Welcoming a newborn baby into this world is the happiest moment for parents. However, childbirth comes at a cost. The cost should not overshadow the joy of parents, which is where maternity coverage in health insurance comes into the picture. In this article, we will understand what maternity coverage is and what should you look for before selecting a plan.
What is maternity coverage in health insurance?
Maternity coverage is part of health insurance and covers medical treatment expenses related to pregnancy and childbirth. It covers normal delivery and caesarean section (C-section) delivery. Maternity coverage also covers expenses towards lawful medical termination of pregnancy during the policy period.
Usually, a maternity cover includes the following:
- Expenses related to childbirth: Hospitalisation, room rent, diagnostic tests, operation theatre, doctor consultations, nursing, medications, etc.
- Pregnancy related complications during hospitalisation
- Pre-natal and post-natal care (usually for up to 90 days)
- Newborn care
Before finalising a policy, please read the policy wording to understand what exactly is included and what is excluded. Some plans cover vaccinations for the first year.
What to look for?
When choosing maternity coverage, an individual should look for the following things.
- Waiting period
Most health insurance plans offered to retail customers come with a waiting period for maternity coverage. The waiting period usually ranges from 9 months to 48 months. The lower the waiting period, the better.
Some companies offer the same plan in different variants. Usually, in higher variants of the plan, the waiting period is shorter than in the base variant. For example, the Niva Bupa Aspire Health Insurance Plan is offered in four variants. The maternity waiting period for the 4 variants is as follows: Gold+ (48 months), Diamond+ (24 months), Platinum+ (9 months), and Titanium+ (9 months). As the plan variant goes higher, the premium increases because it offers more or higher benefits.
In some products, the waiting period for maternity coverage depends on the type of product chosen. For example, in the Super Health Insurance Plan offered by SBI General Insurance, the waiting period for maternity coverage differs with product type. For an individual policy (covering a single adult), the waiting period for maternity coverage is 48 months. However, for a family floater plan, the waiting period for maternity coverage is 24 months.
If you are planning to start a family and would like childbirth expenses covered through health insurance, you will have to plan well in advance. You will need to buy a health insurance plan with maternity coverage that has a waiting period that suits your needs.
Most corporate plans don’t have a waiting period for maternity coverage. Even if some plans have a waiting period, it is usually much shorter than retail plans.
2. Coverage sub-limits
You may have chosen a health insurance plan with a specified sum assured. However, do keep in mind that the maternity coverage has sub-limits within the sum assured. Most plans have separate sub-limits for normal delivery and C-section delivery. If the hospitalisation bill for childbirth-related expenses is higher than the sub-limit, the difference will have to be paid from your pocket.
In most plans offered in multiple variants, the sub-limits for maternity coverage vary with the plan variant. Usually, the higher the plan variant, the higher the sub-limit for maternity coverage, and the higher the plan premium.
For example, SBI General Insurance offers the Super Health Insurance Plan in 5 variants. The sub-limits for maternity coverage for the 5 plan variants are as follows.
Plan variant | Maternity coverage sub-limits |
Prime | Not applicable |
Elite | Not applicable |
Premier | Normal delivery: Up to Rs. 25,000, C-section delivery: Up to Rs. 50,000 |
Platinum | Normal delivery: Up to Rs. 50,000, C-section delivery: Up to Rs. 75,000 |
Platinum Infinite | Up to Rs. 2,00,000 |
Source: SBI General Insurance website
In some plans, the maternity coverage expenses limit is linked to the base sum assured. For example, the Sarvah Plan (Uttam variant) from Manipal Cigna Health Insurance follows this. Under this plan, the maternity cover is up to 20% of the base sum insured opted, subject to a maximum of Rs. 5 lakhs in addition to the base sum insured opted.
3. Number of deliveries covered
The next thing you must check is the number of deliveries covered. Most plans usually cover up to 2 deliveries. For example, the Sarvah Plan (Uttam variant) from Manipal Cigna provides coverage for up to a maximum of 2 deliveries or terminations.
4. Whether included in the base policy or offered as an add-on
Maternity coverage is either built into the base policy or as an optional add-on. For some policies that are offered in multiple variants, the lower variant(s) may not include maternity coverage, and the higher variant(s) may have maternity coverage.
For example, in the Super Health Insurance Plan from SBI General Insurance, the Prime and Elite variants don’t offer maternity coverage. The higher variants, including Premier, Platinum, and Platinum Infinite, offer maternity coverage.
The Sarvah Plan (Uttam variant) from Manipal Cigna offers maternity coverage as an optional cover. It has to be added to the base plan with an additional premium payment.
You should also check whether there is a different limit for a baby boy and a baby girl. For example, the Medicare Plan from Tata AIG offers different coverage limits for a baby boy and a baby girl. Under the Medicare Lite and Medicare Premier variants, for a baby boy, the coverage is up to Rs. 50,000 for a sum insured up to Rs. 50 lakhs, and up to Rs. 1 lakh for a sum insured of Rs. 75 lakhs or above. For a baby girl, the coverage limit is higher at up to Rs. 60,000 for a sum insured up to Rs. 50 lakhs, and up to Rs. 1.2 lakh for a sum insured of Rs. 75 lakhs or above.
Choosing the best maternity coverage
Today, there are 100s of health insurance plans with maternity coverage available in the market. Going through the details of so many plans and choosing the best option can be overwhelming. Hence, you must consult a health insurance advisor. They will analyse your requirements and, accordingly, recommend an appropriate health insurance plan with the best maternity coverage to suit your needs.