Maternity Health Insurance

As medical costs rise, so do people’s expectations for their babies’ births and their medication. However, a middle-class or a low-income family cannot afford the bill, which is why maternity health insurance is available. As for safety, people take maternity health insurance to make sure the delivery can complete without any issues. 

health insurance plans for maternity cover the mother during all phases of her pregnancy. This insurance plan covers both normal births as well as cesarean (C-Section) deliveries, prenatal care, and newborn vaccinations. 

Benefits of Maternity Health Insurance: 

Talking about the benefits of this insurance there are an extensive number of benefits:  

  • As a pregnant woman, you’re entitled to many prenatal tests, medical procedures and could have to undergo hospitalization. Additionally, there are significant coverage requirements for caesarean sections for childbirth and many post-natal tests and recuperation. A maternity insurance plan entails that you have the necessary coverage and don’t have to deplete your savings during this period. 
  • Complications during childbirth may not be covered by general insurance policies. A maternity insurance plan protects you from these risks. Insurers these days offer maternity insurance plans with multiple riders which has an impact on the payable premiums. A maternity plan, however, generally covers complications included in the main plan, so you are entitled to additional coverage without having to pay a premium. 
  • Extra coverage options, transportation benefits: Maternity insurance policies usually cover ambulance charges and nursing fees, etc. Not only are your extra maternity expenses covered, but also that you’ll undergo a financially stress-free birthing process. 
  • Your new-born is covered by the maternity insurance plan up to a certain period of time. Your new-born is covered against any congenital conditions as well as diseases. 

What is covered in Maternity Health Insurance? 

Expenses for 30 days before hospitalization and 60 days after hospitalization. Normal and C- section delivery expenses. The following expenses can be attributed to hospitalization: nursing, room rent, OT fees, anesthesiologist fees, and doctor’s fees. Medical expenses for a newborn infant. Day-care treatment. New-born vaccination insurance. Costs associated with commuting the insured by ambulance. Cost-free treatment in hospitals that are part of a network. 

What is Not covered in Maternity Health Insurance? 

  • Maternity Expenses relating to the harvest and storage of stem cells as a preventative measure against possible future illnesses  
  • Pregnancy complications associated with ectopic pregnancy. These expenses are covered under Base Plan. 

Importance of Maternity Health Insurance? 

Motherhood is a delicate time – not just for the mother, but for her entire family. Quality maternity care is the key to ensuring a safe delivery – ensuring the health of the new mother and her child. 

Deciding to become a parent is one of the most important decisions one can make in life. For every couple, it is a dream come true. Having sufficient maternity insurance will ensure you aren’t burdened with hospitalization expenses while your anxiety about being a parent settles. Couples should not ignore the cost involved in having a baby, even though there are many other factors to consider. Considering the escalating medical costs across the country, a normal delivery in a decent hospital could cost anywhere between Rs. 50,000 and Rs. 2 lakhs. Preparing financially for the medical bills that arise during pregnancy becomes imperative when these figures are released. Thus, maternity insurance offered by several health insurance companies is a very good option to address these expenses. 

Maternity insurance offers protection against financial risks during pregnancy, prenatal and postnatal care, ambulance services, and delivery expenses, regardless of whether it is a normal delivery or cesarean section. Additionally, the maternity insurance plan covers the newborn baby until a certain period of time. 

There are some cases of good quality maternity care and treatment available at private hospitals throughout the country, but it can still be very expensive to raise a child. That is why a properly crafted maternity insurance plan can not only assist in easing off the rising costs of child care but can also allow you to cherish your family life without having to stress out over financial worries. 

Complications such as premature birth require the newborn to be kept in an incubator in a neonatal intensive care unit (NICU) for at least 20 days. Depending on the length of stay, the cost can reach Rs. 10,000 per day, leveling off at Rs 2,00,000. Cost increases can make these unforeseen circumstances even more stressful. You may receive some financial relief if you have a good maternity insurance policy since it will cover most of your expenses. The parent may be covered for the newborn’s medical expenses if he/she develops a congenital disorder or has a critical illness. Maternity Insurance is as important as planning for the future baby. 

Maternity Insurance Claim Process: 

As soon as you are admitted to the hospital for delivery, you should get in touch with your insurance company so that you can start the claims process. You can claim both cashless and reimbursement. Here is the procedure: 

  • Submit the duly filled-in claim form to the insurance company after informing them via the website or toll-free number 
  • Insured documents will be verified by the hospital and then forwarded to the insurer 
  • The insurance company will, after verification, directly pay the hospital if you are admitted to one of the network hospitals 
  • If you were not admitted to the network hospital, or for whatever reason your claim was rejected, you could receive the payment under the reimbursement system, if you were unable to admit to the hospital through the network. 
  • According to the above-mentioned method, you will pay the hospital bill at the time of discharge; however, once the provider receives your documentation and bill, they will reimburse you 

Documents Required for Maternity Insurance:  

  • Duly filled in claim form 
  • Policy documents 
  • Admission advice 
  • Discharge summary 
  • Fitness certificate 
  • KYC documents 
  • Consultation bill 
  • Original hospital bill 
  • Pharmacy bills 

When Claim can be Rejected? 

We understand that health insurance involves paying an annual fee (premium) to ensure your health and well-being. It also covers medical treatment when you need it. Sadly, such plans include and exclude a wide range of terms and conditions that are different from insurer to insurer, and from policy to policy. Anytime you choose to purchase a product, you need to know all the details of its usage and ignore the exclusions, which result in claim rejection-which can lead to significant financial losses. To help you understand the terms and conditions, or exclusions, that you may encounter while shopping for, or using, a health insurance policy, here are the most common ones. 

