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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:

FAQs

  • I am young and healthy. Do I really need health insurance?
    Health insurance covers you against unforeseen health expenses. Even if you are healthy and haven't had the need to see a doctor in a while it is essential that you get yourself covered for future emergencies. Also, health insurance policy premiums at the time of subscription may be higher if you subscribe at a later age.While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren’t too costly like routine doctor’s visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury. Please do understand your policy and its inclusions and exclusions and make the right decision.
  • What happens if the primary insured person covered under a family floater policy expires?
    In case the primary insured expires post hospitalization then the claimable health expenses would be reimbursed. If the primary insured is also the eldest member in the family, then for the succeeding years after the death of the primary insured the premium would be calculated on the basis of the age of the next eldest member. For this to happen, the family should fill up the change of request form provided by the insurer. Please note that in case there were only two members covered under the policy then the family floater plan would be converted to an individual plan.
  • What are the things to look for while choosing a health insurance plan?
    When choosing a health insurance policy there are a few things which you should be ready with are: The number of members and relations to be covered- Because this will be the basis of buying a policy. Type of coverage – Individual, Family floater or group. Sum insured or coverage amount – Ensure that you consider future expenses too. Room rent – Check for the capping amount or criteria defined if applicable. Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also, check if the plan has a copay feature. Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital. Policy wording – Most important thing to check before buying a policy. In case you are not sure about the certain term or conditions you can always contact the insurer for clarification. Add-ons: Check for the add-ons that are available and choose the ones that you are definitely likely to use in the following year.
  • Can I cancel my policy and if yes will I get my premium back?
    Yes, you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause you can cancel the policy and get a refund. Stamp duty, expenses on medical check-ups and proportionate risk premium (the number of days that the insurance company was at risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer to the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded. Note: For the refund to happen there should be no claim during the policy period.
  • What are important exclusions under the mediclaim policy?
    There are four important types of exclusions in a Mediclaim policy they are: Time-related exclusions: e.g. Waiting period- general, specific ailments and pre-existing Non-medical expenses: e.g. Registration charges Illegal reasons: e.g. drugs, alcohol abuse, self-inflicted injuries Out-of-scope: e.g. Unproven medical procedures, HIV, adventure sports, etc.
  • Is health insurance policy applicable if hospitalization is for less than 24 hours?
    Yes, your health insurance policy is very much applicable even if the hospitalization is less than 24 hours. This is known as Day Care Treatment. Here, 24 hours hospitalization is not required and you do have a scope of coverage too. Day Care refers to any treatment or surgical procedure that is performed under general or local anaesthesia in a medical clinic/hospital or a day care centre requiring hospitalization for a period of fewer than 24 hours because of technological advancement. However, remember that OPD (out-patient department) are not a part of the Day Care treatments.
  • What will happen if my health insurance lapses when I am hospitalized?
    There can be 2 possible cases: Case 1: You are hospitalized just before the policy expiry date & have intimated the insurance company before the policy lapses (where the policy lapses while you are still in hospital), the company will pay the benefit as per the plan chosen Case 2: If your health insurance lapses and you are hospitalized during the grace period, on intimation during the grace period about the hospitalization, the company will pay the coverage as per the plan, and its terms and conditions.
  • My employer provides me with health insurance coverage. Is it advisable to buy another policy on my own?
    It is strongly advised to take a private policy due to 2 reasons: If you change your job, you might not necessarily get health insurance from your new employer & you will be exposed to health costs in the transition period between jobs. The track record that you have built-in health insurance at your old employer will not transfer to the new company policy. Covering pre-existing diseases might be a problem. In most policies, pre-existing diseases are covered only from the 5th year onwards.
  • Is there any tax benefit that one can avail of while purchasing health insurance?
    Yes, there is a tax benefit available under Section 80D of the Income Tax act 1961. Every taxpayer can avail of an annual deduction of Rs. 15,000 from taxable income for the payment of health insurance premiums for self and dependents. For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show proof for payment of the premium. (Section 80D benefit is different from the Rs 1,00,000 exemption under Section 80 C).
  • Is a medical checkup necessary before buying a policy?
    A medical checkup is necessary for a new health insurance policy for customers above the age of 40 or 45 years depending on the health insurer’s norms. Medical checkups are usually not needed for the renewal of policies.
  • Who is a Third Party Administrator?
    A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely settlement.
  • What do you mean by Cashless Hospitalization?
    In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from the hospital. The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This is for your convenience. However, prior approval is required from the TPA before the patient is admitted into the hospital. In case of emergency hospitalization, approval can be obtained post-admission. Please note that this facility is available only at the network hospitals of the TPA.
  • What is the difference between Health Insurance & Critical Illness policies or Critical Illness Riders in insurance?
    A health insurance policy is reimbursement of medical expenses. Critical illness insurance is a benefit policy. Under a benefit policy upon the occurrence of an event, the insurance company pays the policyholder a lump sum amount. Under a critical illness policy, if the insured is diagnosed with any critical illness as specified in the policy, the insurance company will pay the policyholder a lump sum. Whether the client spends the amount received on the medical treatment or not depends on the client’s own discretion.
  • How does the insurance company decide whether a disease was a pre-existing one or not?
    While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware of whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses. Note: It is important to disclose any disease you might be suffering from before buying the health insurance policy. Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future.
