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The very idea of becoming a parent is so exciting and blissful. The minute you and your partner decide that you wish to have children, the mental planning starts. There is absolutely no doubt that raising a family requires a lot of planning, and the first step for preparing for this momentous journey is investing in a good health insurance policy that covers you for maternity benefits too.
Birth of the child is not the only expense that you need to cater for. Pregnancy can be a complex process and it is highly recommended that you spend some time and thought in finding a maternity insurance policy that suits you and your spouse. Having maternity insurance will help you prepare for a smooth and safe pregnancy and rather than worrying about managing funds so that you and your partner would be able to enjoy this wonderful period.
Your existing health insurance may or may not cover maternity expenses, you must confirm the same from your insurer. In case it does not, you can always add this benefit as an add-on to your basic health insurance plan.
Normal delivery in a decent hospital can cost you something around INR 50,000 to INR 1.5 lakhs, whereas the cost of a C-section delivery can be much higher. Your standard medical insurance might not cover all pregnancy and pregnancy-related issues. Thus a maternity insurance plan is specially designed to provide you with a cover for the expenses you may incur during pregnancy. It includes pre and postnatal check-ups and treatments, hospitalisation charges, etc. However, in India, there is no stand-alone maternity-only health insurance plan, and hence it needs to be taken along with an indemnity health insurance plan.
Maternity expenses have been clearly defined through IRDA’s circular on Standardised Definitions, which was issued in 2013. It includes the hospitalisation that can be due to childbirth. It also includes termination of pregnancy as well as pre/postnatal expenditure. In India, maternity insurance is not a standalone health insurance plan but is a benefit in an indemnity plan. Most health insurance companies offer ‘maternity insurance’ as an add-on to the base policy.
Maternity insurance is slowly becoming popular practice and more and more people are realising the importance of having a good maternity insurance policy. Therefore, all major health insurance companies are providing maternity insurance plans that come with a long list of benefits.
Key Features of Maternity Insurance Plan
There are various health insurance companies in the market today that offer maternity insurance. Though there are different benefits and services that are offered by different companies, the basic features remain the same. It is recommended that you clarify about them before you finalise the plan.
Before we discuss maternity insurance in details, let us take a quick look at its key features:
- Waiting Period
Like all health insurance plans, maternity insurance also comes with a waiting period. Only when this period is over will you be able to health insurance claim the benefits. Some health insurance companies have a waiting period that is as short as 9 months, while in some, it lasts for 6 years.
- Pregnancy Related Complication
A pregnancy-related complication can lead to a termination of the pregnancy. Under such circumstances, the insurance will cover all the expenses that arise due to the same.
- Number of Children
Most policies will provide a cover for the birth of two children.
- Coverage Benefits
Indemnity health insurance plans offer all hospitalisation expenses like pre-post hospitalisation, in-patient hospitalisation expenses, day care expenses, cashless facility, etc. Maternity specific indemnity health insurance plans have additional benefits like prenatal and postnatal expenses coverage, newborn coverage and birth defects, domiciliary expenses, etc. as well.
Benefits of Maternity Insurance
When Neha announced her pregnancy, both she and her husband Kunal were very excited and started saving to welcome a new member to their family. Things were going smooth and they were expecting a normal delivery, but at the last minute certain complications arose and she had to undergo a c-section. Even after the surgery both Neha and the newborn baby were in ICU for 3 days. Needless to say, a major chunk that Neha and Kunal had saved up was used in clearing the hospital bills.
The upcoming months were a little difficult for the new parents, and they often regretted not having invested in a maternity insurance plan at the right time.
The rise in maternity expenses, like all other healthcare services, has been very steep. And in times like these, having maternity cover is not less than a blessing. Let us take a look at the multiple benefits of having maternity insurance.
- Financial Aid
A pregnancy is the beginning of a very important phase in your life. In such a situation, you would want that every small detail to be taken care of. Being under the cover of maternity insurance, you would not need to dig into your savings, in case of an emergency. This financial security can save you from undue stress and help you prepare for a pleasant onset of parenthood.
- Cover for New-born Baby
Your maternity insurance will just not cover you but also your new baby for the first 90 days (check about the same from your insurer). The cover will take care of vaccinations or any other complications that may arise.
For the first 3 months, that is 90 days, the new-born baby is covered for all vaccinations that are required as per the National Immunization Schedule defined by the Government of India.
- Long Term Benefits
A long-term policy can fetch you various deals and discounts. Many maternity plans offer increased benefits at the birth of the second child.
- Necessary Pregnancy Related Expenses
In certain cases due to medical conditions termination of the pregnancy, miscarriage may be advised, which may otherwise be excluded from other regular health insurance plans. Your maternity insurance will cover the expenses you incur towards lawful terminations.
