Inclusions And Exclusion In Maternity Health Insurance

While you are all excited about your pregnancy and delivery, one thing that you and your spouse or partner need to avoid at this stage is unnecessary anxiety and worries. This is the best time of your life and you should enjoy it, cherish the moments and retain these fond memories for a lifetime.

Unfortunately, medical expenses in India are very high, especially in the metropolitan cities. In 2022–23, the medical trend rate in India – medical inflation – was 14 per cent, the highest in Asia and higher than the global average of 10.7 per cent for the same period. A Caesarean – Section delivery in a quality medical facility can range between Rs 75,000 to Rs 2,00,000 in the more expensive cities. In case of any complications in your pregnancy or delivery, these costs may rise further. The cost of treatment often becomes unaffordable for a lot of people.  Such significant expenses and related implications are enough to give you and your spouse or partner sleepless nights.

What is Maternity Health Insurance?

You should purchase health insurance with maternity cover to safeguard yourself financially and ensure you and your newborn baby have access to quality maternity care. A maternity insurance policy is tailored to meet the expenses associated with your pregnancy, delivery and newborn child. In other words, a pregnancy insurance policy acts as a safety net that will absolve you of your pregnancy-related financial worries and allow you to make the best of your pregnancy.

As per the Insurance Regulatory and Development Authority of India (IRDAI), maternity expenses or treatment in the context of insurance for pregnant women includes the following:

1. Medical expenses during hospitalisation for delivery – including C-Sec and complicated deliveries
2. Legal, medical termination of pregnancy – subject to a maximum of two deliveries and terminations during the entire lifetime of the person who has been insured
3. Medical expenses both, pre-natal and post-natal, incurred either during a delivery or termination

Why Should You Opt for a Maternity Insurance Policy?

Following are the reasons as to why you should opt for a pregnancy health cover:

Early Planning for Parenthood 

There is no fixed age for you to become a parent. Pregnancy insurance is a vital part of your phase of family planning. Ideally, you should purchase your policy when you get married or start living together if you plan to go the family way early.

Financial Comfort 

Welcoming your bundle of joy into the world feels amazing, but it also brings with it additional responsibility in the form of increased expenses. Maternity insurance largely spares you from additional expenses in this crucial period.

Coverage for Complications 

While we all desire a smooth pregnancy, unfortunately, unforeseen complications can arise. Your pregnancy health cover will take care of the related expenses, leaving you free to deal with the situation smoothly.

Coverage of Maternity Expenses: 

The costs relating to pregnancy, delivery, and maternity can add up to quite a lot. Your insurance policy for pregnant women will bear the financial impact, leaving you free to enjoy your baby’s arrival.

Covering Gaps in Group Insurance Cover Provided by Your Workplace: 

The coverage provided by your employer-provided group health insurance policy is subject to sub-limits for pregnancy and is inadequate in taking care of the total expenses. Your personal health insurance with maternity cover helps cover the gaps.

Like any other insurance policy,  maternity health insurance has specific inclusions and exclusions. You need to read and understand these very clearly to have a fair idea of them. Please go through the terms and conditions of the policy and all the fine print we tend to avoid reading to know what is included and what is not. Knowing this will help you purchase the right policy that matches all your requirements and will ensure you are not disappointed when you need your policy the most.

Inclusions in Maternity Health Insurance

A typical list of features included in a maternity insurance policy is as follows:

1. Delivery Charges: Delivery charges are covered, whether a normal delivery or a C-section delivery. All expenses covering delivery, including the surgeon’s fees, are included.
2. Pre-natal and Post-natal Care: Your health insurance policy will cover the medical expenses incurred before and after your delivery. Doctor’s fees, tests and medicines for you and your baby are all included in the coverage provided by your maternity insurance policy.
3. Hospitalisation expenses: Maternity insurance covers all hospital expenses, including room charges and nursing charges.
4. Coverage for New Born Baby: Your newborn baby is covered by your maternity health insurance policy for one year. All expenses relating to vaccinations, medicines, ventilator care if necessary, and health check-ups are all included in the coverage.
5. Pre-Hospitalisation and Post-Hospitalisation Expenses: Your pre-hospitalisation and post-hospitalisation expenses are included in the coverage provided by your health insurance with maternity coverage. The number of days covered in both instances depends upon the terms and conditions of your maternity health insurance policy.

