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  • Maternity Health Insurance Plans - An Overview

    What is Maternity Health Insurance?

    Maternity insurance provides cover for maternity-related expenses. According to latest reports, the average age of women becoming mothers has risen to 32 to 33 years in India. There is a view that women who have their first child in their early 30s are more likely to have complicated pregnancies. Significantly, the ratio of caesareans to normal deliveries stood at 65:35 in metropolitan cities, according to a study done in the recent past. Several women are, therefore, increasingly opting for health insurance plans which offer maternity expenses as well. Typically, maternity insurance plans come with high premiums and long waiting periods.

    Maternity-related expenses are covered in the form of riders of a health insurance product (policyholders will be charged additional premium for the cover). In some cases, maternity coverage comes under the ambit of OPD related expenses. In other cases, group policy in the company encompasses maternity insurance.

    Features and Benefits of Maternity Health Insurance:

    The salient features and benefits of health insurance for maternity coverage are listed in the table below:

    Features

    Description

    Waiting period

    Most maternity health insurance policies have a waiting period of 3 to 6 years in that a policyholders can claim benefits only after the said period of time post commencement of insurance policy. Group insurance policies which offer maternity coverage have a waiting period of 9 months (sub-limit not above Rs.50,000)

    Inclusions/Coverage

    Varies according to the insurance provider but the general expenses which may be covered are as follows:

    • Hospitalization expenses (with a cap)
      • Pre-hospitalization expenses:30 days
      • Post-hospitalization expenses: 60 days (room charges, nursing expenses, anesthetist charges)
    • Delivery expenses
    • Vaccination of the infant (some cases)
    • Ambulance charges
    • Pre and post-natal expenses (depends upon the type of delivery - caesarean and normal)
    • Baby cover (if newborn is diagnosed with congenital disorders)
    • Emergencies (several insurance providers cover emergencies for up to Rs.50,000)

    Premium

    A health insurance policy with maternity benefit is expensive as it is considered a high risk product owing to almost 100% claim ratio as opposed to other insurance policies. Premium, which is typically higher than basic policies, depends upon various factors as listed below:

    • Type of industry
    • Risk factors
    • Age profile
    • Number of employees (group policies)
    • Company location (group policies)

    What's the Right Time to Seek?

    Maternity is a life-altering journey for a women in more ways than one. With rising medical inflation and overall expenditure, childbirth-related expenses have become expensive. Lack of proper planning may result in you burning a hole in your pocket which may override the happiness of being blessed with a child. According to experts, you should plan well in advance given that maternity health insurance policies, typically have a long waiting period, which may prove to be tricky for most consumers.

    Given that most insurance companies do not offer maternity health insurance to women who are already pregnant, deeming it as a pre-existing condition, women who wish to take maternity insurance should apply for it before they conceive. It is important to note that most maternity health insurance policies have a waiting period of 3 to 4 years. Maternity health insurance is, therefore, a critical aspect of a planned pregnancy.

    Exclusions:

    • Non-allopathic treatment costs
    • Consultation fees
    • Regular check-ups
    • Medicine costs
    • Congenital diseases
    • Termination of pregnancy (under 12 weeks)
    • Pre-existing ailments or injuries diagnosed within 48 months of the policy commencement
    • Expenses related to self-inflicted injuries, drug use or alcohol
    • AIDS treatment-related expenses
    • Dental treatment expenses
    • In-vitro fertilisation and infertility-related expenses

    Claims Process:

    While the claim process may vary from one insurance provider to another, in most cases, policyholders have to follow the below mentioned procedures

    • Claim intimation (Emergency cases within 24 hours of hospitalisation and planned hospitalisation within 48 hours)
    • Cashless pre-authorisation entails the following:
    • Fill out the pre-authorisation form available at TPA desk or download it from the insurance provider’s website.
      • Upon receiving the pre-authorisation form, the claim management team of the insurance company sends a letter of approval
      • You can then file for your re-imbursement claim
    • Re-imbursement claim process entails the following:
      • You have to fill in and submit the claim form in addition to the documents required to the insurance company
      • Upon receiving the said form, the claim management team of the insurance company sends a letter of approval

    Some of the Maternity Insurance Plans:

    The following are some of the maternity health insurance plans available in India:

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