Maternity Health Insurance Coverage
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Welcoming a new member into a family and caring for the baby can be an overwhelming experience for parents. Each pregnancy is different and can pose a challenge for family members. Looking after the baby after delivery is a full-time job however, this is one aspect of pregnancy and childbirth. Another is the financial aspect. In today’s time, where the costs of healthcare are increasing with each passing day, one may feel a dire need for a financial backup. This is where maternity health insurance coverage can provide solid support.
The following article gives a deep insight into how one should create a financial safety net with Maternity Health Insurance. Additionally, its features, add-ons, and benefits are also discussed. Take a look
What is Maternity Health Insurance?
Maternity health insurance, is an insurance coverage that provides a financial back up related to childbirth. It covers the cost of hospitalization related to normal or cesarean delivery. The insurance coverage is not limited to childbirth but extends to the newborn baby up to certain days after being born.
Why should you buy Maternity Health Insurance Coverage?
Buying maternity health insurance coverage will help you get peace of mind about financial costs related to childbirth. This cover comes at a low cost when bought as an add-on for your existing health insurance plan and provides adequate financial coverage for hospitalization and delivery costs. Here are a few reasons why one should consider opting for maternity insurance:
Financial Coverage
The cost of delivery and childbirth are as high as 50 thousand to 1 lakh rupees in some parts of India. The price may be proportional to the quality of healthcare services availed during this time. It can be loosely implied that buying pregnancy insurance can ensure higher quality health care facilities for the new mother and her child. Thus, the importance of insurance is high.
Surgical Deliveries Cost Higher
A surgical or cesarean delivery is when the natural process of childbirth can prove to be difficult for both mother and the baby. Here medical intervention is required and the baby is born via a major abdominal surgery. Opting for a cesarean can also be done by choice. The cost of a cesarean is much higher than the cost of a normal delivery. These costs can be covered under the mediclaim policy with maternity coverage.
Peace of Mind
Once the financial liability is reduced with a maternity cover, parents-to-be can focus on enjoying this important milestone in their lives. Planning for things like naming the baby, decorating the room, throwing a baby shower party, and so much more can be done with a free mind.
When should you opt for Pregnancy Insurance?
One should buy health insurance coverage as early as possible. The earlier you buy health insurance the cheaper it will be. Remember that you are the oldest today yet younger than tomorrow. Now is the best time to get a health insurance policy. Maternity plan is an add-on that you can buy either upon getting married i.e. in the middle of a policy period or upon renewal of the health insurance plan.
Maternity cover comes with a waiting period. The waiting period can vary from insurer to insurer. Some insurance companies have a waiting period of 9 months after buying the maternity add-on while some have a waiting period of a few years. You need to get in touch with your insurer to get clarity about the waiting period. Maternity insurance policy or maternity benefits are also available with Group Health insurance plans. For example, Employee health insurance schemes. These plans usually do not come with the waiting period clause. A permanent employee of a company can raise a claim for maternity benefits without waiting for a specific time period.
Eligibility Criteria for Maternity Health Insurance
The eligibility criteria are not extensive when it comes to buying a maternity insurance plan. Insurance companies may only require the insured to be of a certain age to avail the benefit. The entry age is 18 years and some insurers have set the exit age at 45 years.
Some insurance companies have a cap on the number of maternity claims at 2 living children. This means that a person can get maternity benefit for 2 deliveries only. There could be exceptions in case of loss.
Required Documents to Raise a Maternity Claim
One may need the following documents to raise a claim against maternity benefits:
ID proof
Discharge summary
Claim form
Health insurance policy
Pre-authorization form in case of cashless claims
Prescriptions for medicine and other items
Any other document as required by the insurance company
Key Features & Benefits of Buying Maternity Insurance Policy Online
One of the major downsides of buying traditional insurance is that the process requires a lot of your time and manual research. You need to get in touch with insurance agents or insurers to understand the existing insurance plans. This alone could take days. Next, you would go through insurance brochures, read the details and manually compare policies from various insurance companies. Then comes the process of applying for a policy. After the purchase is over, you would have to wait for the physical copy of the insurance policy to arrive by post.
On the other hand, buying a maternity insurance policy online provides the following benefits:
Quick purchase that saves time.
Option to compare policies in a few clicks.
Online discounts like vouchers, points, etc. that can be redeemed during the purchase.
Since online policies are also sold directly by insurance companies or aggregators no agent commissions are involved. This reduces the cost of maternity cover.
You can buy the maternity plan from your comfortable space be it home, office, or any random cafe.
Coverages of Maternity Health Insurance
Coverages are situations when the claim for maternity benefit will be payable. The coverages are not only limited to the delivery and childbirth, and related expenses for the mother but also for the newborn baby. Here are the general inclusions of a Maternity health insurance plan:
Pre-hospitalization and post-hospitalization coverage.
Hospitalization expenses
Cost of a medically necessary termination of pregnancy in a life-threatening situation.
Cost of normal and cesarean deliveries.
Coverage for a newborn baby: A newborn baby can be covered under maternity benefits up to 90 days from birth at no additional costs. After 90 days, the baby needs to be included in the base plan as an insured person.
Coverage for vaccination: A newborn baby needs to be vaccinated at regular intervals. The costs of customary and reasonable vaccinations are covered under the maternity benefits of a health insurance plan. The following vaccines are covered:
BCG
OPV+IPV-B1/OPV
Hepatitis B-1
DTPw booster-1 or DTPa booster-1
Hib
Measles
MMR-1
Typhoid
HPV (female child)
Meningococcal
Tetanus Toxoid
What is the Waiting Period for Maternity Benefit?
