Are maternity-related expenses covered under health insurance?
Health insurance with maternity coverage is essential for financial protection, as maternity-related healthcare costs can vary significantly and reach substantial amounts. It helps cover expenses associated with both normal and C-section deliveries.
Pregnancy and childbirth are significant life events that come with their own set of challenges and expenses. While the joy of welcoming a new member into the family is immeasurable, it's also important to consider the financial aspect of maternity-related expenses.
Maternity-related healthcare can be quite expensive, with costs ranging from tens of thousands to over a few lakhs for normal delivery, while a C-section delivery can be on the much higher end. This is where health insurance with maternity coverage plays a crucial role in providing financial protection against such expenses.
In this article, we will explore the extent to which maternity-related expenses are covered under health insurance and provide insights on selecting the right policy to ensure a smooth and financially secure transition into parenthood.
Understanding health insurance coverage
Health insurance typically covers a range of medical expenses, including hospitalisation, surgeries, diagnostic tests, and prescription medications. However, the coverage may vary from one policy to another and from one insurer to another. Maternity-related expenses fall under a specialised category and may or may not be covered, depending on the terms and conditions of your health insurance policy.
Maternity coverage in health insurance
Many health insurance plans do provide coverage for maternity-related expenses, but there are several factors to consider:
Waiting period: Most insurers impose an initial waiting period of 9-12 months or even more for maternity claims. After the waiting period, both prenatal and postnatal hospitalisation expenses are covered, including sonography, tests, medicines, etc.
Pre and post-natal care: Health insurance policies may cover not just the hospitalisation expenses during childbirth but also pre and post-natal care. This includes doctor consultations, diagnostic tests, and medications related to pregnancy.
Extent of coverage: The extent of coverage varies across insurers but generally includes expenses related to normal delivery, medically necessary C-sections, prenatal and postnatal hospitalisation costs, newborn baby care, etc. Some policies may limit the number of deliveries covered (usually up to two children). Some insurers cover home delivery charges as well, while others may exclude it. Pre-existing diseases are usually not covered during pregnancy.
Newborn Coverage: Newborn babies are also covered from birth up to the age of 90 days for illnesses requiring hospitalisation, subject to the mother's maternity benefit sum insured. This provides financial protection for any medical care the baby may require, including treatment for jaundice or other vaccination costs.
Note: All the above-mentioned coverage are common coverages and might vary across insurers and plans.
Exclusions to take note of
While health insurance policies do provide maternity coverage, there are certain exclusions that you should be aware of:
Age limit: Some policies may have an upper age limit for maternity coverage. If you are beyond this age, you may not be eligible for maternity benefits.
Waiting period: If you have not completed the waiting period specified in your policy, you won't be able to claim maternity-related expenses.
Pre-existing conditions: If you have any pre-existing conditions related to pregnancy before purchasing the policy, these may not be covered.
Expenses beyond limits: Any expenses beyond the sub-limits imposed by your policy will need to be paid out of pocket.
Choosing the right policy
To ensure that your maternity-related expenses are covered adequately, it's crucial to choose the right health insurance policy. Here are some tips to help you make an informed decision:
Planning ahead: It's advisable to opt for a comprehensive health insurance policy with adequate maternity coverage at least 6-12 months before planning a pregnancy. This ensures all pregnancy-related medical costs are covered without any restrictions or co-pays after the initial waiting period.
Compare policies: Compare various health insurance policies available in the market. Pay attention to the coverage, waiting periods, sub-limits, and premium costs.
Read the fine print: Carefully go through the policy document to understand all the terms and conditions, including any exclusions and limitations.
In conclusion, health insurance can be a valuable resource to cover maternity-related expenses. To ensure that you are adequately prepared for the financial aspects of pregnancy and childbirth, it's crucial to select a policy that aligns with your family planning and healthcare needs. Proper planning well in advance can help reap maximum benefits from health insurance when it's needed the most.
Maternity coverage may increase your insurance premiums, but it provides much-needed financial protection during one of life's most important events. So for new and expecting parents, including adequate maternity benefits, is vital to remain financially secure against rising healthcare costs.
Rakesh Goyal, Director at Probus Insurance
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First Published:2 Nov 2023, 01:13 PM IST
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