Are you preparing for the arrival of a new baby, whether it’s your first or another addition to your growing family? As you begin this exciting journey, it’s important to consider how to manage the financial aspects of maternity and hospitalization.
You would, of course, want your child to get the best pediatric care possible at a trusted nursing hospital. And that’s expensive.
That said, your insurance can actually share much of this financial burden.
In this blog, we’ll explore key strategies and tips to help you plan and budget for these expenses with your insurance effectively, ensuring a smooth transition into this new chapter of your life.
Table of Contents
What is Maternity Coverage?
Maternity coverage is a benefit that covers the cost of pregnancy, childbirth, and postpartum. This coverage can provide cashless or reimbursement treatment of expenses during the maternity period. It’s important to note that not all health insurance plans offer maternity coverage, so it’s crucial to check before purchasing a policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy.
The Basics of Maternity Insurance Coverage
Maternity insurance is an essential component of health insurance plans for those planning to start or expand their family. It helps cover the often substantial costs associated with pregnancy, childbirth, and postpartum care. Let’s break down what typical maternity insurance plans include:
- Pre and Post-natal Care
Maternity coverage usually encompasses regular check-ups, essential diagnostic tests like ultrasounds and blood work, and prescribed medications throughout pregnancy and the recovery period. These services are crucial for monitoring the health of both mother and baby.
- Delivery Charges
Whether you have a normal vaginal delivery (NVD) or require a cesarean section (C-section), your insurance should cover the associated costs. This includes fees for the surgeon, anesthesia, labor room charges, and the hospital stay.
- Hospitalization Costs
During your hospital stay related to childbirth, maternity insurance typically covers room rent, boarding, nursing care, and medication expenses.
- Newborn Care
Some plans extend coverage to the newborn baby for a designated period, usually up to 90 days. This can include hospitalization costs if medically necessary, as well as basic vaccinations and essential newborn care.
It’s important to note that group health insurance policies, often provided by employers, may offer more comprehensive coverage for newborns from day one. However, this coverage is typically limited to hospitalization costs and observation. Specific benefits like immunization and general well-baby care might not be included unless explicitly stated in the corporate plan.
Is Maternity Coverage Important?
Maternity coverage is an essential aspect to consider when buying a health insurance policy. Pregnancy and childbirth can be expensive, and without insurance coverage, medical costs can add up quickly. If you have maternity coverage, it can help you focus on your baby, rather than how you will pay for the medical expenses.
When it comes to choosing the best health insurance plan for maternity coverage, there are two options: retail health insurance and group health insurance plans.
PlanCover suggests that a potential customer carefully check the inclusions or exclusions while buying the policy. Group health insurance plans often provide more benefits than retail health insurance plans, including maternity coverage from the day of purchase.
What are Maternity Benefits in Health Insurance Plans?
In a retail health insurance plan, also known as an individual health plan, maternity coverage is typically covered but has a waiting period of 9 months. This means that a claim from day one is not possible. Some policies even have a three-year waiting period.
Therefore, to the question ‘is there any health insurance that covers maternity’. The answer is, yes. Group health insurance provides maternity coverage from the day of purchase, with maximum benefits.
Maternity Expenses in India: A Closer Look
To better understand the importance of adequate maternity coverage, let’s examine the average costs associated with childbirth in India. According to a 2021 report by the National Health Accounts (NHA) of India:
- The average cost of a normal delivery is approximately ₹41,000.
- For a cesarean section (C-section) delivery, the average cost rises to about ₹62,000.
However, it’s crucial to recognize that these figures can vary significantly based on several factors:
- Location: Urban areas generally have higher costs compared to rural regions.
- Type of Hospital: Costs differ between public hospitals, private hospitals, and specialized maternity clinics.
- Amenities: The level of comfort and additional services chosen by parents can impact the overall cost.
Trends in Maternity Expenses
Over the years, maternity expenses in India have been steadily increasing due to inflation and advancements in medical technology. This upward trend underscores the importance of having comprehensive maternity insurance to mitigate the financial burden.
Comparative Costs Across India’s Cities
India’s tiered city system significantly influences the cost and availability of healthcare services, including maternity care. Let’s explore how costs vary across different city tiers:
Tier-1 (Metro Cities)
- Known for specialized healthcare with advanced hospitals and experienced providers.
- Higher prevalence of cesarean sections, contributing to increased overall expenses.
