Maternity Health Insurance: Coverage, Benefits and Claim Settlement Process

Maternity health insurance policy provides financial assistance to women for all pregnancy-related expenses. This health insurance plan provides coverage for pre-hospitalisation, post-natal, day-care and other expenses. However, they usually have a waiting period. Read on to get a detailed insight into health insurance with maternity cover, benefits and how to choose one.

What is Maternity Health Insurance?

Maternity health insurance acts as a boon for women by providing financial coverage for pregnancy costs. Whether it is normal delivery, a C-section, a newborn’s vaccination or post-hospitalisation costs – comprehensive maternity insurance covers all big and small expenses. It enables women to get the best care and access to safe healthcare facilities. Maternity health insurance covers up to two pregnancies.

Benefits of a Maternity Health Insurance Policy

Here are the benefits of getting a maternity health insurance policy:

1. Provides Extensive Coverage

Maternity health insurance provides coverage for all the hospitalisation charges including ambulance charges, consultation fees, nursing expenses, room charges, OT charges, doctor’s fees, surgeon’s fees, anaesthetic consultation, regular check-ups before and after hospitalisation, vaccination costs, etc. It provides coverage for both normal and C-section deliveries. Moreover, if the need arises, it also covers the costs of pregnancy termination.

2. Provides Newborn Baby Coverage

A few maternity insurance plans provide newborn baby cover for at least 3 months from the baby’s birth. 

3. Provides Financial Support

Maternity health insurance keeps you financially prepared for planned or unplanned pregnancies.

4. Keeps You Stress-free

The charges of delivery in a private hospital can range from Rs.50,000 to Rs.1 lakh.  Moreover, deliveries are subject to complications, which may add to this cost. Thankfully, your maternity insurance plan will cover the cost of all necessary treatments.

5. Provides Day-care Treatments

Pregnancy insurance cover provides financial coverage for various doctor and medicinal expenses that require day-care treatments. These include treatments that do not require a patient to be admitted to a hospital for more than 24 hours.

6. Tax Benefits

Policyholders can claim deductions of up to Rs. 25,000 on the premium paid towards their plan under section 80D of the Income Tax Act, 1961.

Why Should You Buy Maternity Health Insurance?

Maternity expenses are usually not covered in most health insurance policies. Only the insurers providing fully inclusive medical insurance policies provide maternal and newborn coverage. Others offer maternity insurance as an add-on policy. As a result, many people do not know that their insurance policy does not cover pregnancy-related expenses.

Best Maternity Health Insurance Plans In India

Here are the top health insurance plans offering maternity coverage as an add-on in 2022:

Name of the Plan	Insurance Company	Sum Insured	Age of Entry
Activ Health Platinum – Enhanced Plan	Aditya Birla Health	Rs. 2 lakh to Rs. 2 crore	91 days and above
Smart Super Health Insurance Policy	Bharti AXA Health	Rs. 5 lakh to Rs. 1 crore	NA
Health Guard Gold Family Floater Health Insurance Policy	Bajaj Allianz Health	Rs. 3 lakh to Rs. 5 lakh	18 years to 65 years
SBI Arogya Premier Plan	SBI Health	Rs.10 lakhs to Rs.30 lakh	3 months to 65 years
Tata AIG Medicare Premier Plan	Tata AIG Health	Rs. 5 lakh to Rs. 50 lakh	Up to 65 years
Gold and Platinum Plan	Edelweiss Health	Rs. 20 lakh to Rs. 1 crore	90 days to 65 years
Future Generali Comprehensive Health Insurance (Superior and Premium)	Future Generali Health	Premium Plan – Rs. 50 lakh to Rs. 1 crore; Superior Plan – Rs. 15 lakh to Rs. 25 lakh	18 years and above
Heartbeat Family Floater Plan	Max Bupa Health	Rs. 5 lakh to Rs. 1 crore	18 years to 65 years
Privilege Healthline Insurance Plan	Cholamandalam	Rs. 5 lakh to Rs. 25 lakh	18 years and above
NaviCure	Navi	Rs. 2 lakh to Rs. 1 crore	18 years and above

6 Benefits Of Maternity Health Insurance Policy

Pregnancy is a challenging time for would-be mothers. However, having a financial safety net of pregnancy insurance policy, lets a mother prepare for childbirth better. Here are the benefits of getting a maternity health insurance policy:

1. Provides Extensive Coverage

Maternity health insurance provides coverage for all the hospitalization charges including ambulance charges, consultation fees, nursing expenses, room charges, OT charges, doctor’s fees, surgeon’s fees, anaesthetic consultation, regular check-ups before and after hospitalization, vaccination costs, etc. It provides coverage for both normal and C-section deliveries. Moreover, if the need arises, it covers the costs of pregnancy termination.

