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Recently married and planning to start a family?

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What is Maternity Insurance?

The joy of maternity is indescribable. But, so are its costs. While pregnancy and childbirth mark a new chapter in your life, the medical expenses associated with the same can prove to be a burden. That is the reason why many health insurance plans offer maternity coverage as a part of their plan benefits. This coverage comes in handy in meeting the costs of deliveries and pre/post-natal care.

 

Maternity Insurance is an optional coverage that can be added to an Individual or Family Health Insurance policy to cover all maternity-related expenses.

 

Anyone with an existing or new Health Insurance plan can include this benefit for themselves or their spouse. This helps when the time comes, the insurer can cover and take care of all of the maternity expenses for the delivery of a baby and/or treatment related to any complications in the pregnancy. or medically necessary termination.

 

Additionally, the coverage covers fees related to reproductive concerns and the newborn baby's hospitalisation costs owing to any medical complications. It also includes vaccine costs for up to 90 days after delivery.

 

Pregnancy and starting a family are important milestones of life, especially when it is your first time. Right away from pregnancy to childbirth, the journey can be an exciting and adventurous one for the couple. They discover new aspects every day. 

 

Besides being joyous, pregnancy also gives you time to prepare for the coming baby so that, you can start your family on the right note. While doctors and the elders in the family would give you invaluable advice on how to make your pregnancy a good time, a maternity cover can make you better prepared for the exciting future ahead.

Why should you buy Maternity Health Insurance Coverage?

The medical expenditures of delivering a newborn infant have been steadily growing in tandem with rising healthcare costs. Especially if the pregnancy includes a C-section or any other problems. The prenatal period of family planning can be extremely expensive. For couples who conceive naturally, the approximate sum you would spend throughout the prenatal phase is around Rs. 1 lakh, and for couples who use IVF, the amount may be as high as Rs. 2.5 lakh. We know that in 2022, couples can get maternity procedures from missionary hospitals for under 75,000 too. However private hospitals in tier 1 and tier 2 cities charge over 1 Lakh for the same procedures and these costs are bound to increase.

 

Also, you must know that corporate health insurance has a sublimit for maternity. Hence it's important to cover your additional maternity expenses with personal health insurance so that you claim across 2 policies. 

 

Choosing a maternity benefit in your private health insurance plan would make things easier for you and your spouse. By reducing the financial burden and guaranteeing that everything from your beautiful child's birth to its first three months is easy and stress-free.

 

After all, he or she will be your bundle of joy, and we want to make sure you can fully appreciate and enjoy those happy times.

When should you opt for Pregnancy Insurance?

If you are unmarried and do not plan to get married anytime for at least 2 to 3 years, then you don't need maternity insurance coverage. 

However, if you are married, about to get married or about to start a family, an important thing that you need to do is opt for maternity coverage. It should be as early as possible so that you cover the waiting period well in time. When doing so, a layer of protection will ensure that your financial planning does not go awry. This would help you plan for a secured financial future and save for your collective goals.

Eligibility Criteria for Maternity Health Insurance

Most insurance companies have set a minimum entry age of 18 years and a maximum age of 45 years to be eligible for maternity insurance coverage.

Required Documents to Raise a Maternity Claim:

You should have specific paperwork on hand when filing maternity insurance claims to ensure a smooth process. The following are some of the documentation needed to file a maternity insurance claim, though the list varies by company.

  1. Duly filled claim form

  2. Policy documents

  3. Admission advice

  4. Discharge summary

  5. Fitness certificate

  6. KYC documents

  7. Consultation bill

  8. Original hospital bill

  9. Pharmacy bills

Coverage of Maternity Health Insurance:

Let's take a look at the major categories covered by maternity insurance: 

  1. Pre- and post-hospitalization charges: At least 30 days previous to the date of admission to the hospital, pre-hospitalization expenses are covered. Post-hospitalization expenses can be reimbursed for at least 60 days after the date of discharge from the hospital. These figures vary from plan to plan 

  2. Hospitalisation charges: Expenses associated with hospitalisation including room rent. This is coupled with the surgeon, anaesthetist, medical practitioner, and consultant costs. Furthermore, some insurance plans include coverage for emergency ambulance costs.

  3. Ambulance Costs: some insurance plans include coverage for emergency ambulance costs.

  4. Pre- and post-natal coverage: Delivery costs (pre-and post-natal expenses are included)

  5. Newborn baby cover: Infants who have been diagnosed with a congenital disease or a life-threatening illness.

  6. Vaccination Cover: For a newborn, vaccination expenses are covered under most plans

What is the Waiting Period for Maternity benefits?

There are three different types of waiting periods in maternity health insurance plans. They are as follows:

  1. Waiting Period for Pregnancy Coverage - Maternity insurance policies typically cover maternity expenses after a waiting period of 9 months to 6 years. However, this period varies with different plans.