- Delivery costs can range from ₹75,000 to ₹2,00,000 or more for both normal and C-section deliveries.
Tier-2 (Non-Metro Cities)
- Offer a balance between affordability and quality maternity services.
- Costs are generally lower than in Tier-1 cities while still providing comprehensive care.
Tier-3 (Non-Metro Cities)
- Most affordable option, catering to diverse financial capabilities.
- While essential care is accessible, specialized services may be limited.
- Normal deliveries can cost as low as ₹15,000, with C-sections ranging from ₹25,000 to ₹60,000.
Factors Influencing Maternity Costs
To make informed decisions about your maternity coverage, it’s essential to understand the various factors that can impact your overall expenses:
1. Hospital Type
The choice of hospital plays a significant role in determining your maternity costs:
a) Tertiary Care Hospitals (Tier-1 Cities)
- Equipped with advanced technology and specialists.
- Offer the highest level of care but come with premium pricing.
- Delivery costs range from ₹75,000 to ₹2,00,000 or more.
b) Boutique Hospitals (Tier-1 & Tier-2 Cities)
- Known for personalized care and luxurious amenities.
- Delivery costs can range from ₹1,00,000 to ₹3,00,000 or more.
c) Government Hospitals (All Tiers)
- Most budget-friendly option.
- Normal deliveries can cost as low as ₹15,000, with C-sections ranging from ₹25,000 to ₹60,000.
- May have longer wait times and limited amenities.
2. Healthcare Provider Fees
The expertise and reputation of your healthcare providers can significantly impact costs:
a) Doctor’s Experience and Reputation
- A renowned doctor in a Tier-1 city might charge ₹50,000 to ₹1,00,000 or more for delivery.
- A qualified doctor in a Tier-3 city could charge ₹20,000 to ₹50,000.
b) Anesthesiologist Fees
- Local anesthesia might cost around ₹10,000 to ₹15,000.
- An epidural could range from ₹20,000 to ₹30,000.
c) Pediatrician Fees
- Initial newborn check-up typically falls between ₹2,000 to ₹5,000.
3. Specific Services Provided
The type of delivery, room selection, pain management choices, and required newborn care services can all impact your final bill:
a) Type of Delivery
- Normal Delivery: ₹15,000 to ₹50,000 in government hospitals; ₹75,000 to ₹1,50,000 or more in private hospitals.
- C-Section: ₹50,000 to ₹1,00,000 or more in government hospitals; ₹1,50,000 to ₹3,00,000 or more in private hospitals.
b) Room Type
- Shared Room: Most economical option.
- Private Room: Can cost ₹10,000 to ₹15,000 or more per night than a shared room.
- Suite: Most luxurious option, significantly more expensive than a private room.
c) Pain Management
- Local Anesthesia: ₹10,000 to ₹15,000.
- Epidural: ₹20,000 to ₹30,000 or more.
d) Newborn Care Services
- Phototherapy for jaundice: ₹5,000 to ₹10,000 per day.
- NICU Stay: ₹20,000 to ₹50,000 or more per day, depending on the level of care needed.
Maternity Insurance Coverage Limits
Now that we’ve explored the various costs associated with maternity care, let’s get into the specifics of maternity insurance coverage limits:
1. PolicyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy Type
Maternity insurance coverage can be obtained through two primary avenues:
a) Standalone Maternity Plans
- Generally have fixed premiums.
- Designed specifically for maternity coverage.
b) Riders on Existing Health Insurance Policies
- May lead to an increase in the overall premium amount.
- Can be a cost-effective option if you already have a comprehensive health insurance policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy.
2. Coverage Limits
Most maternity insurance policies impose sub-limits on specific expenses:
- Room rent
- Doctor’s fees
- Diagnostic tests
Selecting plans with higher coverage limits naturally results in higher premiums. It’s essential to carefully review these limits and ensure they align with the average costs in your area.
3. Waiting Period
A crucial aspect of maternity insurance is the waiting periodThe period of time that an individual must wait either to become eligible for insurance coverage or to become eligible before benefits can be availed:
- Can vary from a few months to several years.
- Policies with shorter waiting periods often come with higher premiums.
- Group Health Insurance (GHI) schemes may offer maternity coverage from day one, but with limited coverage.
4. Age and Medical History
Your age and medical history can influence the cost and availability of maternity coverage:
- Older individuals or those with pre-existing medical conditions may face higher premiums due to perceived higher risk.
