Home / Money / Personal Finance /  Don’t assume your health policy covers maternity insurance

Parenthood is perhaps one of the most significant transitions in one’s life. And for women, the path to it, pregnancy, can be emotionally, financially and physically challenging. She must prepare herself to be mentally and economically strong. If she is mentally fit, she will be in the right position to manage the challenges of pregnancy and the life of a newborn baby. And if she is financially fit, she can easily face any difficulty that might come up during or after pregnancy. In such a case, a health policy with maternity insurance can be supportive.

However, maternity insurance is not by default a part of your regular health policy. Although some insurers have started providing maternity insurance as part of their comprehensive health policy, many still offer it as an add-on to the policy. This way, many people buy health insurance thinking that the maternity feature is part of the policy without checking the policy features with the insurers.

Maternity insurance offers coverage for all kinds of pregnancy-related expenses, up to the policy’s specified limit and till the policy term is existent. Most insurance companies also provide pre-and post-natal expenses and newborn baby expenses. Natal expenses mean medical expenses related to ultrasound, doctor’s consultation fee, medicines, regular check-ups, etc.

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Paras Jain/Mint

It is not covered as a default coverage under your health insurance plan; however, it comes as an add-on feature for a few health policies.

Indraneel Chatterjee, co-founder, RenewBuy, says childbirth is an expensive affair nowadays. Standard delivery or Caesarean sections can cost anywhere from 40,000 to 2 lakh today. “A regular health policy would not be adequate to bear the high expenses related to maternity care and the required medical support for pre- and post-natal treatment. It would cover the basic charges for maternity-based doctor consultation and basic hospitalization, which would not solve the purpose of consumers. Hence, insurance companies have introduced maternity insurance—a separate cover—so that they can bear the expenses for end-to-end treatment and ensure that the entire pregnancy process is relaxed for consumers," said Chatterjee.

Moreover, one must also be aware that most insurance companies do not provide maternity based insurance if one avails of the policy after getting pregnant.

“Many insurers consider pregnancy as a pre-existing condition and are only covered after a waiting period of three to four years. Hence, one cannot get maternity coverage while being pregnant," said Rakesh Goyal, director, Probus Insurance.

However, they can get regular health insurance when pregnant but will not get maternity coverage. Most insurance companies consider pregnancy as a pre-existing condition, and thus, one will need to undergo a waiting period to avail of coverage under the maternity policy.

Goyal said, “The waiting period for maternity insurance differs from insurer to insurer, and plan to plan; hence it is suggested to opt for such coverage during the wedding if the couples plan to have the child within three-four years of marriage."

Policy exclusion: The maternity insurance policies might not cover treatment costs traceable to fertility, birth control procedure, sterilization, etc., and treatments taken from a person who is not a medical practitioner. Moreover, specific health policies also come up with exclusions of unexpected termination of pregnancy, monthly check-ups, etc.

Additionally, there is a limit on the sum insured while availing maternity benefits under a health policy. In such a case, if the treatment cost during the maternity period goes beyond the sum insured limit while making claims, the insured has to pay for the remaining balance.

What you should do: Different insurance companies provide different types of health policies with maternity coverage as an add-on. The premium payable for maternity coverage in a health insurance policy is usually higher than a regular health policy. This is mainly because claim settlement in the case of maternal health insurance is inevitable, unlike other illnesses or accidents.

Hence, one should do a detailed cost comparison around the insurance benefits offered to make optimum use of the insurance coverage. Besides, one should also check the sub-limits of the policy while assessing the options available.

“One should be aware that the premium for maternity insurance increases with age," said Chatterjee.

Some of the benefits of maternity insurance that one should look for in a policy include pre-and post-hospitalization.

Hospitalization expenses should get covered for 30 days before delivery and up to 60 days post-delivery. Insurance companies also offer coverage for newborn baby expenses, which include neonatal care for up to 90 days.

Buyers should also analyze whether the insurer will cover the cost in case of premature labour or complicated delivery, etc. Apart from this, one must also look for the initial waiting period of the policy.

Do proper cost-benefit analysis before zeroing in on a health policy with maternity insurance.

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