Welcoming a newborn baby into this world is the happiest moment for parents. However, having a child comes at a cost. Cost should not overshadow the happiness of parents, this is where maternity coverage in health insurance comes into the picture. In this article, we will understand what maternity coverage is and what you should look for before choosing a plan.
What is maternity coverage in health insurance?
Maternity coverage is part of health insurance and covers medical treatment expenses related to pregnancy and delivery. This includes normal delivery and cesarean section (C-section) delivery. Maternity coverage also covers the expenses for legitimate medical termination of pregnancy during the policy period.
Typically, maternity cover includes the following:
- Expenses related to delivery: Hospitalization, room rent, diagnostic tests, operation theatre, doctor consultation, nursing, medicines, etc.
- Pregnancy complications during hospitalization
- Prenatal and postnatal care (usually up to 90 days)
- newborn baby care
Before finalizing a policy, please read the policy wording to understand exactly what is included and what is excluded. Some plans cover vaccinations for the first year.
What to look for?
When choosing maternity coverage, one should consider the following things.
- waiting period
Most health insurance plans offered to retail customers come with a waiting period for maternity coverage. The waiting period usually ranges from 9 months to 48 months. The shorter the waiting period, the better.
Some companies offer the same plan in different variants. Generally, in higher variants of the plan, the waiting period is less than the base variant. For example, Niva Bupa Aspire Health Insurance Plan is offered in four variants. The maternity waiting period for the 4 variants is as follows: Gold+ (48 months), Diamond+ (24 months), Platinum+ (9 months), and Titanium+ (9 months). As the plan version goes higher, the premium increases as it offers more or more benefits.
In some products, the waiting period for maternity coverage depends on the type of product chosen. For example, in the super health insurance plan offered by SBI General Insurance, the waiting period for maternity coverage varies with the product type. For an individual policy (covering a single adult), the waiting period for maternity coverage is 48 months. However, for family floater plans, the waiting period for maternity coverage is 24 months.
If you’re planning to start a family and want to cover childbirth expenses through health insurance, you need to plan in advance. You will need to purchase a health insurance plan with maternity coverage that has a waiting period that suits your needs.
Most corporate plans do not have a waiting period for maternity coverage. Even though some plans have a waiting period, it is usually much shorter than retail plans.
2. Coverage Sub-Limits
You may have chosen a health insurance plan with a specified sum assured. However, keep in mind that maternity coverage has sub-limits within the sum insured. Most plans have separate sub-limits for normal delivery and C-section delivery. If the hospitalization bill for delivery related expenses exceeds the sub-limit, the difference will have to be paid from one’s own pocket.
In most plans offered in multiple variants, the sub-limits for maternity coverage vary with the plan variants. Generally, the higher the version of the plan, the higher the sub-limit for maternity coverage, and the higher the premium of the plan.
For example, SBI General Insurance offers Super Health Insurance plan in 5 variants. The sub-limits of maternity coverage for the 5 plan variants are as follows.
plan type |
Maternity Coverage Sub-Limits |
|
main |
Not applicable |
|
Aristocrat class |
Not applicable |
|
Prime |
Normal Delivery: Rs. till. 25,000, C-section delivery: Rs. till. 50,000 |
|
platinum |
Normal Delivery: Rs. till. 50,000, C-section delivery: Rs. till. 75,000 |
|
platinum infinity |
Up to Rs. 2,00,000 |
Source: SBI General Insurance website
In some plans, the maternity coverage expense limit is linked to the basic sum assured. For example, Manipal Cigna Health Insurance’s Sarva Plan (Best Edition) follows it. Under this plan, maternity cover is up to 20% of the basic sum assured chosen, subject to a maximum of Rs. An option of Rs 5 lakh in addition to the basic sum assured was chosen.
3. Number of deliveries covered
The next thing you should check is the number of deliveries covered. Most plans usually cover up to 2 deliveries. For example, Manipal Cigna’s Serva Plan (Superior Edition) provides coverage for a maximum of 2 deliveries or terminations.
4. Whether included in the base policy or offered as an add-on
Maternity coverage is either built into the basic policy or as an optional add-on. For some policies that are offered in multiple variants, the lower version may not include maternity coverage, and the higher version may include maternity coverage.
For example, in SBI General Insurance’s Super Health Insurance Plan, the Prime and Elite variants do not offer maternity coverage. Higher variants including Premier, Platinum and Platinum Infinite offer maternity coverage.
Manipal Cigna’s Sarva Plan (Superior Edition) offers maternity coverage as an optional cover. This has to be added to the base plan with additional premium payment.
You should also check if there is a different limit for a baby boy and a baby girl. For example, Tata AIG’s Medicare plan offers different coverage limits for a baby boy and a baby girl. Under Medicare Lite and Medicare Premier variants, for a child, the coverage is up to Rs. 50,000 for sum insured up to Rs. 50 lakhs, and Rs. till. Rs 1 lakh for sum assured. 75 lakh or more. For a girl child, the coverage limit is as high as Rs. Rs. 60,000 for sum assured up to Rs. 50 lakhs, and Rs. till. For sum assured of Rs 1.2 lakh. 75 lakh or more.
Choosing the Best Maternity Coverage
Today, there are hundreds of health insurance plans with maternity coverage available in the market. It can be overwhelming to look at the details of so many plans and choose the best option. Therefore, you should consult a health insurance advisor. They will analyze your needs and accordingly, recommend a suitable health insurance plan with the best maternity coverage to suit your needs.