- Some policies may have age restrictions or require additional medical underwritingThe process by which an insurer determines whether or not to accept an insurance application and on what basis/terms it for certain conditions.
5. Geographical Location
Healthcare costs vary significantly across regions in India, impacting maternity coverage:
- Metropolitan cities typically have higher medical expenses compared to smaller towns or rural areas.
- This variation is reflected in the cost structure of maternity coverage, with higher premiums in metro cities.
6. Provider Network
Many insurance companies have tie-ups with specific hospitals or healthcare providers:
- In-network hospitals often translate to lower out-of-pocket expenses.
- Utilizing services within the network can provide cashless hospitalization benefits.
Choosing the Right Maternity Coverage: Key Considerations
Selecting the most suitable maternity coverage option requires careful consideration of several factors:
1. Individual Needs and Budget
- Analyze your specific requirements regarding the extent of coverage desired.
- Consider your financial capacity to shoulder the premiums.
2. Family Planning Timeline
- If planning a pregnancy in the near future, opt for a rider with a shorter waiting periodThe period of time that an individual must wait either to become eligible for insurance coverage or to become eligible.
- Standalone plans may be better for those with a longer-term pregnancy timeline.
3. Existing Health Insurance Coverage
If you already have a health insurance policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy, explore adding a maternity rider before considering standalone plans.
4. PolicyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy Wording and ExclusionsSpecific conditions listed in an insurance or medical care policy that is not covered by benefit payments. Common exclusions include
Scrutinize policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy documents to understand:
- Waiting periodThe period of time that an individual must wait either to become eligible for insurance coverage or to become eligible
- Sub-limits on specific expenses
- Coverage exclusionsSpecific conditions listed in an insurance or medical care policy that is not covered by benefit payments. Common exclusions include (pre-existing conditions, specific complications)
- Claim settlement procedures
5. Network Hospitals
- Check if your preferred hospitals and healthcare providers are within the insurance company’s network.
- Consider the convenience and potential cost savings of cashless hospitalization benefits.
6. Additional Benefits
Some maternity insurance plans offer extra perks that can provide value:
- Pre and post-natal classes
- Lactation consultation
- Newborn care packages
7. Claim Process
Understanding the claim process is crucial for a smooth experience:
- Familiarize yourself with the documentation required for claims.
- Check if the insurer offers a dedicated maternity claims helpline.
8. Renewability and Portability
Consider the long-term aspects of your maternity coverage:
- Check if the policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy is renewable and under what conditions.
- Explore portability options if you plan to switch insurers in the future.
What is the coverage limit for both C-sections and Normal deliveries?
The coverage limit for both normal deliveries and C-sections may vary.
- Normal delivery usually costs less as hospitalization is limited to 1-2 days only
- C-section delivery involves surgery, and therefore the days of hospitalisation increase. Yet there is a limit upon the expenditure as per the policy rules.
Is Room Rent at the Hospital Covered Under Maternity?
Yes, the room rent during the maternity process is covered under the policy. However, it’s essential to note that room rent limits are as per those applicable for normal hospitalizations, within the specific terms and conditions of the policy. In case the patient avails of a higher than entitled class of room as specified in the policy, then the difference in the “room rent” will be borne by the insured and not the insurance company.
What is Pre and Postnatal Coverage?
Prenatal coverage refers to the expenses incurred during the nine-month period of pregnancy, while postnatal coverage refers to the expenditure that arises after the delivery. The expenses pertaining to OPD and medicines are covered in most insurance plans.
The coverage is for 30 days prior to hospitalization for maternity pre-hospitalization (prenatal) and extends up to 60 days post-hospitalization (post-natal).
Is ‘hospitalization before the delivery date due to complications during pregnancy’ covered?
In most cases, hospitalization before the delivery date due to complications during pregnancy is covered under the maternity section of the insurance policy. If other treatments are required by the mother during the pregnancy period that is before delivery, it will be covered. However, diseases or illnesses unrelated to maternity like COVID-19, dengue, chikungunya, high fever, dehydration, jaundice, kidney issues, heart issues, blood pressure, HTN, DM, anemia, thyroid, and others are not covered under maternity terms.
Is ‘hospitalisation after delivery resulting from post-delivery complications’ covered?
Many women are unsure about what kind of maternity coverage their health insurance plans offer. One common question that arises is whether hospitalisation after delivery resulting from post-delivery complications is covered. The answer is that it depends on the specific terms and conditions of the policy.