Initial Waiting Period – There are typically two exclusions in a policy, initially and later on. The initial exclusion is that from the date when you purchased the policy, until the period of 30-90 days after purchase (depending on your policy), any claim you make will be rejected, though there may be exceptions for emergency situations. 

Waiting period for pre-existing conditions –   There is a waiting period for claims pertaining to pre-existing conditions; any claim relating to a pre-existing disease will be rejected during this timeframe. The policy might state that you cannot recover any costs associated with asthma for a period of one year after the date of purchase if you disclosed asthma as a pre-existing condition at the time of purchase and you make a claim for treatment costs incurred for the condition, but even after the 30–90-day initial waiting period is over, your claim may still get rejected. This happens because the policy might state that asthma costs cannot be claimed within one year of purchasing the policy. 

Specific Waiting Period – Maternity coverage is another common waiting period. This is a fixed period that is used as the basis for the waiting period. Maternity benefits may have a waiting period in some policies. The insurance company may allow you to claim benefits after 9 months from the date your policy was purchased, if you placed the order in June 2016. Others require waiting periods of 24 or 36 months. 

Permanent Exclusions – Exclusions that you can never expect your policy to cover: These are the conditions that will never be covered by your policy. Diseases such as diabetes, sexually transmitted diseases, cancer, or even expenses relating to treatment for unexpected accidents, specific medicines that may be expensive, eyewear and prosthetic limbs could be included. A policy with enhanced coverage that excludes only a shorter list of permanent exclusions may also encompass treatment in intensive care units (ICUs) and critical care. Take the time to review the list thoroughly to make sure you do not have any surprises once the program has started. 

Room Eligibility – There is nothing trivial about room eligibility. However, many policyholders are shocked when they get a claim rejected, partially reimbursed, or only partially preapproved because the room rent is more than the range set forth in the policy. When your policy states that only 1% of the total insured sum can be allocated to room rent charges at the hospital, then charges above that amount will not be reimbursed. You will only be eligible for a room rent of Rs5,000 per day if your policy covers you for a sum of Rs5 lakh. Different types of rooms are billed differently at hospitals, based on the number of medical expenses incurred. In other words, if you choose a room costing Rs6,000, the related medical expenses also will be charged, so you can only use your policy to cover those associated with an Rs5,000 room. It will be necessary to pay the remainder out of pocket.   

Frequently Asked Questions: 

What is the waiting period of Maternity Health Insurance?

Ans –   Prior to benefits becoming available, maternity insurance policies require a waiting period of 3-4 years. Check the policy wordings before paying the premium to make sure that the insurer provides maternity cover. 

Can you take out health insurance when you are pregnant? 

Ans – Almost any time you apply for a health insurance policy, you can apply while pregnant. When you are pregnant, it’s common to take out a health insurance policy to protect your dependents if you die untimely.   

What is covered in all these insurance plans?  

Plan participants are covered for Maternity Expenses up to the Maternity Sum Insured specified in the Policy Schedule following a waiting period of 24 months for the delivery of a child and Maternity Expenses relating to medically necessary treatment or lawful medical termination of pregnancy. It is only covered up to a maximum of two events, including, but not limited to, the following: 

  • 2 deliveries (including twins) or 
  • 2 terminations or 
  • 1 delivery (including twins) and 1 termination during the lifetime of an Insured Person between the ages of 18 years to 45 years 

What is not covered? 

  1. When stem cell harvesting and storage is being performed as a preventative measure against possible illnesses in the future, medical expenses will apply. 

(ii)         Any Pre-hospitalization Medical Expenses or Post – hospitalization Medical Expenses will not be covered under this Benefit 

(iii) It will not be possible to cover any Reloaded Sum Insured under this benefit. 

Conditions: 

  •  All claims will be covered by the Maternity Expenses cover up to the amount of the Maternity Sum Insured. 
  • Vaccination expenses are only covered if the Insured Person whose maternity claim has been accepted by Us continues to keep the Policy with Us during the period. A policy year has four quarters during which vaccination expenses can be claimed for reimbursement. 
  • As outlined below, benefits will be available to eligible policyholders on an individual basis, up to the limits stated in the Policy Schedule for an Individual Policy, and to all eligible policyholders on a floater basis, up to the limits stated in the Policy Schedule for Family Floater Policies. 

Every Insurance Plan has its own conditions and benefits kindly read all the terms before taking any insurance plan. 

Why maternity is not provided in insurance? 

Ans – The majority of insurance companies do not provide maternity insurance for pregnant women. Pregnancy is considered a pre-existing condition and is beyond the policy’s coverage. 

Can husband wife both claim maternity health insurance? 

Ans – Both husband and wife may claim from the insurance provided by their employers if both are covered. 

What is the difference between SMP and maternity allowance? 

Ans – Unlike Maternity Allowance, Statutory Maternity Pay is dependent on eligibility and benefits that are available to employees during maternity leave (and whether the employer is obliged to pay) Normally, you can obtain just over 90% of Statutory Maternity Pay back from the government. 

Age criteria to get the health insurance? 

Ans – Generally, the minimum entry age for maternity insurance is 18 years, with the maximum age being 45 years. For children, the entry age is 1 day to 24 years, but may vary from company to company. 

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