Planning for a baby would be one of the most exhilarating yet challenging phases in life. The responsibility of safeguarding the health and well-being of the mother-to-be and the infant begins right from the moment of taking this life altering decision. The financial commitment can be quite overbearing for many, given the high costs of pregnancy and childbirth. Timely preparation by investing in the right health insurance plan with ample maternity cover will help mitigate the burden on personal savings to a large extent.
Maternity benefits are largely offered through add-on covers i.e., optional riders in the base health policy with additional premium payable. These benefits are available in varying combinations of features and conditions that differ across insurers.
Listed below are seven key policy features to be aware of before buying health insurance with maternity coverage.
1] Waiting period: Most insurance companies in India require a waiting period on maternity coverage which could range from nine months to four years. This means that an ongoing pregnancy will not be covered by a standalone health insurance cover. Even if the mother-to-be is insured under group medical cover (either as the primary member or the spouse of the employee), it is important to cross-verify whether maternity is covered at all, and whether the coverage is effective from day 1. If not, then the couple should consider investing in a personal health insurance cover with maternity benefits, well in advance, to minimise medical overheads, and comfortably complete the applicable waiting period in time to avail themselves of the maternity coverage.
2] Pre- and post-partum care: The chosen option should ideally provide for pre- and post-delivery care-related expenditure (such as diagnostics and ultrasound, regular check-ups, consultations with OB-GYN etc.). Certain insurers offer such benefits up to a specified number of days (for example, some plans cap this at 90 and 45 days, respectively). It is important to note that not all plans with maternity riders offer such features. It would be prudent to cross-verify the inclusion of these expenses within the shortlisted plan to avoid any claim rejections in future.
3] Delivery charges and room category: Childbirth surgical procedures related to normal or caesarean delivery should be included in the maternity coverage, preferably up to the sum insured amount of the plan. Moreover, the new mother should have access to the desired room in the hospital (single A/C or suite), so that she can recover in comfort.
4] Sub-limits: Maternity expenses-related coverage amounts could vary from a pre-determined sum to a percentage of the overall sum insured amount. In some plans, it could be up to the full sum insured amount, subject to policy conditions. Some insurers allow policyholders the flexibility to decide on the requisite maternity coverage amount for a nominal additional premium.
5] Exclusions: Certain aspects of pregnancy, such as deliberate terminations, unless medically advised, ectopic pregnancies, assisted reproductive treatments (such as IVF) etc. could be omitted from maternity coverage. It is important to go through the terms and conditions attached with the maternity coverage to ensure complete understanding of all the nuances.
6] Other terms and conditions: One should look out for other relevant terms and conditions, such as the number of deliveries allowed (some insurers allow up to maximum two deliveries during lifetime), maximum age of the mother (some plans specify 45 years of age). Few insurers insist that the spouse should also be covered under the same floater plan.
7] Just born and newborn coverage: Not all health insurance plans with maternity benefits cover the newly born baby by default. Depending upon the insurer and the selected plan, the just born baby could be automatically included within the mother’s insurance coverage. Or, the baby could be included only for up to 90 days after birth, post which the baby will have to be insured for extra premium payable. Moreover, the coverage amount could be up to a restricted amount. Infant inoculations, if covered, could be as per the list provided by the insurer, or up to a specified amount.
Deciding upon the right add-on cover for maternity benefits should be done based on a careful study of the terms and conditions. Compare the various plans and select the one most suitable for you.
The author is co-founder, SANA Insurance Brokers Pvt. Ltd.
(Disclaimer: Views expressed are the author’s own, and Outlook Money does not necessarily subscribe to them. Outlook Money shall not be responsible for any damage caused to any person/organisation directly or indirectly.)