Maternity Insurance: Coverage, Claim & Exclusions

Updated: 15-09-2023 09:16:00 AM

Bringing a new life to the world is a big responsibility. However, this new responsibility brings in not only happiness and excitement, but also hospitalisation expenses. And to manage the pregnancy-related expenses, one can go for maternity insurance under a health insurance policy.

What is Maternity Insurance?

Maternity insurance, a part of the health insurance, covers the cost of delivery and related aspects, be it a normal delivery or a caeserean. At times these costs can dig a big hole in the pocket. Thus, maternity insurance can be a big saving grace at such times. It covers hospitalisation, pre-natal and post-natal expenses, pre-delivery care as well as post-delivery care.

What all Maternity Insurance Covers?

Let us look at the broader categories covered under maternity insurance, though they may vary for different categories.

• Pre–and post-hospitalisation: Pre-hospitalisation expenses up to 30 days prior to the date of admission to the hospital. For post-hospitalisation, expenses up to 60 days prior to the date of discharge from the hospital is covered.
• Hospitalisation expenses: Room charges, boarding and nursing expenses along with surgeon, anaesthetist, medical practitioner and consultant fees. Moreover, some of the insurance plans also provide cover for emergency ambulance charges.
• Pre- and post-natal cover: Delivery,including pre- and post-natal expenses, is included.
• Coverage for new-born baby: Infants, if they are diagnosed with congenital disorder or critical illness.
• Vaccination cover: Coverage under reasonable and customary charges for vaccination are included for new-born baby.

Eligibility Criteria

To be eligible to avail the benefits of maternity insurance, most of the insurance providers have kept the minimum entry age at 18 years, with the maximum being 45. For children, it is 1 day to 24 years, though it may vary for different insurance companies.

Maternity Insurance Claim Process

On being hospitalised for the delivery, you should immediately inform the insurance company to take the claim process forward. The claims can be both cashless and reimbursement. Let us look at the process:

• After informing the insurance provider through the website or toll-free number, submit the duly filled in claim form
• The hospital will verify and then forward the required documents submitted by you to the insurance company
• If you are admitted to the network hospital, then after verification, the insurance company will directly pay the hospital as part of the cashless claim payment
• In case you could not admit to the network  hospital or for some reason, your claim was rejected under cashless payment, you will be entitled to get the payment under reimbursement system
• For the above mentioned method, you will make the hospital payment on discharge; however, after submitting the documents and the bill to the provider, you will be reimbursed

Documents Required for Claim Process

While making claims for maternity insurance, you should have certain documents in place to make it a smooth process. Here are some documents required to claim maternity insurance policy, though the list of documents varies for different companies.

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

Cases Where You Can’t Claim Maternity Insurance (Exclusions)

Before buying a maternity insurance plan, individuals need to understand the features of the plan well so that maximum output can be enjoyed.  You should be aware that some expenses are not included in the plan. Some of them are:

• Expenses spent on tonics and vitamins mentioned in the plan
• Doctor’s visit for regular checkup
• Diagnostic tests and doctor’s consultation during the pregnancy (9 months)
• Treatment costs regarding infertility treatment

Companies Offering Maternity Insurance in India

Some of the insurance companies providing maternity insurance as part of the health insurance are:

• • Royal Sundaram
  • Religare
  • Star Health
  • HDFC ERGO

Important Aspects

While buying a maternity insurance, you should understand all the aspects in order to get the best deal, and you don’t regret later. Let us look at some points to be kept in mind while opting for this insurance.

• Always check and compare the insurance company and the plan before finalising one
• Know the waiting period to  claim the benefit
• Know the exclusions and the coverage that would suit your needs and  requirements

Advantages of Buying Maternity Insurance

Considering the soaring medical costs, it makes sense to take a maternity insurance so that the medical expenses do not minimise the happiness associated with going the family way. Here are some of the advantages of purchasing a maternity insurance.

• It covers hospitalisation charges, including hospital room rent and  other expenses, so one can be relieved of these expenses
• It also takes care of pre and post hospitalisation expenses
• It also covers pre and post natal care
• The premium paid under the insurance offers tax benefits under Section 80D of the Income Tax Act, 1961

FAQs

Q1. I am already pregnant. Can I get a maternity insurance coverage?

Most of the insurance companies count for pregnancy as pre-existing condition, you will not get coverage under the plan if you are already pregnant.

Q2. What is waiting period?

Waiting period is the time an insured must wait for before all coverage comes into effect. For some insurance companies, waiting period for the plan can be 3-6 years after which the policyholder can claim the benefits. However, group insurance policies have a waiting period of 9 months for maternity coverage.

Q3. What happens when a child is born with a birth deformity?

If a child is born with deformity, critical illness, disease, injury or others, it is termed as congenital condition. Under the maternity insurance plan, a child is provided with new born coverage where the policyholder can claim for the expenses related to the treatment.

Q4. What is the minimum sum assured under maternity insurance?

Minimum sum assured is different for different insurance companies. Individuals must read the policy document carefully before taking any maternity insurance policy.