Maternity cover is a very under-rated insurance cover, it is important to avail one since the expenditure pertaining to maternity can be quite high and create financial stress. Maternity insurance can be a lifesaver while fending maternity expenses, the expenses related to childbirth can be quite significant. One can avail of this as either a standalone policy (i.e. maternity-oriented plan) or as an add-on cover.

Maternity insurance – What is it?
Maternity insurance is a part of the health insurance instrument. Maternity is an insurance plan which covers the expenses related to childbirth to a pre-determined extent. Maternity is not allowed as an inherent cover, one has to avail the same as a standalone policy (maternity-oriented) or an add-on cover over the base health plan by providing an additional premium. The maternity insurance plan also covers expenses incurred on infants. 

Need for maternity insurance:
The average cost of normal delivery expenses in a reasonably decent hospital can range between Rs. 70,000 to Rs. 1.5 Lakh. Caesarean could cost a little higher depending on the complications during the childbirth process. Often, there are complications associated with the baby, wherein there is a requirement for neonatal care for the infant, these costs may create a strain on your finances.

Typically, complications are not planned for, it is better to avail of maternity insurance to cover the costs. The journey of maternity involves multiple consultations with the gynaecologist, various tests, occasional scans etc., All these costs may add up to be a significant number by the end of the journey.

The journey to parenthood should be one loaded with happiness and pride, particularly should not involve any kind of stress. It should not become a financial burden, availing of a maternity cover can help cover all the medical expenses related to the entire journey of pregnancy and childbirth. This can be quite expensive when looked at from a holistic perspective. The amount of coverage is specific for the maternity plan and if it has been availed as an add-on rider, then the particular limit is a function of the base sum assured.

Inclusions in maternity insurance
One of the most important factors to consider whilst availing of a maternity plan is the inclusions is an important factor to consider in the effort to avail any health insurance plan. These are the expenses covered under maternity insurance plans:

1. Hospitalisation expenses:
   30 days of pre-hospitalisation and 60-days post hospitalisation expenses are covered along with the expenses concerning the stay at the hospital during childbirth. The actual stay in the hospital could be lower in many scenarios if there have been no complications. However, the care and medication/consultations that may be required post childbirth could be significant. One should ensure that pre and post hospitalisation is allowed as coverage under the maternity plan.
2. Delivery expenses:
   There are two types of deliveries: Normal and C-section, the first one is considered to be less risky for both the mother and child. A C-section is considered when there are any complications or any development which could potentially be life-threatening.
   
   The cost for normal delivery is usually lower than that of a C-section, this is a form of complicated surgery which may require other specialists like anaesthetists, assistant doctors, multiple types of equipment to monitor blood levels and other vitals, operation theatre etc., the cost/fee of each of these items will be added as delivery expenses. Irrespective of the type of delivery, the costs are covered under the maternity insurance plan.
3. Associated hospital expenses:
   Hospitalisation expenses include multiple tests, nursing, food, visiting doctors apart from the room rent. These associated hospital expenses are also covered under these plans. There are many instances when the newborn child may require assistance in some form and thus, the mother may require to stay in the hospital to provide the required support to the newborn and feed the child as per schedule. In such events, the hospitalisation charges could escalate quickly and get out of hand. Family history is necessary for this aspect.
4. Infant treatment expenses:
   Often infants may require neonatal care before they move to a normalised environment, there is a specialised ICU for newborns called the NICU, the vitals of the infant is monitored continuously. These are environments that are highly sanitized and restricted areas, the cost per day could be significant. If the infant requires a prolonged stay in the NICU, it could cause severe stress in your finances.
5. Daycare treatment expenses:
   There may be instances where the infant needs outpatient or daycare treatment this could be the case for the new mother as well. In which case the baby and/or the mother may require frequent consultations with the appropriate specialist. Such consultations could be frequent, although, over a shorter timeframe, they could add up to be a significant expense. This aspect is also covered adequately under the maternity insurance plan.
6. Vaccination expenses:
   There is a slew of vaccination that applies to the newborn, all the way up to the child turns 2 years old, after that the frequency of the vaccination is lower. Every vaccination involves a consultation fee and the cost of the vaccination itself, on average the cost of vaccination could range between Rs. 1500 – 6000 depending on the type, the consultation could be between Rs. 300 – Rs. 800. Although on the face of it, the amount may seem minuscule and insignificant, however, by adding up the entire set of costs associated with the vaccination, you can gauge that the amount is quite significant.

7. Ambulance / specific emergency-related expenses incurred:
   The complications surrounding childbirth are unforeseen, for many mothers, it could be a smooth sail and a wonderful experience. For others, it could lead to significant trauma, there are times when the mother is rushed to the hospital under emergency. There are other instances when the mother and the newborn are brought back home in the ambulance, due to the inability of the mother to recover at a fast pace. In such cases, the ambulance service may be used, such costs are covered under the maternity insurance plan.
8. Access to network hospitals:
   Most of the maternity insurance plans, be it standalone (maternity-oriented) or add-on rider, offer access to a large network of hospitals. It is important to look at the hospital network and the proximity of your home. Also, the reputation of the doctor, hospital, required expertise to handle complex cases, necessary equipment to handle emergencies have to be evaluated. Most of the insurance plans offer a network of hospitals that carry a good reputation, however, it is always prudent to associate oneself with a hospital and doctor with whom you are comfortable.

