re covered before any such conditions arise.

• Age

Maternity health insurance for women typically has a minimum age requirement of 18, while the maximum age limit can vary by insurer, often around 45.

• Waiting periods

Many insurers impose a waiting period before maternity coverage kicks in. Buying beforehand ensures you meet this requirement before getting pregnant.

• Coverage limits and exclusions

Be mindful of sub-limits (the pre-determined maximum amount the insurance company will cover for certain expenses related to childbirth) within maternity coverage, as they cap the insurer’s payout for specific expenses. There may also be pre- and post-hospitalisation exclusions in maternity plans. That means you may have to pay out-of-pocket. 

When should you get maternity health insurance plans?

The ideal time to get pregnancy insurance plans is well before you conceive. Some factors make it important to get maternity health insurance before planning the pregnancy. One such factor is the waiting period. There is a set limit of time before which you can’t claim the insurance.

Since many plans that cover maternity expenses also have a 12 to 24-month waiting period, having maternity coverage in place beforehand allows for better pregnancy planning, fostering a sense of security and eliminating financial uncertainties. Moreover, you can buy a women’s care family floater plan as soon as you get married, as these plans contain multiple benefits for women, including maternity. 

Maternity coverage in Group Plans (Employer-sponsored)

Many companies offer group health insurance plans that cover their employees. These plans can extend to include maternity benefits for expecting mothers. Let’s explore the advantages and limitations of employer-sponsored maternity coverage.

Advantages:

• Cost savings: Company-sponsored insurance policies require you to pay less premium as the employer shares your premium costs.
• Comprehensive health cover: Employee pregnancy insurance plans are usually complete packages. Hence, the maternity cover includes almost all the pre-natal, post-natal, and delivery expenses.

Limitations:

• Limited network: Employer-sponsored pregnancy insurance plans might have a restricted network of hospitals covered under the maternity benefit. This could limit your choice of birthing facilities, especially if you prefer a specific hospital or doctor.
• Limited customisations: Unlike individual plans, where you can choose the level of coverage and potentially add higher sub-limits, employer-sponsored plans offer a standardised set of maternity benefits. This might not cater to your specific health insurance needs or preferences.

Key Takeaways

Including maternity coverage in health insurance plans offers peace of mind and financial security for expecting parents. However, coverage varies by policy, so review your plan’s inclusion, exclusion, waiting periods and other details carefully before buying the plan.