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Why Women Should Consider Health Insurance with Maternity Benefits?

Team AckoJun 20, 2024

The arrival of a newborn brings immense joy to a family, yet parenthood is filled with challenges. Mothers endure physical discomfort during childbirth, while fathers offer unwavering support throughout the journey. From conception to postnatal care, caring for a child is a demanding task. This includes medical checkups, medications, hospital visits, and delivery expenses, all of which require significant financial investment.

With healthcare costs on the rise, particularly concerning pregnancy-related expenses, obtaining health insurance with maternity coverage is necessary. Such coverage alleviates the financial burden associated with prenatal and postnatal care, ensuring that parents can focus on their child's well-being without the added stress of exorbitant medical bills. Investing in comprehensive health insurance not only provides financial security but also peace of mind during this transformative phase of life. Read ahead to know more about maternity health insurance.

Why

Contents

What is Maternity Coverage in Health Insurance?
- Pre- and Post- Natal Expenses
Maternity Health Insurance Coverage
Waiting Period
Premium
Major Exclusions
Group Health Insurance
Need for a maternity cover
Tips to Avoid Mistakes While Choosing the Insurance
Eligibility Criteria
- Exclusion Criteria
Own Fund

What is Maternity Coverage in Health Insurance?

Maternity coverage within health insurance is a specialised policy catering specifically to women, often offered as an add-on to standard health insurance or mediclaim plans. Its primary aim is to alleviate the financial strain associated with pregnancy and childbirth. This coverage spans a wide range of expenses related to pregnancy, starting from prenatal care in the later stages of pregnancy, proceeding through the costs of both normal and caesarean deliveries, and encompassing any childbirth complications that may arise.

Pre- and Post- Natal Expenses

Although the specifics of coverage may vary across insurers, many maternity health insurance policies also cover pre- and post-natal expenses. These can include ultrasound scans, consultations with healthcare providers, medications, and post-delivery care for both the mother and the newborn. Nonetheless, it's essential to understand that maternity coverage typically excludes expenses related to pre-existing conditions affecting pregnancy, congenital diseases, or infertility treatments.

By offering financial assistance for pregnancy-related expenses, maternity coverage ensures that women have access to high-quality healthcare throughout their pregnancy journey without the burden of the often extreme costs associated with childbirth. This insurance type plays a vital role in promoting maternal health and well-being by eliminating barriers to essential prenatal and postnatal care.

Maternity Health Insurance Coverage

The following maternity health insurance coverage might vary from insurer to insurer.

Medical expenses related to hospitalization 30 days before delivery

Medical expenses related to hospitalization 60 days after delivery

Health complications in the mother post delivery

Expenses related to cesarean or normal delivery

Hospitalization charges such as: room rent, charges for nurse, surgeon, anesthetist charges, etc.

Cover for newborn baby for a period of 90 days covering critical illness

Waiting Period

Health insurance with maternity coverage has its waiting period. One might have to wait for a period of 9 months to four years to raise a claim. Therefore, it is suggested to plan accordingly and purchase health insurance for pregnancy as early as possible. The waiting period depends upon the insurer from whom you are purchasing the policy.

Premium

Unlike other health insurance policies where the chances of the event against which insurance is taken are less, here the event is almost certain. Therefore, the premium is on the higher side. You need to make a cost-benefit analysis based on the annual premium charged, the cover obtained, the cost of pregnancy care in your locality, and the waiting period.

Major Exclusions

There might be certain sub-limits (limit on the maximum amount payable by the insurance company) to your health insurance plan. Make sure to check them. Expenses beyond the sub-limit won’t be covered.

45 years is the age limit for the insured

Ectopic pregnancy is not covered

Group Health Insurance

Some employers also provide a pregnancy cover to their employees as a part of their group health insurance cover. If your employer provides such a cover, consider that policy’s extensiveness before purchasing or claiming against your individual plan.

Need for a maternity cover

The need for a maternity cover is felt especially in cases where you are not covered as a part of a group insurance plan or a regular health insurance plan. Make sure that you at least have some basic coverage. If not, include a maternity cover in your health insurance policy. The cover might not factor for the entire expenses related to maternity, but the payout will certainly lend financial support in meeting the total expenses.

Tips to Avoid Mistakes While Choosing the Insurance

Choosing the right health insurance plan can be a critical decision that impacts your financial well-being and access to healthcare services. To avoid mistakes and make an informed choice, consider the following tips:

Research Plans

Research different maternity insurance plans available in your area. Compare their coverage options, premiums, deductibles, copayments, and out-of-pocket maximums to find the best fit. Understand your healthcare needs, including any existing medical conditions, anticipated medical expenses, and the coverage requirements for you and your family members. Ensure that the maternity insurance policy includes your preferred doctors, hospitals, and specialists in its network.

Review Benefits

Pay attention to the specific benefits offered by each plan, such as prescription drug coverage, preventive care, mental health services, and maternity benefits. Understand the total cost of the insurance plan, including premiums, deductibles, copayments, and coinsurance. Consider how these costs will impact your budget and healthcare spending.

Evaluate the plan's out-of-pocket maximum, which is the most you'll have to pay for covered services in a year. Choose a plan with a reasonable out-of-pocket maximum to limit your financial risk.

Review Exclusions and Limitations

Carefully review the plan's exclusions and limitations to understand what services are not covered or have restrictions. Look for any clauses related to pre-existing conditions, waiting periods, or specific treatments. Research the insurer's reputation and customer reviews to gauge satisfaction levels, claims processing efficiency, and customer service quality.

If you're unsure about certain aspects of the insurance plans or need clarification, don't hesitate to reach out to insurance agents, brokers, or customer service representatives for assistance.

Eligibility Criteria

In India, maternity benefits are often integrated into existing health insurance plans, catering specifically to women aged 18 to 45. However, eligibility can be affected by factors like congenital disorders or fertility issues, and there's typically a waiting period of nine months or more before benefits can be utilised. Understanding the insurer's documentation is crucial for determining comprehensive eligibility. By tailoring these benefits exclusively to women, insurers aim to address the unique healthcare needs related to pregnancy and childbirth, thereby alleviating the financial burdens associated with prenatal and postnatal care.

Exclusion Criteria

Despite its advantages, the age restrictions and exclusion criteria underscore the importance of thoroughly reviewing policy terms. This ensures that individuals can make informed decisions about their healthcare coverage, guaranteeing comprehensive support throughout the stages of pregnancy and childbirth. It's imperative for individuals, especially women planning to start a family, to be aware of the specific terms and conditions of their health insurance policies. This proactive approach ensures that they can access the necessary support and resources when embarking on their journey to parenthood.

Own Fund

As there are a lot of sub-limits and a long waiting period associated with a maternity cover, it is wise to create our own fund. Newly married couples should create their own fund to meet future maternity expenses. This can be done by creating a fixed deposit account, by investing in low-risk mutual funds etc. Savings via an own fund, can help you to manage maternity-related expenses without any issues.

Bringing a child in this world is a wonderful feeling. Make sure you are completely ready to welcome the newest member of your family by availing the right insurance plan.

Also, read: Health Insurance for Women

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.