Pregnancy And Health Insurance: What You Must Know

You and your partner are overjoyed because you are expecting a baby. You have already started thinking about baby names, painted the nursery, and even bought some baby clothes. But then, a thought crosses your mind: how will you cover the costs of delivery, doctor visits, and everything else that comes with pregnancy? You may have health insurance, but does it cover pregnancy expenses? It is an important question, especially when medical bills can start piling up. Let's find the answer to this.

Does health insurance cover maternity expenses?

Yes, most health insurance plans provide coverage for pregnancy, but with certain terms and conditions. If your standard plan excludes pregnancy, you can opt for a maternity add-on available at an additional premium over your standard health plan premium.

Let's understand what the insurer actually covers when it comes to pregnancy.

1. Delivery expenses

A health insurance policy with a maternity add-on covers C-sections and normal deliveries. The policy covers the procedures and includes medication costs, doctor's fees, room rent, and other associated expenses.

However, it is essential to check with your insurer whether they cover consumable items, such as surgical tape and similar items.

2. Pre and postnatal care

Prenatal care includes medical expenses incurred during pregnancy, such as ultrasounds, doctor visits, and medical screenings. On the other hand, postnatal care refers to medical expenses necessary to maintain the health of both the baby and the mother, including follow-up check-ups, treatments, and vaccinations.

However, it is important to check if the amount covered under the policy is capped for prenatal expenses.

3. Cashless treatment

Maternity insurance providers have partnerships with advanced healthcare facilities across India. When undergoing a C-section or a normal delivery at such a facility, you don't need to pay anything except the deductible. The insurer will directly settle the medical costs for the covered expenses with the hospital.

4. New-born baby expenses

When a baby is born, his/her immune system is still developing, making the infant susceptible to multiple diseases. Even after taking all precautions, if the baby contracts any ailment, maternity cover extends coverage to the newborn from the hour of birth.

5. Vaccination

During the initial years of the birth, newborns are administered with several vaccinations to ensure they stay healthy. Some of these vaccinations include-

A health insurance plan offers coverage for the above vaccinations. However, checking for any terms and conditions associated with such coverage is essential.

What does maternity insurance exclude?

1. Premature pregnancy termination
If you plan to terminate a pregnancy within the first trimester (the first 12 weeks), the insurer won't cover associated expenses, such as surgical procedures or medication for the abortion.

2. Ectopic pregnancy
This happens when a fertilised egg implants outside the uterus, typically in the fallopian tubes. This condition prevents the embryo from developing properly and can cause severe complications.

The insurer does not cover treatment or medication costs if you are diagnosed with this condition.

3. In-Vitro Fertilisation (IVF)
IVF is commonly chosen by couples facing infertility issues. In this process, an egg is fertilised by sperm outside the body in a lab. The resulting embryo is then implanted into the woman's uterus to achieve pregnancy. However, maternity health insurance does not cover this procedure.

Additionally, if you conceive after the age of 45, such pregnancies are typically subject to policy exclusions.

What is the waiting period in maternity insurance?

The waiting period refers to a duration during which you cannot claim your health insurance benefits. This duration varies based on the disease. For maternity, as it is a planned condition, the standard plan includes a waiting period clause ranging from 2 to 6 years.

Conclusion

Health insurance is crucial when planning for pregnancy. However, when investing in maternity insurance, check the waiting period clause and review coverage limits for prenatal and postnatal care, delivery, and newborn expenses. Ensure the policy covers both normal and C-section deliveries. It is also important to check for exclusions like pre-existing conditions or complications not covered under the plan to avoid surprises.

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