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Indian Health Insurance for Maternity and Pregnancy

Having a new born baby in a family is perhaps one of the most awaitied events in the lives of a husband and wife and it is important that they prepare themselves both emotionally and financially for this event. From the expenses leading upto the birth, to hospital expenses to delivery costs including the medicines, childbirth is an expensive affair and having an insurance policy to take care of most of these expenses is perhaps the ideal approach to take. Having therefore a Maternity Insurance policy can ensure the financial stress is eased up to allow the parents to thoroughly enjoy these special moments.

Maternity insurance is normally available as an add-on with the main health insurance policy. This insurance policy covers expenses related to both baby delivery options - caesarean or normal delivery. One must ensure to carefully read the terms and conditions of the policy to understand what is covered and what is excluded under their maternity policy. Generally, maternity plans come with high premiums and long waiting periods (upwards of 36 months).

According to current reports, the average age of women becoming mothers has risen to between 32 to 35 years in India and as a result, pregnancies are becoming more complicated. Hence women are ensuring they have adequate insurance coverage through a maternity plan to ensure they are financially covered for their pregnancy. Currently caesareans to normal deliveries stand at 65:35 in metro cities.
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What are the normal coverages under a Maternity Insurance Plan?

While the coverages vary across insurance providers, the general expenses covered are as follows:
  • Hospitalisation Expenses (with a cap)
  • Pre-hospitalization expenses :30 days & Post-hospitalization expenses : 60 days (room charges, nursing expenses, anaesthetist charges)
  • Delivery expenses (Normal or Caesarean)
  • Pre and post-natal expenses (depends upon the type of delivery - Caesarean or normal)
  • Vaccination of the infant (some cases)
  • Baby cover (if newborn is diagnosed with congenital disorders)
  • Ambulance charges
  • Other Emergencies (several insurance providers cover emergencies for up to Rs.50,000)

What are the Typical Exclusions under a Maternity Insurance Plan?

The normal exclusions include:
  • AIDS treatment-related expenses
  • Congenital diseases
  • Pre-existing ailments or injuries diagnosed within 48 months of the policy commencement
  • Early Termination of pregnancy
  • Regular check-ups
  • Consultation fees / Medicine Costs
  • In-vitro fertilisation and infertility-related expenses

FAQ’s on Maternity Health Insurance

Maternity Health insurance plans normall have a waiting period that varies between insurance companies, and ranges from 9 months to 72 months (6 years). You can avail the benefits of your maternity health insurance plans only after the completion of this waiting period and provided you have been insured for consecutive policy years.
The ongoing pregnancy will be treated as as a pre-existing condition, and hence coverage will not be provided by the insurer.
Most insurers do not cover the newborn baby from day one until they are 90 days old. From day 91, they can be added to the parent's policy as a new member by paying the additional premium.
Pre and post hospitalization expenses will not cover ultrasound/scan charges or all your visits to the gynaecologist leading upto the birth of the baby. Besides, AIDS treatments, Fertility treatments like IVF, IUI etc. also are not covered. Abortions are also excluded and so are complications arising in the pregnancy which are self inflicted. Consultation Fees and other Routine charges are also excluded.
If the baby is born with an abnormality, deformity, disease or illness, it is termed as a congenital condition and most policies do not offer coverage for such congenital conditions.
Yes, you can purchase a maternity health insurance while you are pregnant. However, the expenditures incurred for the current pregnancy will not be covered by the policy since it will be a pre existing condition. The subsequent pregnancy after completion of the waiting period will be covered under the policy.
Factors that impact the premium payable are Sum Insured, Co Pay %, Age of the Mother, Location.
Yes, all maternity plans cover both Caesarean and normal deliveries. The Sum insured vary for both delivery types.
As in the case of a health policy claim, one must intimate the insurer about the pregnancy assuming that your plan includes the Maternity benefit. And when the insured get hospitalized for the delivery of the baby, you must raise a claim with the insurance company to ensure a cashless coverage can be availed.
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