  • Can I seek treatment at home and be reimbursed for it under health insurance?
    Most policies offer the benefit of treatment at home: a) When the condition of the patient is such that he cannot be moved to the hospital Or b) When there is no bed available in any of the hospitals and only if it is like the treatment given at the hospital/nursing home which is reimbursable under the policy. This is called “domiciliary hospitalization” and is subject to certain restrictions both in terms of the amount which is reimbursable as well as the disease coverage.
  • What is a Critical Illness Insurance?
    Critical Illness Insurance is a policy that pays out a lump sum amount upto the Sum Insured upon diagnosis of a critical illness covered under the policy.
  • Why should I purchase Critical Illness Insurance?
    Critical Illness Insurance provides you and your family, the additional financial security on the diagnosis of a critical illness. The policy provides a lump sum amount which could be used for: Costs of the care and treatment Recuperation aids Debts pay off Any lost income due to a decreasing ability to earn Fund for a change in lifestyle.
  • What is a Fixed Benefit policy?
    Under a benefit policy on the happening of an insured event, the insurance company pays the policyholder a lump sum amount.
  • How does a Critical Illness benefit health insurance policy help you?
    The company will pay the Sum Insured as a lump sum on the first diagnosis of any one of the following Critical Illnesses, provided that the Insured Person survives a period of 30 days from the date of the first diagnosis. The following Critical Illnesses are covered under our plan:- Heart Attack (Myocardial Infarction) Coronary Artery Bypass Surgery Stroke Cancer Kidney Failure Major Organ Transplantation Multiple Sclerosis Paralysis
  • Which documents are required at the time of Claim?
    The Insured shall arrange for submission of the following documents required for processing of the claim within 45 days from the date of Intimation. Duly Completed Claim Form Original Discharge Summary. Consultation Note/ Relevant treatment papers. All relevant medical reports along with supporting invoices and doctors requisition advising the same. Original and Final hospitalization bills with a detailed breakup. Pharmacy Bills along with prescriptions. Any other documents as may be required by the Company. On receipt of claim documents, claims will be processed in accordance with the terms and conditions of the Policy.
  • What is Personal Accident Insurance?
    Personal Accident Insurance protects your finances by providing a lump sum compensation in the unfortunate event of a fatal accident or one that disables you permanently. The compensation shields you and your loved ones from a financial crunch. This insurance also covers accidental hospitalization costs.
  • I am a homemaker who spends the majority of my time at home. Do I also need personal accident insurance?
    Accidents can happen to anyone. Motor accidents, rail accidents, natural calamities, the list is endless. These can sound scary. But, getting intimidated is not the solution, being financially prepared is. Opting for Personal Accident Insurance helps you to meet expenses in case a crisis arises.
  • I travel to different countries often for business and at times for leisure. What if I meet with an accident outside India?
    Accident policies offer worldwide coverage. Your claim will be paid even if you meet with an accident overseas. Contact OneAssure partner to help you understand terms of each policy before buying.
  • I already have health and life insurance coverage. Why should I buy Personal Accident Insurance?
    Life insurance offers a death benefit to your nominee in case you pass away. Health insurance provides compensation and/or reimbursement of hospitalization and other medical expenses. A Personal Accident Insurance policy, on the other hand, insures against the financial risk that could arise due to accidental permanent total disability or accidental death of an earning family member. In short, the policy is essential as it strengthens your financial portfolio securing the future of dependent family members against unforeseen events.
  • What happens if I am hospitalized after an accident? Will the hospitalization expenses be covered by my health insurance?
    Yes. Health insurance policies have optional covers that you get by paying an additional premium. An Accidental Hospitalization Cover provides reimbursement for medical expenses related to hospitalization and a Daily Cash Cover provides you with a cash allowance for each day of hospitalization.
  • Would I need to pay a high premium for availing of Personal Accident Cover?
    No. For example, the premium for a basic policy of Rs. 5 lakh (duration 1 year) is approximately Rs. 610*. It is but a small price for ensuring your family's financial security!
  • I have a family to support. Does Personal Accident Insurance cover death?
    Yes. All you need to do is mention the name of your nominee in the policy document. The sum insured will be paid to your nominee by the insurance company.
  • What is Travel Insurance?
    Travel insurance in India provides coverage for medical expenses incurred overseas for any treatment received as an inpatient or outpatient. All plans also cover trip-related exigencies like trip delays, trip interruptions, trip cancellations and related problems that may arise during your trip. Some plans also provide services such as travel-related advice, Medically required Evacuation to your home in India or a hospital overseas for continued medical treatment. Other assistance services include providing emergency cash or help in the event of the loss or theft of your money, valuables or travel documents.
  • Do I have to get a medical exam done before buying a travel insurance policy?
    No, there is no such requirement to get a medical test for travel insurance. Some companies might ask for medical tests for travellers more than seventy years for higher coverage. Coverage often to fifteen thousand dollars is provided without medical tests.
  • Where should I call for claims assistance while I am abroad?
    You can reach out to us at +91 63643 34343 and we’d be happy to help. You can also contact OneAssure partners for claims assistance. Rest assured that you will be provided with timely support. In addition, your policy document would also have the details to get in touch with you insurer directly.
  • Can I get travel medical insurance for senior citizens who are above 70 years?
    Yes, some insurers are offering travel insurance for travellers aged 71 to 85. Yes, senior citizen travellers who are aged 71 to 85 years are also eligible to buy a Bajaj Allianz travel insurance policy for 6 months with $50,000 coverage.
  • What is Sum Insured Restoration Benefit in Health Insurance?
    It is a benefit that allows an insured to reinstate the entire sum insured in the policy year when it gets exhausted due to incurred claims. Most of the health plans these days offer the ‘restoration benefit'. It is just like a ‘magical backup’ to recharge your exhausted sum insured. In case the entire cover is exhausted, it gets replenished automatically for the next hospitalization that occurs within the policy year. In a situation when the sum insured is completely exhausted, sum insured restoration proves to be of great help not only to family floater policies but individual health insurance policies, equally.

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