2. Provides NewBorn Baby Coverage

Maternity health insurance also covers the expenses of newborn baby care. A few maternity insurance plans provide newborn baby cover for at least 3 months from the baby’s birth.

3. Provides Financial Support

Maternity health insurance keeps you financially prepared for planned or unplanned pregnancies.

4. Keeps You Stress-Free

The charges of delivery in a private hospital can range from Rs. 50,000 to Rs. 1 lakh.  Moreover, deliveries are subject to complications, which may add to this cost. You don’t have to worry about the complications arising in your pregnancy, as your maternity insurance plan will cover the cost of all necessary treatments.

5. Provides Day-Care Treatments

Pregnancy insurance cover provides financial coverage for various doctor and medicinal expenses that require day-care treatments. These include treatments that do not require a patient to be admitted to a hospital for more than 24 hours.

6. Tax Benefits

Health plans with maternity coverage, just like any other insurance policy, extend tax benefits. Therefore, policyholders can claim deductions on the premium paid towards their plan under section 80D of the Income Tax Act, 1961. Individuals can claim up to Rs. 25,000 as a deduction under the ITA.

Who Should Buy Maternity Health Insurance?

You may purchase maternity health insurance if:

• You are newly married and plan to expand your family in the next few years.
• You are planning for a second child and want to ensure financial security.
• You are not married but plan to get married soon and start a family.
• You want to keep yourself financially prepared for an unplanned pregnancy.

Also Read: What Are The Benefits Of An Employer-Provided Health Insurance Policy?

Best Maternity Health Insurance Plans In India

Here are the top health insurance plans offering maternity coverage as an add-on in 2022:

Name of the Plan	Insurance Company	Sum Insured	Age of Entry
Activ Health Platinum – Enhanced Plan	Aditya Birla Health	Rs.2 lakh to Rs.2 crore	91 days and above
Smart Super Health Insurance Policy	Bharti AXA Health	Rs. 5 lakh to Rs. 1 crore	NA
Health Guard Gold Family Floater Health Insurance Policy	Bajaj Allianz Health	Rs. 3 lakh to Rs. 5 lakh	18 years to 65 years
SBI Arogya Premier Plan	SBI Health	Rs.10 lakhs to Rs.30 lakh	3 months to 65 years
Tata AIG Medicare Premier Plan	Tata AIG Health	Rs. 5 lakh to Rs. 50 lakh	Up to 65 years
Gold and Platinum Plan	Edelweiss Health	Rs. 20 lakh to Rs. 1 crore	90 days to 65 years
Future Generali Comprehensive Health Insurance (Superior and Premium)	Future Generali Health	Premium Plan – Rs. 50 lakh to Rs. 1 crore; Superior Plan – Rs. 15 lakh to Rs. 25 lakh	18 years and above
Heartbeat Family Floater Plan	Max Bupa Health	Rs. 5 lakh to Rs. 1 crore	18 years to 65 years
Privilege Healthline Insurance Plan	Cholamandalam	Rs. 5 lakh to Rs. 25 lakh	18 years and above
NaviCure	Navi	Rs. 2 lakh to Rs. 1 crore	18 years and above

How To Choose The Right Maternity Insurance Plan?

You can keep in mind the following things while choosing your maternity insurance plan:

• Specific Requirements

Every individual’s requirements are different. Therefore, compare insurers and maternity plans before deciding on one. Your maternity plan must cater to your specific requirements to the best of its ability. Check the list of coverages provided by the policy to ensure that all the necessary things are covered.

• Waiting Period

Maternity insurance waiting period ranges from 9 months to 48 months, depending upon the insurance company. During this period, a policyholder cannot avail of the benefits of his/her policy. Therefore, it is best to take note of a plan’s waiting period before buying it. It is best to buy maternity health insurance beforehand. 

• Premium Rate

Depending on the extent of coverage provided, premium rates for every plan differ. Therefore, you must find a plan that comes with comfortable premium rates to not strain your present budget.

• Standalone Policy Or Cover

Pregnancy insurance is offered as a standalone policy and also as an additional cover. Therefore, you must compare the benefits of a standalone policy and a cover to know which is more profitable for you. If your base health policy with an additional maternity cover offers better benefits, you shouldn’t need to buy a standalone policy and pay additional costs.

• Claim Settlement Ratio

Buy your policy from a reliable insurer that has a high claim settlement ratio.

• Eligibility

To be eligible for such insurance, most insurers have an entry age of 18 years, the maximum age being 45 years. Additionally, it ranges from 1-24 days for children. However, remember that the eligibility criteria differ for various insurance companies.

• Sub-Limits

Some plans come with a feature named sub-limit, wherein there is a cap on the maximum coverage that you can avail yourself. Additionally, bear in mind that plans with a sub-limit cover only 10-20% of the maternity expenses.