Exclusions in Maternity Health Insurance

Your maternity health insurance policy has a comparatively low cover for maternity benefits. The cover is subject to sub-limits and ranges between Rs Twenty thousand and Rs One lac. Another issue you may face is the tendency to reject claims if you are pregnant beyond the age of 35. 

A list of common exclusions in maternity health insurance policies is as below:

1. Waiting Periods: Nearly all maternity health insurance policies have a waiting period ranging from two to six years. Any pregnancy-related claim filed within the waiting period of the specific policy will be rejected.
2. Pre-existing Diseases and Conditions: Maternity health insurance policies do not cover pre-existing diseases. Even pregnancy is treated as a pre-existing condition if you purchase your policy after you are pregnant, and the claim will get rejected.
3. Regular Check–Up: Your visits to the doctor for your regular check-up periodically are excluded from the coverage of a maternity insurance policy.
4. Consultation and Diagnostic Tests: Most maternity health insurance policies do not include consultation fees and diagnostic tests in the nine months of your pregnancy. Consultation and diagnostics are only covered when you are hospitalised for your delivery.
5. Complications from Unrecognised Procedures: Many insurers exclude the expenses arising from complications from any treatments or procedures not recognised by medical authorities. For example, in case you have any complications arising out of pre-natal gender determination tests, which are illegal in India, your claim will be rejected.
6. Medical Expenses of Ectopic Pregnancy: Maternity health insurance policies do not cover any costs relating to an ectopic pregnancy, where the pregnancy occurs outside the uterus, usually in one of the fallopian tubes.
7. Non-Medical Expenses: All maternity health insurance policies will reject non–medical expenses like diapers, blankets, baby’s clothes, or any other personal item.
8. Multiple Births: As per IRDAI, all maternity insurance policies cover a maximum of two births and two legal medical termination of pregnancy (MTP) procedures in one’s lifetime. Insurers will reject any birth or MTP procedures beyond this. Also, some policies may only cover a single birth at a time. You need to refer to the terms and conditions of your policy if you are expecting twins, triplets, or more.
9. Infertility Treatments: Maternity health insurance policies do not cover infertility treatments. Your claim for In vitro fertilisation (IVF) will be rejected.
10. Supplements: Maternity insurance policies exclude the cost of supplements like tonics and vitamins.
11. Late Pregnancy: Most maternity insurance policies do not include coverage for a pregnancy after age 45.
12. Alternative Birth Methods: Your maternity insurance policy may not include alternative birth methods. If you plan to use any such method, you must check with your health insurance company to avoid unpleasant surprises later.
13. Unrecognised Providers: Your maternity insurance policy may only support listed healthcare providers. Please check and confirm that your health insurance company recognises your providers.
14. Harvesting and Storing of Stem Cells: The harvesting and storing of stem cells is not included in the coverage provided by your maternity insurance policy.

This brings us to the question of the best health insurance for pregnancy. In India, there are no health insurance policies that exclusively provide maternity insurance. It is offered as a feature or as an add-on to a regular health insurance policy.

Care Health Insurance presents Care Joy, a product offering maternity health insurance specially designed for young couples planning to start a family. The policy focuses on maternity-related hospitalisation but also covers other hospitalisations while in force.

Looking exclusively at maternity benefits, Care Joy offers maternity benefits, including pre–natal and post-natal care up to Rs 50,000. Your newborn baby is covered from Day 1 until 90 days of age up to a maximum amount of Rs 50,000. 

Care Joy Today variant comes with a waiting period of maternity of only nine months. Also, the benefits of maternity expenses are applicable till the age of Forty-five.

Care Joy offers a number of pertinent value-added services without any waiting period.

Conclusion

Maternity cover is a handy feature to have in your health insurance coverage. Like all other insurance products, there are several inclusions and exclusions in this type of coverage. Do read your policy details carefully to be aware of these.

>> Also Read: Factors Before Investing in Maternity Cover

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.