- Sense of Security
The most sought after benefit of insurance is the sense of security and the peace of mind it brings for you. The birth of your baby should be nothing but a joyous memory that you can cherish for life.
- Tax Benefits
Like all health insurance plans, premiums paid towards maternity specific indemnity health insurance plans are also eligible for a tax deduction under section 80D of the Income Tax Act, 1961 upto INR 25,000 per annum.
What is Covered?
The following features are covered in Maternity Insurance:
- Expenses During Delivery & Labour
All the expenditure that is incurred, up to the value of the sum insured, will be covered under the maternity insurance.
- Caesarean Delivery
Also known as a C-section, a caesarean delivery is a surgery that is performed to deliver the baby when a vaginal delivery is not safe for the mother and/or the baby. It will be covered under maternity insurance.
- Cover for the New Baby
The maternity insurance will cover your new baby for the first 90 days (check about the same from your insurer) and will take care of vaccinations or any other complications that may arise.
- Treatment of Infertility
In case you or your partner are facing infertility issues, the expenditure of the infertility treatment will be paid by the insurance company.
- Complications During Pregnancy
Some women face medical complications during their pregnancy and may require treatment for the same. The pregnancy-related complications are also covered under your insurance.
- Room Rent
The hospitalisation and the room charges will also be covered under medical insurance.
Sometimes due to certain medical conditions, termination of the pregnancy may be advised. The expenses you incur towards lawful terminations will be covered.
What is not Covered?
There are certain services that will not be a part of your maternity insurance, these are called exclusions.
- Harvesting and storage of stem cells that is done to prevent possible illnesses in the future
- Expenses made on ectopic pregnancy cannot be claimed under the maternity cover. It may be under your individual health insurance plan
- Unless the pre and postnatal check-ups require hospitalisation, your maternity insurance will not cover it
When to Choose a Maternity Insurance Cover?
Buying maternity insurance is important, but what is all the more important is the timing. Most health insurance plans come with a waiting period, so does maternity insurance. The waiting period, as mentioned earlier can be from 9 months to 6 years. So, choose maternity insurance if:
- You have recently got married and plan to start a family in the coming years
- You are unmarried, but plan to get married soon, and are buying health insurance for yourself
- You have had a baby, without maternity insurance, and plan to have another child a few years later
How Much Coverage is Adequate for Maternity Insurance?
Before investing in a maternity insurance plan, you must understand the coverage terms of the insurer's company.
Even if your total health cover is INR 3 lakhs, the maternity cover will be much lower, generally between INR 20,000 to INR 30,000. Normal delivery in a decent hospital would cost you around INR 20,000, and a c-section can easily cost around INR 50,000. The expenses will not stop with childbirth. The newborn baby and the new mother would require regular visits to the doctor and a pediatrician for vaccinations of the baby. High-value policies with INR 10 lakhs and more sum insured give a cover of INR 1 lakh too.
Most companies do not include pre and post-natal expenses in their cover and so you would be spending on investigative tests, regular check-ups, medicines, consultations, etc.
You may want to go through the list of network hospitals that have a tie-up with the insurance company and select a cover that would help you get the best treatment from doctors and hospitals that suit your budget.
Factors affecting Maternity Insurance Premium
Since there is no specific maternity-only health insurance plan in India, the health insurance premium for a Maternity Insurance Plan would be the same as any health insurance plan like age, medical history, family history, BMI, occupation, marital status, location, pre-existing ailments, etc.
Maternity Insurance Claim Process
There are two ways in which you can make a claim:
- Cashless Claims
If you are getting your delivery at one of the network hospitals, you can easily make a request for a cashless health insurance claim. You simply need to present your Health/Policy Card at the Helpdesk and fill in the Cashless Claim Request Form. Submit the signed form and the other required documents, once done the hospital along with TPA, Third-Party Association, will take it from there. Your forms and documents will be checked, and if everything is found in order, your claim will soon be processed.
- Reimbursement Claims
If for some reason you could not go to a network hospital, and went to some other non-network hospital, inform your insurance company within the first 24 hours of hospitalisation. The hospital and the TPA will analyse the paperwork and then if everything is found in order, your claim will soon be processed and the amount that you have spent on the treatment will be reimbursed to your account.
