What is a Maternity Insurance Policy?

Maternity insurance is a type of health coverage you can purchase as a rider or as part of a customised women's healthcare plan. When you pay the premium, the insurer agrees to pay for maternity-related hospitalisation and associated expenses before admission to the hospital and after discharge. It covers C-sections, consultation fees, consumables, drugs, and other costs.

Like any other health insurance plan, claims for maternity coverage can be cashless or reimbursement.

What is the waiting period?

A waiting period is the duration for which you cannot claim any medical bills. It is classified based on the type of illness. Let's understand this in detail.

1. Maternity waiting period

Maternity is not considered a medical uncertainty but is a planned condition. If you buy a standard healthcare plan, the waiting period can range from 3-6 years. If you supplement your plan with a maternity add-on cover, the waiting period is cut short to 1 year, and with some insurers, six months. However, the lower the waiting period, the higher will be the premium. 

2. Initial waiting period

This tenure applies to all health conditions. The initial waiting period typically spans from 30 to 60 days. However, there are some exceptions to this, such as road accidents. For example, assume a person acquired a health insurance plan on April 5, 2024, and then had an accident on April 10, 2024, requiring rapid hospitalisation. In this instance, the insurer will pay the bills. 

3. PED waiting period

You cannot use your insurance policy immediately to treat a health issue that existed before purchasing the healthcare plan. Pre-existing disease waiting periods vary between 1 and 4 years, depending on the insurer. 

Let's understand how this works.

You purchased a maternity cover rider that has a six-month waiting period. You also have diabetes, and your coverage requires a two-year waiting period for pre-existing conditions. 

Following the completion of the maternity waiting period, you plan to start a family, but diabetes causes significant issues on the day of delivery. In this instance, the insurance will only reimburse the price if the invoice differentiates the charges for maternity and complications from diabetes.

Exclusions of Maternity Insurance 

Now that you have understood the meaning of the waiting period let's understand some of the key exclusions of the maternity add-ons.

1. Congenital diseases

It refers to ailments your newborn inherited in the womb or at birth. It includes spina bifida, heart disease, Down’s syndrome, truncus arteriosus, and a few more. The insurer does not reimburse for any expenses incurred when treating congenital disorders. 

2. Infertility

If you have problems conceiving, any money you spend to treat this condition is subject to the policy's exclusion. Maternity insurance also does not cover IVF treatments.

3. Supplements

Any medication not prescribed by your doctor or supplements like vitamin tablets are not covered under maternity plans. You also won't get coverage for expenses incurred on non-allopathic medications. 

4. Routine Check-ups

Most maternity plans cover routine check-ups associated with pregnancy up to a specific limit. Anything above that is subject to policy exclusion.

Conclusion 

Considering today's maternity-related expenses, investing in maternity coverage is the best decision you can ever make as a couple. Although this policy comes with a waiting period, you can pay an extra premium to waive or reduce the tenure. Also, keep in mind that instead of solely focusing on the maternity cover, look at what all your standard healthcare plans cover and what the policy exclusions are. You must also review the claim procedure and the claim settlement ratio.