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Coverage of Abortion under Health Insurance Policies in India

By Juhi Walia
30 August 2022, 2:51 PM

Abortion or the medical termination of pregnancy (MTP) is often undertaken by women as a means to end an unwanted or unplanned pregnancy. However, while most standard health insurance plans do not cover such costs, they provide an add-on maternity health insurance cover at an extra premium. Some of these add-on maternity health insurance plans will cover all abortion costs if the pregnancy is terminated as per the provisions of the MTP Act currently in force and subject to the limits specified by the add-on plan purchased. Some of them may cover specific procedures only. You can get coverage for abortion under dedicated maternity health insurance plans too, after a waiting period of up to nine months.

An Overview of Abortion

Sometimes a woman may find the need to terminate a pregnancy due to severe abnormalities being detected in the foetus – as taking care of a severely handicapped child can be a huge challenge, especially in rural areas, where support systems are few and far between.  The more advanced the stage of pregnancy, the more difficult and dangerous the MTP procedure becomes and, therefore, more expensive. In other cases, a woman may find the need to terminate a pregnancy due to failed contraception.

No matter what the reason behind the procedure is, the experience is often traumatic. The trauma is often magnified by the stigma attached to abortion in India. Thus, knowing that the cost of medically terminating your pregnancy is covered by your health insurance plan could significantly reduce the stress at that point of time.  

Abortion Coverage Under Health Insurance Plans

Most basic health insurance plans do not cover the costs associated with pregnancy, childbirth or the medical termination of pregnancy. However, most health insurance service providers provide an add-on along with the standard plan, on payment of an extra premium. Depending on the rider, the plan may only cover pregnancy and childbirth. Some may extend the coverage to MTP only if the continuation of the pregnancy poses a high risk to the mother’s life. Some may offer coverage if MTP is undertaken due to severe abnormalities detected in the foetus. However, even if the plan does cover the abortion, coverage will only be provided if the procedure undertaken is as per the norms laid down by the MTP Act 1971, as amended in 2021.

You can even buy a dedicated maternity plan for the said purpose.

Evaluate These Things Before Finalising a Health Insurance Plan for Abortion 

If you are female, newly married, and are about to give birth to a child, you may consider it advisable to take an add-on maternity health insurance plan in addition to your regular plan. However, before finalising the plan, here are some of the clauses you need to look into:

Waiting Period

Most maternity health insurance plans come with a waiting period. This may be as much as nine months in regular circumstances. However, if the pregnancy needs to be terminated due to complications arising from pre-existing diseases, the waiting period may extend to as much as four years. The pre-existing disease referred to here has been explained by the Insurance Regulatory and Development Authority of India (IRDAI) to mean any medical condition, ailment or injury for which there were signs and symptoms or which was diagnosed within 48 months prior to the first policy issued by the insurer and also renewed continuously thereafter.  Some plans offer to relax the waiting period in case of miscarriage or MTP induced by accident or illness.

Procedures Covered Under the Maternity Health Insurance Plan

Are all expenses related to pregnancy and childbirth covered, including medical termination of pregnancy or only selected procedures?  While most responsible adults plan their pregnancy and child birth, and may not be comfortable with the thought of abortion, the fact is that sometimes, you may be confronted with a life-or-death choice – continuing the pregnancy could pose a severe risk to your health. Alternatively, an ultrasound may reveal a foetus with severe congenital abnormalities and your  financial and social resources may not be adequate to ensure a decent quality of life for your unborn child. Discontinuing the pregnancy may be a  hard choice for you and your spouse – but the right choice. You, therefore, need to be aware of whether the maternity health insurance plans will support the termination of pregnancy in such scenarios.

Coverage Amount Provided

The premium amount of your maternity health insurance policy will determine the coverage provided in case of child-birth or medical termination of pregnancy. Some policies may cap the amount for different procedures. Since medical termination of pregnancy in the advanced stage may require hospitalisation, you need to be confident that the amount the insurer promises to pay against the procedure is sufficient to cover expenses in a facility that meets your standards.

Summing Up

While most basic health insurance plans do not provide coverage for abortions, this cover can come in an add-on or an altogether separate maternity health insurance plan. However, you need to check whether the plan offered to you covers only pregnancy and childbirth or whether it also includes coverage of medical termination of pregnancy.

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1. When is it medically safe to go in for an abortion?

As such, the earlier the stage of pregnancy, the less risky the termination procedure will be. In India, and in general, termination of pregnancies up to twenty weeks is not considered risky if conducted under medical supervision.

2. Is there a difference between miscarriage and abortion?

Miscarriage is a spontaneous or “natural” but unexpected ending of pregnancy within the first twenty weeks. In most cases, these are due to factors beyond our control. After twenty weeks of gestation, a pregnancy loss is termed as a “still birth”. An abortion, however, is the termination of a pregnancy which may be induced medically or surgically.

3. What are the norms under which I may claim coverage of abortion from my maternity health insurance service provider?

Your maternity health insurance service provider will only provider coverage of such a claim if the abortion is carried out as per the norms laid out by the Medical Termination of Pregnancy Act as amended in 2021.

For termination of pregnancy within twenty weeks, the opinion of one registered medical practitioner (RMP) is required

For termination of regnancy between twenty to twenty-four weeks, the opinion of two RMPs are mandatory.

The opinion of a state level board is mandatory for termination of pregnancy beyond twenty-four weeks of gestation.

However, you need to check the specific clauses of your policy, to see if coverage is provided for all the above situations.

4. Can I buy a maternity health insurance plan as a standalone policy?

Yes, you can buy a maternity health insurance plan separately. Besides, you can buy a maternity add-on with your regular health insurance policy for an additional premium.

5. What should I choose between a maternity add-on over regular health insurance and a dedicated maternity insurance plan for abortion?

Choosing between the two requires getting an idea of the abortion costs in India. Although abortion may be the last thing on one’s mind, getting an idea of the cost does no harm. Check the maternity add-on coverage amount and the one you will get under a dedicated maternity plan. Choose the one that offers the maximum coverage in exchange for the premium you can afford.

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