The key point to note is that the claim is limited to the type of plan and the sum assured. There may be sub-limits within the plan for items, such itemised sub-limits have to be taken not of whilst zeroing in on an appropriate plan.

Exclusions under maternity plan
After looking at the inclusions, the most logical thing to look at is the exclusions. This refers to all those expenses which may be related to maternity, but are not covered under the maternity insurance plan. One should look for plans where the exclusions are minimal, this is not just for maternity insurance plans, it holds good for all health insurance plans. A good health insurance plan or maternity insurance plan offers wide coverage at nominal premiums. The common exclusions that you may come across in most maternity insurance plans are:

1. Pre-existing diseases which could affect pregnancy:
   There could be instances when pre-existing diseases which interfere during pregnancy, especially diabetes or other such lifestyle diseases. Typically, pre-existing diseases have a waiting period of 2 years for comprehensive coverage. Hence, a maternity plan would not provide coverage against any complications arising out of pre-existing diseases. However, if the maternity plan is an add-on to your base plan and your base plan covers pre-existing diseases, then medication/treatment aimed at the pre-existing diseases will be covered under the base plan.
2. Congenital diseases:
   Maternity insurance companies often do not cover any disease that exists from birth and is beyond the realm of permanent resolution. If there is any evidence of congenital disease interfering in the complication related to the pregnancy or childbirth, then the claims could run into trouble. Any expense incurred to treat the congenital condition to ensure safe pregnancy will not be covered under the maternity insurance plan.
3. Infertility treatment:
   There are increased cases of women who opt for infertility treatment to get pregnant. This treatment is quite expensive and does not fall within the realm of maternity insurance. There are specific plans which cover infertility treatment, one must avail a plan that adequately aligns with one requirement. Within infertility insurance plans, one should again look for exclusions, this could be an expensive affair and thus, the lower the exclusions, the better.
4. Medicine costs that do not fall within the purview of the treatment:
   Some women require a limited set of medicines such as vitamins, folate etc., any medicine which is not directly linked to maternity treatment will not be reimbursed under the plan. There may be instances where the insured is on medication for diabetes or similar other lifestyle diseases, these may not be covered under the maternity insurance plan. However, such expenses may be covered under a base plan (if the maternity plan is an add-on) if the required waiting period is over.
5. Frequent doctor’s consultations:
   If the insured has been put on frequent consultations, then such expenses may not be covered. Typically, the doctor visits, tests, and scans are done according to the baby’s growth milestones covered under the plan. However, if for any reason, the pregnant woman is required to make frequent visits to the doctor, then such expenses may not be covered.

Waiting period for maternity insurance plans:
If you are planning to go the family way, then the first thing you should consider is availing of a maternity insurance plan. Many of the insurers impose a waiting period for maternity benefits which vary from 9 months to 36 months. Experts often suggest availing of a maternity plan during one’s wedding, typically, one could plan a child over the next 3-4 years, by which time, the waiting period could be over and you can enjoy your journey towards parenthood in a stress-free manner.

Premium calculation:
Maternity insurance plans have premium calculations different from regular health insurance plans. The premiums of maternity insurance plans carry a slightly higher premium as compared to regular health insurance plans which do not cover maternity. This is primarily due to the certainty of the occurrence of the event for which the insurance is undertaken. The insurer knows upfront that the claim will happen, the assumption of financial risk by the insurer is significantly high. Most insurers ensure that the premium is kept quite high to reduce the risk at their end.

From an applicant perspective, it is not only important to evaluate the lower premium with optimal coverage, there is a need to consider the cost-benefit analysis before availing of such a plan.

Under most scenarios, group insurance policies do not cover maternity benefits, hence, even if your employer provides a health insurance cover, it is imperative to ascertain whether maternity is covered. If it is not covered, then you should consider availing of a standalone maternity health insurance plan or a maternity-oriented health insurance plan. Alternatively, you may check if there is an option to buy an add-on maternity cover on your base insurance plan provided under the group insurance offered by the company.

Choosing the maternity insurance policy
There is a slew of options available within the world of maternity insurance policy, you must associate with one that aligns well with your needs.

• Check for inclusions and exclusions
• Read through clauses like tenure, room–rent, sub-limits, co-payments, waiting periods, renewability, claim settlement mode etc.,
• Look through the network of hospitals
• Reach out to the insurer to clarify all your doubts, seek the help of experts to choose the right plan
• Compare multiple maternity plans across their benefits, premium, features, claim settlement ratio, coverage details, pre and post hospitalisation expense coverage, neonatal care etc., through authentic online resources
• Choose a plan that fits well within your budget and aligns with your requirement and preferences

The joyous occasion of parenthood should not be plagued by financial stress, take time well in advance to acquaint yourself with the concept of a maternity insurance plan. The timeline to buy the plan should also account for the waiting period if any for such coverage, it is an integral part of financial planning and planning for a family.

Conclusion

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