Maternity Benefit in Health Insurance
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Sep 14 2024
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What is Maternity Benefit in Health Insurance?
Maternity Benefits in Health Insurance refer to coverage specifically for pregnancy and childbirth related medical expenses. This includes Prenatal and Postnatal care, delivery costs (including caesarean section), and complications that may arise during pregnancy. Some plans also cover newborn care and vaccinations. The primary goal of maternity benefits is to alleviate the financial burden on expectant mothers and families, ensuring access to necessary medical care during and after pregnancy. Coverage Specifics, such as waiting periods, limits, and exclusions, can vary depending on the insurance policy.
What is covered under Maternity Insurance?
An insurance policy with maternity benefits provides extensive services related to pregnancy, childbirth, and postpartum care. This includes:
- Prenatal healthcare checkups
- Ultrasound tests
- Other necessary lab tests
- Baby delivery costs, regardless of the method (vaginal or caesarean)
- Hospital stays.
Maternity benefits insurance also covers complications that may arise during pregnancy or childbirth. Some plans offer coverage for newborn care immediately after birth, lactation consultations, and postpartum check-ups. Since coverage specifics can vary by insurer and plan, it is crucial to review policy details thoroughly to understand the benefits and limitations.
What are the Benefits of Health Insurance with Maternity Coverage?
The advantages of having health insurance policy with maternity benefits are numerous. Here are the main benefits you can expect:
- Comprehensive Care: Covers pre- and post-natal expenses, ensuring complete healthcare for both mother and baby.
- Hospitalisation Costs: Includes expenses related to delivery (standard or caesarean) and any complications arising during pregnancy.
- Newborn Coverage: Some policies extend coverage to the newborn for a specified period post-delivery.
- Preventive Care: Covers routine check-ups, scans, and necessary medical tests during pregnancy.
- Financial Support: Reduces the economic burden of high maternity-related medical expenses.
- Access to Quality Healthcare: Often includes coverage at reputed hospitals and maternity centres.
- Cashless Facility: Many insurers offer a cashless facility at network hospitals, simplifying the payment process.
- Additional Benefits: This may include cover for ambulance charges, medication, and consultation fees.
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Conditions for Coverage of Maternity Costs in Health Insurance
- Before purchasing a health insurance policy with maternity benefits, familiarise yourself with these conditions:
- Policy Inclusion: The health insurance policy must specifically include maternity coverage as an add-on cover. You will need to pay an additional premium for this coverage. Maternity benefits are generally not included in standard health Insurance policies.
- Waiting Period: Many policies impose a waiting period before maternity benefit can be claimed, typically ranging from 9 to 36 months. This means purchasing maternity cover after pregnancy has begun may not be beneficial.
- Pre-existing Conditions: Any pre-existing conditions related to pregnancy must be disclosed and are often subject to specific terms.
- Network Hospitals: Coverage may be limited to specific network hospitals associated with the insurance provider.
- Sum Insured: Maternity expenses are sometimes capped, coverage is limited to a certain amount.
- Number of Pregnancies: Some policies may limit coverage to a certain number of pregnancies (e.g., first two pregnancies).
- Inclusions: Typically, covered expenses include pre-and post-natal care, delivery (normal and caesarean), and newborn baby coverage.
- Exclusions: Certain expenses, such as routine check-ups not specific to pregnancy, non-medical items, natal treatment of certain congenital disorders, and infertility treatment, may not be covered.
- Documentation: Proper medical documentation and proof of expenses are required to file a claim.
- Co-payment: Some policies may require co-payment, where the insured is responsible for a portion of the costs.
Who should purchase Health Insurance with Maternity Cover?
Individuals planning to start or expand their families should consider purchasing health insurance with maternity cover. This type of insurance is particularly beneficial for couples anticipating pregnancy, as it helps cover the costs associated with prenatal care, childbirth, and postnatal care. Additionally, it can ease the financial burden of unforeseen complications during pregnancy and delivery. For those who want to ensure comprehensive healthcare for both the mother and the baby, a policy with maternity benefits can provide significant peace of mind and financial security.
When Should One Purchase a Maternity Cover?
It is essential to secure maternity cover before pregnancy to ensure coverage throughout the entire pregnancy and childbirth. Many policies have a waiting period before maternity benefits can be claimed. Purchasing maternity coverage early helps avoid the risk of being without coverage when needed most and allows access to comprehensive prenatal, delivery, and postnatal care without financial stress. Additionally, purchasing early may offer a broader range of policy options and benefits.
Health Insurance with Maternity Benefits: A Plan You Can Consider
While choosing a health insurance policy for your family, it is crucial to check if the policy includes maternity benefits. ManipalCigna is dedicated to making healthcare services accessible to Indian families. If you are planning to start or expand your family, consider the maternity cover offered by the following plan:
ManipalCigna Sarvah Uttam
Benefits of the Maternity Cover:
- Maternity Coverage: Covers up to 2 deliveries
or terminations. Expenses are covered up to 20% of the base
Sum Insured, with a maximum cap of ₹5 lakhs. This coverage
does not reduce the sum insured available for other medical
expenses.
- Newborn Coverage: Covers
in-patient hospitalization expenses for the new-born
baby covered within the maternity sum insured
limit.
- First-Year Vaccination: Covers the
baby’s vaccinations as per the national immunization program
within the maternity coverage limit.
Please Note:
- Any restored amount (if applicable) is not available for coverage under the maternity section.
- Applicable deductibles and co-payments will also apply to maternity benefits, meaning the insured may have to share a portion of the costs.
Eligibility for ManipalCigna Sarvah Uttam with Maternity Benefits:
- Woman: The insured female adult must be covered under the base policy and the maternity expenses for at least 36 months before claiming this benefit. This means there is a waiting period of three years for maternity coverage to be applicable.
- Man: In individual policies, maternity expenses can be offered to an adult-insured male member. However, claims under this benefit are payable to the female spouse upon adding them as an insured in the policy, with the applicable waiting period linked to the first policy inception.
Conclusion
Health insurance is a crucial component of financial planning, and including maternity benefits is wise if you plan to have biological children. By securing health insurance with maternity coverage, you can reduce out-of-pocket expenses and avoid financial concerns related to medical needs. Trust a reliable insurer, pay your premiums on time, and ensure that finances will not be a burden when medical needs arise.
FAQs
Q1. What is the maternity benefit of health insurance?
A1. Maternity benefits in health insurance cover prenatal, childbirth, and postnatal care costs, including hospital stays, doctor visits, and necessary medications. There is often a waiting period before the insurance is activated.Q2. What is not covered by maternity insurance?
A2. Maternity insurance typically does not cover non-pregnancy-related tests, cosmetic procedures, fertility treatments, or expenses for the baby beyond initial care.
Q3. Can I buy maternity insurance when I am pregnant?
A3. Health insurers consider pregnancy a pre-existing condition, and a waiting period is usually applicable. If you buy maternity insurance while pregnant, you cannot benefit from the coverage. However, check with specific providers for exceptions.
Q4. Is there any age limit for maternity insurance?
A4. Yes, age limits for maternity insurance vary by provider, often ranging from 18 to 45 years old.
Q5. Can both husband and wife claim maternity insurance?
A5. We can offer Maternity Expenses to Adult Insured Male (husband) member as well female Insured (Spouse). However, claim under this benefit shall be payable to the female spouse upon adding them as an Insured in the Policy. In such cases the applicable waiting period shall be as per the first inception of the policy.
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