According to pre and post-natal coverage, hospitalisation within 60 days of delivery due to complications will be paid by the insurer. However, if pre and post-natal coverage is not included in the health care policy, then complications related to maternity will not be covered.
If a mother has a natural delivery and catches UTI or any other complication due to giving birth, it will be covered under postnatal terms in the policy. Similarly, if sutures develop infections after a C-section delivery, it will be covered only if postnatal coverage is there. Therefore, the coverage of post-delivery complications is dependent upon specific clauses of the policy’s terms and conditions as there are limits defined for pre and post-natal treatments.
Is premature delivery’s expense covered?
Yes, the expense of premature delivery is covered, but the costs will be limited to maternity capping only as per the policy.
Can a newborn be added to a health insurance policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy?
Yes, a newborn can be added to a health insurance policy with intimation within 30 days of birth. The newborn can be added with the mother’s name if the name hasn’t been decided yet. Within the given duration, name corrections can be done subsequently.
What is the meaning of ‘Pro-rata’ payment in maternity claims?
If a patient avails a room higher than the entitled class as mentioned in the policy, the expense will be borne by the insured.
Another case is if the number of days needed to be increased for a patient’s stay at the hospital. In this situation, the insurer will only bear the cost decided in the maternity plan, and the cost of the increased number of days will be borne by the insured itself.
Can I make a maternity claim under two health insurance policies?
If a person has two medical insurance policies, and both policies have maternity coverage, then a partial claim from each is possible. For instance, if at the time of hospitalisation, the bill is for a lakh and the first policy’s maternity coverage limits to Rs. 50,000 only, then the remaining Rs. 50,000 can be claimed as reimbursement from the second policy if its coverage allows.
It is important to consider certain points while making partial claims. Intimations are not mandatory, and proof of payment (receipt) is the requirement for reimbursement. Therefore, the insured needs to take proof of payment paid at the hospital, discharge summary, results of tests and films along with all other documents. The second claim will be processed only after the settlement of the first claim. A settlement letter from the first insurer is essential to claim the reimbursement from the second insurer.
Is the birth of the third child or twins on the second attempt covered under an insurance policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy?
As per the standard health insurance policy, maternity is not covered for the third child. However, there are some insurance companies that do provide third child maternity coverage under their group health insurance plan but at a higher premium.
If an unfortunate event takes place, and any of the first two children die, the claim cannot be considered for the third-born child. But in the case of twins, both will be covered under the maternity plan.
What is GPLA? Meaning and History
GPLA is an acronym used in obstetrics to summarize a woman’s obstetric history. It stands for:
- G – Gravida: Refers to the number of times a woman has conceived, regardless of the outcome.
- P – Para (Preterm): Indicates the number of pregnancies that have crossed the age of viability (typically around 24 weeks of gestation) but does not specify if the pregnancies resulted in live births or stillbirths.
- L – Live (Living Child): Refers to the number of living children the woman has.
- A – Abortion: Indicates the number of pregnancies that ended in miscarriage or elective abortion.
Example: G4P2L1A1
- G4: The patient has been pregnant 4 times.
- P2: Out of these pregnancies, 2 crossed the viability age.
- L1: Out of the viable pregnancies, 1 resulted in a live birth.
- A1: Out of the 4 pregnancies, 1 ended in abortion.
In this example:
- The woman has conceived four times in total.
- Two of these pregnancies progressed beyond the age of viability.
- One of these viable pregnancies resulted in a live birth.
- One pregnancy ended in abortion.
Let’s look at another example: G1P1L1A0
- G1: The patient has been pregnant once.
- P1: The foetus crossed the viability age.
- L1: The pregnancy resulted in a live birth.
- A0: There was no abortion.
The reason why this example is important is in terms of maternity coverage in group health insurance; this is what’s called a Primigravida (Primi). Primi is used to describe a specific stage in a woman’s reproductive journey–the time of their first pregnancy.
Group health insurance policies that include maternity coverage often have specific terms and benefits tailored for primigravida women. That’s because their medical needs and potential risks can differ from those of women who have had previous pregnancies.
This coverage can include prenatal care, delivery expenses, postnatal care, and other related medical services to ensure the health and well-being of both the mother and the baby during a first pregnancy.