Exclusions of Maternity Benefit Health Insurance:

Individuals should thoroughly comprehend the features of maternity insurance plans before purchasing them to get the most out of them. It is important to note that some expenses aren't covered by the plan. Here are a few examples:

  1. A routine checkup with your doctor.

  2. During the pregnancy, diagnostic testing such as Ultrasound, Sonography and doctor consultations for up to 9 months.

  3. Some plans cover expenses associated with infertility treatment however some plans don't. Ensure that you understand your policy features to be sure of exclusion of infertility treatment

  4. Expenses for tonics and vitamins and over-the-counter medicines.

Maternity Mediclaim Insurance Policy Rules & Terms:

  1. Waiting Period for Pregnancy Coverage - Maternity insurance policies typically cover maternity expenses after a waiting period of 9 months to 6 years. However, this period varies with different plans.

  2. Very few plans allow maternity coverage for single mothers. In most cases, you need a family for maternity benefits to be applicable.

  3. A detailed look at exclusions is a must to avail the maximum benefits from your maternity cover

  4. Ensure that you have a look at maternity sub-limits coverage and what it doesn’t cover. These are highlighted in the policy wording

How is the Cost of the Maternity Benefit Calculated?

In most cases, it is a specific percentage of the sum insured mentioned in the policy wording.

What is the Claim Process for Availing Maternity Benefits?

If you are admitted to the hospital for childbirth delivery, you should contact your insurance provider at once to begin the claim procedure. Both cashless and reimbursement claims are possible. Let's take a look at the procedure:

  1. Submit the correctly filled in claim form after informing the insurance provider via the website or toll-free line.

  2. The hospital will verify and then deliver to the insurance company the required documentation that you have submitted.

  3. If you are admitted to a network hospital, the insurance company will pay the hospital immediately as part of the cashless claim payment after verification.

  4. If you are unable to be admitted to a network hospital or if your claim for cashless payment is denied for whatever reason, you will be entitled to payment under the reimbursement process

  5. For reimbursement, you will pay the hospital upon being discharged. However, you will be reimbursed after submitting the documentation and bill to the insurer.

Tax Benefits Related to Maternity Cover:

Section 80D of the Income Tax Act provides tax deductions for medical expenditures made for the self and the family which can go up to Rs.50,000. Self, spouse, children, parents, and Hindu Undivided Families (HUF) can claim this.

Why Choose One Assure for Health Insurance Plans?

We enable informed buying and servicing of health insurance products. We offer health insurance buying, renewals, porting, claims settlement support, learning and advisory for products catering to physical and mental health.

We believe in strategic process mapping of services. Therefore, we have our insurance advisors to introduce and health insurance experts to help you discover your needs before we find potential solutions.

How to Buy Health Insurance Policy by One Assure?

Buying health insurance or making a claim, Look at how simple it can be!
 

Step 1) Book an appointment to get a health insurance recommendation from our website at the date and time of your choosing

Step 2) Express your insurance needs, location, lifestyle details, and concerns if any

Step 3) Our partners suggest curated plans for you

Step 4) You consult the partners on which one you should pick 

Step 5) Payment & Registration takes place

Step 6) Bam! Your lifetime insurance partner does the rest for you!

How to Buy Health Insurance Policy by One Assure?

Buying health insurance or making a claim, Look at how simple it can be!
 

Step 1) Book an appointment to get a health insurance recommendation from our website at the date and time of your choosing

Step 2) Express your insurance needs, location, lifestyle details, and concerns if any

Step 3) Our partners suggest curated plans for you

Step 4) You consult the partners on which one you should pick 

Step 5) Payment & Registration takes place

Step 6) Bam! Your lifetime insurance partner does the rest for you!

How is maternity insurance premium calculated?

Numerous variables affect the premium of a health insurance plan with maternity benefits. These variables include the sum insured you have selected, your age, the number of insured individuals, your medical history and current health status, the length of the policy, and the insurance company's pricing policy. 

Maternity Benefit is a choice which is opted for by the customer at the time of buying a health insurance plan. In most cases, maternity is a planned expense and hence the insurance companies account for a claim once the waiting period is over.

 

They will expect that most folks will claim considering they are paying for this benefit. Depending on the sum insured the maternity benefit will have a sublimit varying from 5-20% of the sum insured can be used towards maternity benefit. The second variable here is the waiting period, the longer the waiting period the cheaper the premium gets.

 

The higher the sublimit, the more expensive the premium will be. I would say you can budget an increase of anywhere between 30% to 70% in premium based on the waiting period and sublimit vs a plan without maternity benefits.

Which health insurance is good to have for  pregnancy?

In India, many health insurance plans offer maternity coverage. Here’s a look at some of the most popular ones:

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