November 26, 2019

What is maternity cover under health insurance?

Dhirendra Mahyavanshi

Founder, Turtlemint

What is maternity cover under health insurance?

Bringing a child into the world is an emotional milestone in the life of a couple. As the child is born the parents become a family and responsibilities increase. While the birth of a child has definite emotional implications, the financial aspect of maternity cannot be ignored.

Nowadays, medical expenses have touched the roof. A simple case of hospitalization incurs tens of thousands of rupees and in case of specialized treatments, the sky is the limit. Maternity and the costs of childbirth have also become expensive. Since individuals want the best possible treatment for the mother-to-be, they choose the best hospital for the delivery of the child. Even basic hospitals charge a lot of money for childbirth and in the case of premium hospitals, the costs multiply.

Given the expenses associated with maternity, health insurance policies have been designed to cover such costs. There are a lot of maternity oriented health insurance plans which cover maternity expenses and the costs incurred in childbirth. As a financial advisor to your clients, you have the responsibility to educate your clients about the need for maternity health insurance plans. Besides the importance of these plans, the salient features and coverage benefits of the plan, especially the maternity cover, should be explained in detail. So, let’s understand the features of such health plans –

Salient features of maternity health insurance schemes

Health plans which offer maternity coverage have the following features –

• Waiting period for maternity

There is a waiting period after which maternity-related costs are covered. This waiting period ranges from 9 months to up to 6 years. The purpose of having a waiting period is to ensure that the plan is not bought only for the coverage of maternity-related expenses. The applicability of the waiting period ensures that families expecting to have a baby in the near future can buy the plan and then get the maternity costs covered after the waiting period is over.

• Limits on coverage

Expenses incurred in childbirth, as well as pre and post-natal expenses, are covered under maternity health plans. However, the coverage has a specified limit. Expenses up to the specified limit are only covered. Any excess expenses would have to be paid by your clients even though the sum insured is available to cover the excess.

• Number of deliveries covered

A maximum of two deliveries is covered under most maternity health plans. Moreover, there might be a specified time gap between the deliveries.

What is covered under maternity health plans?

Coverage offered under maternity health insurance plans consists of both basic coverage benefits as well as maternity-related benefits. Let’s understand the coverage benefits under each category –

• Common coverage benefits

The below-mentioned coverage features are found mostly in all health insurance plans

1. Inpatient hospitalization which covers room rent, doctor’s fee, surgeon’s fee, nurse’s fee, blood, oxygen, etc.
2. Expenses incurred before and after hospitalization (pre and post hospitalization expenses)
3. Daycare treatments which do not require hospitalization for 24 hours
4. Ambulance expenses for transporting the insured to the hospital
5. Domiciliary treatments which are taken at the home of the insured
6. Organ donor expenses
7. Free health check-ups, etc.

• Maternity related coverage benefits

1. Cost of normal delivery
2. Cost of Caesarean delivery
3. Pre and post-natal expenses
4. Coverage for new born baby up to 90 days
5. Vaccination expenses incurred during the first year

Among the maternity coverage benefits, the first three are found in almost all maternity health insurance plans. Coverage for new born baby and vaccination expenses, however, can be inbuilt under some plans or it can be offered as an optional coverage benefit. If offered as an optional benefit, your client would have to pay an additional premium to avail the coverage.

What is not covered under maternity health plans?

The following maternity-related expenses are not covered under maternity health insurance plans –

• Diagnostic tests taken during pregnancy
• Doctor’s consultations both pre-delivery and post-delivery
• Expenses incurred on buying vitamins, minerals and other medications for the mother
• Expenses incurred in the termination of pregnancy
• Expenses incurred in assisted reproductive techniques. However, under some plans, these expenses are specifically being covered

Common maternity health plans available in the market

Now that you know all about maternity coverage under health insurance plans, here’s a look at some of the plans which offer maternity coverage –

(Disclaimer – The insurers names are used to site examples for better understanding and not to promote a specific insurance company)

Maternity coverage is beneficial for your clients as it shoulders the heavy expenses of childbirth and gives them financial relief. So, understand what the coverage entails and if any of your clients are planning to start a family in the near future, advise them to opt for maternity health plans. The plan would take care of the costs of childbirth and would be in the best interests of your clients.