History of GPLA
The GPLA system was introduced to provide a clear and comprehensive record of a woman’s obstetric history. Historically, some maternity policies only considered two children under their coverage but did not specify whether these should be living children. This lack of specificity could lead to fraudulent claims and misunderstandings about claim eligibility.
By adopting the GPLA system, insurers can more accurately assess and manage maternity claims. It ensures that all aspects of a woman’s reproductive history are considered, preventing fraud and determining the payability of claims. Insurers often require the GPLA history of their clients for these reasons.
How does the GPLA system help the insurer?
If there is a maternity claim, either cashless or for reimbursement, the insurer first confirms the GPLA status of the person. As there could be a condition mentioned in the policy for only two maternity attempts, the third pregnancy will not get covered in the policy.
If complications occur with the newborn post-delivery, will the expenses get covered?
If any complications occur in an infant post-delivery, diagnosis and report expenses will be covered. But the cost of treatment will only be taken care of in the policy only if the baby is added to the policy.
Is there a time limit for adding an infant to the policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy?
The process is to intimate the insurance company about the addition of the newborn. This must be done within 30 days of the child’s birth. If not added within the timeline, the insurer can either decline the request for addition, or the insured may have to wait till the renewal of the policy to add the child.
Do pre and post-natal clauses cover diagnostic tests?
Yes, certain investigations and tests are covered in the health insurance policy under pre and post-natal sections. As mentioned above, the prenatal clause works 30 days prior to delivery, and the post-natal works 60 days after the delivery. Therefore, any tests required within the frame are covered under the policy.
Does health insurance pay for maternity leave?
Often, a thought or question pops into the head of an employee whether the health insurance company pays for the maternity leave or the company. The answer is that the company is liable to pay for the duration of maternity leave. Whereas the health insurance is responsible to pay for the expenses of delivery and for the pre and post-delivery. To manage all this, group health insurance maternity coverage is the best support plan.
I’m sure PlanCover’s guidance will be of use to you while deciding on your group health insurance plan focused on maternity benefit.
We at PlanCover will be delighted to serve you and solve your queries if you have any at your convenient time. We are available at https://www.plancover.com/, connect with us to know more about insurance benefits and choose the policy that meets your needs.
Making an Informed Decision
As you explore maternity insurance coverage, keep these key points in mind:
- Start Early: Begin exploring maternity coverage options well before you plan to conceive. This allows you to serve any waiting periods and ensures you’re adequately covered when the time comes.
- Compare Multiple Options: Don’t settle for the first plan you come across. Compare offerings from different insurers to find the best balance of coverage and affordability.
- Read the Fine Print: Carefully review policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy documents, paying close attention to exclusionsSpecific conditions listed in an insurance or medical care policy that is not covered by benefit payments. Common exclusions include, sub-limits, and claim procedures.
- Consult with Experts: Speak with insurance agents, financial advisors, or healthcare providers to get personalized recommendations based on your specific situation.
- Plan for the Unexpected: While we all hope for smooth pregnancies and deliveries, it’s wise to choose coverage that provides adequate protection in case of complications or unexpected events.
- Consider Your Long-term Family Plans: If you’re planning to have multiple children, look for policies that offer coverage for subsequent pregnancies without additional waiting periods.
- Evaluate Your Employer’s Coverage: If you have access to group health insurance through your employer, carefully review the maternity benefits offered. These plans often provide comprehensive coverage from day one.
- Stay Informed About PolicyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy Changes: Insurance regulations and policyThe legal document issued to the policyholder that outlines the conditions and terms of the insurance; also called the ‘policy terms can change. Stay updated on any modifications to your coverage and be prepared to make adjustments if necessary.
Conclusion
Understanding maternity insurance coverage can be complex, but it’s a crucial step in preparing for the arrival of your little one. By understanding the various factors that influence maternity costs and insurance coverage limits, you can make informed decisions that provide financial protection and peace of mind during this exciting time.
Remember, the goal is to find a balance between comprehensive coverage and affordability. Take the time to research, compare options, and choose a plan that aligns with your specific needs and circumstances. With the right maternity insurance coverage in place, you can focus on what truly matters – the joy of welcoming your new baby into the world.
As you begin this journey, don’t hesitate to seek guidance from insurance professionals, healthcare providers, and fellow parents. Their insights and experiences can provide valuable perspective as you make this important decision. Here’s to a healthy, happy pregnancy and the exciting adventure of parenthood that lies ahead!