The waiting period is the time when you cannot raise a claim after buying the maternity benefit. This time varies from insurer to insurer. Some insurance companies require you to wait for 9 months after buying the benefits while others may enforce a waiting period of a few years on the policyholder.
Exclusions of Maternity Benefit Health Insurance
An exclusion is a situation where the policyholder cannot raise a claim against the maternity benefits. Here are the exclusions of a pregnancy cover:
Cost of infertility treatments.
Costs related to tonics, vitamins, or related supplements.
Ectopic pregnancy unless covered under a base plan.
Claim raised during the waiting period.
Claim raised when the allowed number of claims have exceeded.
Maternity Mediclaim Insurance Policy Rules & Terms
Following are the terms and conditions of a maternity mediclaim policy:
The maternity benefit will end when the base plan ends.
The benefit can change based on the terms laid down by the Insurance Regulatory and Development Authority of India.
The benefits of maternity insurance can be availed only in India.
The claim will be settled in Indian currency.
The benefit will be extended on the insured person listed in the base plan.
A waiting period of a certain number of days will be applicable for availing the maternity benefits.
Add-on Covers in Maternity Insurance
Maternity cover itself is offered as an add-on on the base plan. The base plan is a normal health insurance policy that offers a financial backup upon a medical emergency. It covers the cost of hospitalization and other expenses related to health care.
How is the Cost of the Maternity Benefit Calculated?
The cost of maternity benefit or pregnancy cover depends upon the coverage offered by the insurance companies. Since the coverage may vary, the cost of this add-on is also different at different insurers. The premium depends upon the following factors:
Cost of the base plan
Entry age
Services offered
Scope of the coverage
Waiting period
Sum insured of the maternity benefit
What is the Claim Process for Availing Maternity Benefits?
The claim against a maternity benefit can be raised in the following ways:
Cashless Claim
It is necessary that the delivery takes place in a network hospital to avail a cashless claim. A network hospital is any hospital that has a tie-up with your health insurance company. The insurer needs to be informed about the claim at the time of admission to a network hospital. Once the claim is approved, the policyholder needs to pay a negligible amount under deductibles and no further action is required. All the other expenses will be taken care of directly by the insurance company.
Reimbursement Claim
A reimbursement claim requires the policyholder to first pay the entire bill amount and then approach the insurance company for reimbursement of expenses. This process is more time-consuming as compared to the cashless process.
In this type of claim, the policyholder is not restricted to avail treatment in a network hospital. The delivery can happen at any hospital of the insured’s choice. The policyholder needs to keep a record of documents and bills to raise a reimbursement claim.
If the maternity benefit is bought from a digital insurance company, the policyholder can raise a claim for medical expenses related to maternity online i.e. through a website or a mobile app.
Tax Benefits Related to Maternity Cover
A health insurance plan offers a tax benefit of Rs 25000 in one financial year (the amount may change depending upon the rules) for an Indian taxpayer. Since a maternity insurance cover is an add-on available along with the health insurance plan, it is already covered with tax benefits. There are no separate tax exemptions for buying maternity health insurance plans.
Why Choose Acko for Health Insurance Plans?
Acko is an InsurTech company that is gaining popularity rapidly in today’s time. Being digital-first allows the company to provide online support and policies at the best price in the market.
The no-commission model together with an excellent team of dedicated people ensures that your health insurance experience is flawless in every manner possible. Acko has proven its mettle not only via providing quick and quality services to its customers but it is also one of the top-rated insurance companies in the online space.
Since there are no insurance agents involved, the company can get in touch with the policyholder directly and solve their issues on a one on one basis. These are the reasons that make Acko the ultimate choice for millions in the country.
How to Buy Health Insurance Policy by Acko?
Buying health insurance from Acko is a matter of a few minutes. All you need is an internet-enabled device, an internet connection, and personal details related to you and/or your family members. Here is how you can buy a health insurance policy from Acko:
Visit www.acko.com
Select Health insurance
Choose from various available plans
Enter your personal details and answer a few questions
View quote
Make payment
Receive your health insurance policy at the registered email address
Frequently Asked questions
Here are a few common questions related to Maternity insurance and the benefits it provides
What benefits does maternity health insurance provide?
Maternity health insurance provides a financial backup at the time of delivery and childbirth. It also provides health insurance coverage for the newborn baby and for customary vaccinations.
What is the ideal time to buy maternity health insurance?
One should speak to the insurance company about the waiting period related to maternity benefits on health insurance. Ideally, maternity benefit should be bought while adding a new member (spouse) to the health insurance policy i.e. soon after the wedding.
Can I buy and claim maternity insurance while I am pregnant?
An insurance company may not allow you to buy and claim maternity insurance when you are pregnant. The insurance company will consider this pregnancy as a pre-existing condition while buying the plan and will enforce a waiting period for raising a claim.
What are the coverages of a maternity health insurance plan?
You can find the complete list of coverages of a maternity health insurance plan in this section. Please take a look.
Are there any eligibility criteria for availing the maternity benefit?
Yes, there are a few eligibility criteria when it comes to availing maternity benefits. The maternity can be claimed only by an insured person listed in the base plan. The entry age is 18 years, i.e. the policy seeker should be at least 18 years of age to avail insurance benefits for maternity. The exit age set by some insurance companies can be 45 years. The delivery of the baby needs to take place inside the geographical limits of the country.
Is a newborn baby covered under health insurance?
Yes, the newborn baby automatically gets covered under health insurance under maternity cover for the first 90 days. After which the policyholder needs to list the baby in the base plan.
Disclaimer:
*Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**In case the pre-existing disease surfaces after a policy is issued. However, at the time of claim, if it is found that the policyholder did not disclose any known pre-existing diseases while buying the policy, the claim may get rejected.
