|Minimum entry age||Adult : 18 years, children : 1 day, New born : 1 day|
|Maximum age||Adult : 65 years, children : 24 years, New born : 90 days|
|Renewal||Lifelong renewability. The policy can be renewed under the prevailing health insurance with maternity benefit product or its nearest substitute approved by IRDAI.|
|Co-payment (Sum Insured 5 lakhs & above)||If you enroll at the age of 61 years or more, you will have to pay 20% of the claim amount under the policy. We pay the rest.|
|Waiting period||30 days for any illness except injury. 9 months for maternity. 2 years for specific treatments/ illness. 4 years for pre existing diseases.|
|Grace period||30 days from the date of expiry to renew the policy|
|Policy tenure||3 years|
|Maternity cover||Available only up to 45 years of age.|
|Step 1||Get admitted to any one of network hospitals of the respective insurance companies…you can also call the insurance company/TPA on their Toll Free assistance number. Both these pieces of information are available on eindiainsurance In case of emergency, you can contact the insurance company within 24 hours of admission to the hospital.|
|Step 2||Your Identification : At the network hospital you will need to show your Health Insurance health card (nowadays insurers issue e-health cards) of the insurance company and valid photo ID*, along with your policy number, to be able to use your insurance. This will give the network hospital the details they need to contact us for the cashless hospitalization process. * - Passport / PAN card / voter’s ID for identification purposes.|
|Step 3||Hospital sends cashless hospitalization request form to the insurance company with preauthorization request form which has details of medical history, line of treatment and estimated treatment cost.|
|Step 4||Wherever the information provided in the request is sufficient to ascertain the authorization, the insurer issues the authorization Letter to the network hospital. Wherever additional information or documents are required we will call for the same from the Network hospital and upon satisfactory receipt of last necessary documents the authorization will be issued.|
|Step 5||Hospital will send us the final request for authorization of any residual amount along with final hospital bill and discharge summary. You will be discharged from the hospital upon receipt of final authorization letter from the insurer. Any inadmissible expenses, copayments, deductions will have to be paid by you.|
|Step 6||Once the Hospitalization is done, hospital will send the original claim documents to us. The claim will be assessed by us and payment will be made to the network hospital.|
|Step 1||Contact Toll free Healthline of the Insurance Company / TPA…same is available on https://www.eindiainsurance.com/ Before you seek medical treatment we request that you contact the insurer atleast 48 hours in advance. This will the claims team to help you follow the next few steps. In case of emergency, you can contact the insurer within 24 hours of admission to the hospital.|
|Step 2||You can avail treatment at hospital and settle all hospitalization expenses. Collect original hospital bill, receipts, discharge summary, investigation reports, pharmacy bills and other documents from hospital at the time of discharge from hospital.|
|Step 3||You have to download the claim form from the website https://www.eindiainsurance.com/ .Copy of this form is also included in the policy kit provided to you. Submit the claim documents at nearest branch or Corporate office of the insurance company. The documents should be submitted within 15 days from discharge from the hospital.|
|Step 4||Wherever the information provided in the claim documents is sufficient to ascertain the admissibility of claim, the insurer will approve the claim. Wherever additional information or documents are required , the insurer will call for the same from you and upon satisfactory receipt of last necessary documents the claim will be settled by the insurance company.|
|Step 5||Upon approval of claim by the insurer, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD.|
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.
No,if the applicant is pregnant at the time of applying for the cover, then coverage for the same will not be available since it will be treated as a pre-existing condition. The maternity benefit is only available if the delivery happens after the waiting period.
It is advisable that you should take maternity insurance when you are ready to start a family, however be aware of the waiting periods to ensure complete coverage.
Giving birth to a child is becoming costly day by day due to medical inflation and advances in healthcare. Besides, complications can arise at any time throughout pregnancy especially at the time of childbirth. A maternity coverage provides a financial support for such unforeseen events.
While buying a maternity coverage, you should take care of the waiting period. Only after a waiting period of 2 – 4years, pregnancy related expenses start to get covered under a health plan. Another thing to look out for is the sub limit of the maternity coverage on the total sum insured.
No, IVF is not covered in policies that offer maternity benefits.
Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans..Click here to read more