The following documents will be required when making a claim:
- Policy Papers
- Health/Policy Card
- Pregnancy-Related Documents
- KYC Documents, as asked by the insurance company
- Duly filled and signed claim settlement form
Best Maternity Insurance in India (2020)
|Name of the Company||Highlights of the Plan|
|HDFC ERGO - Suraksha Insurance|
|Royal Sundaram - Total Health Plus|
|Care Health Insurance Company - Joy Maternity Policy|
Star Health Insurance Company - Wedding Gift Maternity Insurance
|Max Bupa - Heartbeat Family Floater Plan|
Maternity Insurance Tax Benefits
Another benefit of having maternity insurance is that you can avail tax benefits that can go up to INR 25,000, in a year. The exemptions can be higher if you pay for your parents’ insurance too. Take a look.
Tax Deductions Under Section 80D
|Scenario||Policyholder, spouse, 2 children||Parents||Total Deduction|
|All family members under 60 years||Up to INR 25,000||Up to INR 25,000||INR 50,000|
|Only Parents above 60 years||Up to INR 25,000||Up to INR 50,000||Up to INR 75,000|
|Policyholder and Parents both over 60 years||Up to INR 50,000||Up to INR 50,000||INR 1 lakh|
Health Insurance Companies have tie-ups with certain hospitals or a chain of hospitals or a medical clinic or a healthcare centre that provide cashless treatment to the policyholders, these medical centres are called network hospitals. The best part of being in a network hospital is that you would not have to run around to raise money for the treatment.
When you buy a maternity health insurance plan, make sure that you ask about the list of network hospitals. Also, see to it, if you are comfortable with the doctors as well as the facilities provided by the Gynaecology Department.
At such a momentous occasion in life, it would be so much better if you could take one thing off your mind. Your health insurance company will settle the bills directly and thus make your shoulders burden-free. Without making a compromise on quality healthcare, you can avail the best facilities.
Maternity Health Insurance FAQs
1. Does maternity insurance cover in case the woman is Covid-19 positive?
In India, maternity insurance is not a standalone health insurance plan, rather is a benefit in an indemnity plan. All indemnity plans will cover you for COVID -19, and therefore, if a pregnant woman is COVID positive, her treatment will be under her health insurance cover.
2. Does a maternity plan cover more than one delivery?
Yes, most health insurance companies cover 2 deliveries. However, it is recommended that you confirm the same from the company.
3. Can I get maternity cover if I'm already pregnant?
You can purchase maternity cover even when you are expecting, but remember that most of the insurance companies will not cover your current pregnancy. In case you have group insurance through your employer, you may wish to confirm the availability of a maternity cover.
4. Is there any waiting period in a maternity plan?
The waiting period can be as short as 9 months and can go up to a period of 6 years. As mentioned in your policy papers, you would be able to make a claim only once the waiting period is over.
5. Are there maternity plans without a waiting period?
There may not be any plans that come without a waiting period. The waiting period can be as short as 9 months and can go up to a period of 6 years, but it will always be there.
6. Can I increase the maternity sum insured with a super top-up health plan?
You can increase the maternity sum insured with a super top-up plan, provided the top-up coverage has maternity benefit. In most plans, maternity coverage comes with a limit. Also, there are certain eligibility criteria for adding-on a maternity cover to your base plan. For instance, if you are not married, you might not get maternity coverage.
7. Does maternity insurance cover pre-delivery and post-delivery medical expenses?
Yes, maternity cover would include all the expenses that are directly related to childbirth. From pre-hospitalisation to post-hospitalisation, delivery, emergencies due to pregnancy, vaccination of the new-born baby will be covered.
8. What are ‘network hospitals'? Why are they important?
Health Insurance Companies have tie-ups with certain hospitals or a chain of hospitals or a medical clinic or a healthcare centre that provide cashless treatment to the policyholders, these medical centres are called network hospitals. The best part of being in a network hospital is that you would not have to run around to raise money for the treatment. Your health insurance company will settle the bills directly and thus make your shoulders burden-free. Without making a compromise on quality healthcare, you can avail the best facilities.
9. Is it worth getting maternity insurance for pregnancy?
Having maternity insurance will help you prepare for a smooth and safe pregnancy and rather than worrying about managing funds. With maternity insurance,you and your partner would be able to enjoy this wonderful period. If you fall in any of the following categories, you must consider buying a maternity cover:
- If you have recently got married and plan to start a family in the coming years
- If you are unmarried, but plan to get married soon, and are buying health insurance for yourself
- You have had a baby, without maternity insurance, and plan to have another child a few years later
10. Does a maternity plan cover medical expenses in case of a termination?
Yes, it does. A pregnancy-related complication can lead to a termination of the pregnancy. Under such circumstances, the insurance will cover all the expenses that arise due to the same.
11. Does maternity insurance cover the medical expenses of a new-born baby?
Certain health insurance companies will offer a cover for the new-born baby from birth until a period of 90 days. After this period, you can include the baby in your Family Floater Health Insurance Plan.
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