Maternity Health Insurance Claim Settlement Process

There are two types of claims available – cashless and reimbursement:

• Cashless Claim: Get the treatment done in any of the network hospitals of your insurer after intimating the insurance company. After a few formalities, the insurer will settle your claim, and you won’t have to pay any money.
• Reimbursement Claim: You can get your treatment from any hospital. You just have to inform your insurer. Then, you pay for the costs and save the bills. These bills have to be submitted to the insurer along with other documents. After proper verification, your insurer will reimburse the amount to you.

Irrespective of the type of claim, you should first ensure that you have crossed your policy’s waiting period. Otherwise, you won’t be eligible to claim the insurance, and your application will be rejected. 

How To Claim Maternity Insurance?

Follow these steps to make a maternity insurance claim:

• Inform the insurer about your claim and get it registered.
• Get admitted to a network hospital to avail of cashless claims. If you are admitted to a non-network hospital, you can pay the bills yourself, which will be reimbursed later.
• Fill out and submit the pre-authorisation form to the insurance company within 3-4 days in case of planned hospitalisation. For emergency hospitalisation, the same should be submitted within 24 hours.
• Your insurer will then assess your claim and approve it.

Documents Required For Maternity Insurance Claim

• ID proof
• Claim form 
• Policy documents
• Discharge summary
• Original hospital bill
• Pharmacy bill
• Fitness certificate
• Consultation bill
• Cashless claim forms
• Prescriptions for medicine or other items

In Which Scenarios Maternity Claims Can be Denied?

Under the following circumstances, an insurer can deny a maternity medical insurance claim:

1. Complications in pregnancy due to other diseases
2. Infertility treatments 
3. Abortion or voluntary termination of pregnancy
4. Congenital disorders (covered by some policies)
5. Regular check-up expenses
6. IVF or other forms of complex fertilisation processes
7. Cases of ectopic pregnancy
8. Claims made during the waiting period

What Does a Maternity Insurance Plan Not Cover?

Though the pregnancy  insurance plans cover almost everything related to pregnancy, there are a few things that are excluded from the maternity health cover:

• Costs of non-allopathic treatments
• Cost of regular follow-ups with your doctor.
• If hospitalisation is not recommended, it won’t cover expenses arising out of pre or post-natal conditions.
• It won’t provide for the costs of vitamins or tonics.
• In case of an ectopic pregnancy, coverage won’t be provided by maternity insurance. Instead, it will be covered under the base health policy.
• Expenses of treatment related to infertility
• Congenital diseases such as heart diseases, Down syndrome, and spina bifida in children after birth are usually not covered by these insurance policies. 
• Costs of medicines outside the purview of treatment

How to Save Tax with Maternity Health Insurance?

As per Section 80D of the Income Tax Act, 1961, maternity insurance policyholders can avail of a tax benefit of up to Rs. 75,000 on annual premium payments. 

Why Buy Family Health Insurance From Navi?

Here are a few reasons why you should choose Navi Insurance for your family health insurance plan:

• Flexibility in choosing the policy tenure, type, etc. depending on your needs and requirements
• Hassle-free, paperless services to their customers to achieve a higher level of customer satisfaction
• Buy the policy for yourself or your entire family, depending on your need
• Facility of adding optional covers
• Some family policies of Navi Insurance come with the option of lifetime renewability. This means you won’t have to worry about renewing your policy to stay protected. You will be covered for life
• Navi’s customer-first approach, you will receive prompt customer care services.

To know more about maternity health insurance you can download the Navi App 

Also Read: How Much GST on Health Insurance Should You Pay? Are there Any Benefits?

Mistakes to Avoid While Opting for a Maternity Insurance Cover

For a first-time maternity insurance buyer, one must consider the following important factors while buying the right maternity insurance:

• Opting for lower-premium plans: Any health-related situation, including childbirth, is unpredictable. Therefore, it is always advised to choose maternity health insurance with significant coverage. It is advised to carefully research and then choose the best maternity insurance.
• Not getting coverage for the baby: The presence of baby coverage when buying maternity insurance should be considered.  A good health insurance provider will accommodate complete coverage for the mother and the infant, until a certain period.
• Knowing about the Sub-limits of the insurance: Most health insurance plans that have maternity cover have certain sub-limits. This means that even if you have a maternity cover for a few lakh Rupees, you will not get the full amount during the payout, and one may end up paying certain expenses from their pocket. 

Final Word

A maternity health insurance plan provides extensive financial coverage for all pregnancy-related expenses. Getting financial cover allows the mother-to-be free from stress and helps avail the best quality treatment and medical facility for safe childbirth. Maternity health insurance is always a wise choice to keep yourself financially prepared. Once you cross the waiting period, you can enjoy all benefits of the maternity plan for welcoming parenthood without fretting about finances.

FAQs On Maternity Health Insurance Policy

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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.