Standard Life Health Insurance: Maternity Coverage Explained

Standard health insurance plans typically cover maternity care, but there are some exceptions. In the US, the Affordable Care Act (ACA) has required all new and renewing individual and small group health insurance policies to include maternity coverage since 2014. Large-group plans have long been mandated to include maternity coverage under the Pregnancy Discrimination Act of 1978, which applies to employers with 15 or more employees. Similarly, in India, maternity benefits are often offered as an add-on to standard health insurance and mediclaim policies, with some companies providing it as a rider or part of their health insurance policy for female employees.

What is maternity insurance?

Maternity insurance is a type of health insurance that covers expenses related to pregnancy and childbirth. It is often provided as an add-on or rider to standard health insurance policies and is designed to cover a range of pregnancy-related costs, from prenatal care and delivery to postnatal expenses and newborn baby care.

In the past, maternity coverage was not guaranteed and was often unavailable to women who were already pregnant when they enrolled. However, since 2014, maternity coverage has been mandatory in the US, and it is now considered one of the 10 essential health benefits that must be covered by all health insurance plans offered to individuals, families, and small groups.

Maternity insurance typically covers a range of pregnancy-related expenses, including:

• Prenatal care and doctor visits
• Gestational diabetes screenings
• Lab studies and medications
• Hospitalization and physician fees
• Lactation counselling and breast pump rental
• Delivery costs for both normal and caesarean births
• Postnatal care and newborn baby care
• Vaccination charges for the newborn

It is important to note that maternity insurance policies do have certain exclusions. Common exclusions include:

• Expenditure on supplements such as tonics and vitamins
• Diagnostic tests and doctor's consultation charges incurred during pregnancy
• Treatment costs related to infertility
• Costs related to harvesting and storing stem cells
• Pregnancy-related costs occurring during the waiting period, which is usually around 9 months

When to Enroll in Maternity Insurance:

It is recommended that individuals planning to start a family enroll in maternity insurance as early as possible to serve the waiting period before the birth of the child. While pregnancy itself is not considered a qualifying life event for special enrollment, the birth of the baby is, triggering a special enrollment period during which parents can enroll in or change their health plan.

When should you buy maternity insurance?

Maternity insurance is a type of health insurance that covers maternity-related expenses. It is important to purchase maternity insurance well before you plan to start a family. By doing so, you will be able to serve the waiting period before starting a family.

Waiting Periods

All maternity insurance plans have stipulated waiting periods during which the insured women cannot make any claims for pregnancy-related medical costs. The waiting period for pregnancy in maternity medical insurance is usually nine months. However, some insurers can have a longer waiting period, so it is important to check the individual policy details.

Planning for the future

Buying a plan at an early age can help ensure extensive cover when needed, helping women manage the expenses for delivery, prenatal care, and postnatal care without any additional financial burden. Hence, it is advisable that women invest in comprehensive maternity insurance at least a couple of years before starting a family.

Peace of mind

Maternity insurance offers peace of mind and financial safety by covering pregnancy, childbirth, and post-natal care expenses. It can be a great choice if you plan to extend your family. The childbearer needs a range of medical expenses and care, and maternity insurance can help manage these expenses without hassle.

Cost savings

The cost of delivery can range from Rs 50,000 to Rs 80,000 for a normal delivery and Rs 1-2 lac for a C-section in metro cities, depending on complications. Therefore, a well-planned maternity health insurance plan can save you money when you wish to become a parent.

Tax benefits

The premium paid for availing maternity insurance offers you tax benefits under Section 80D of the Income Tax Act, 1961.

What does maternity insurance cover?

Maternity insurance is a type of health insurance that covers maternity-related expenses. It offers comprehensive coverage for medical expenses incurred during pregnancy, including delivery expenses, hospitalisation costs, pre- and post-natal care, medical tests, medicines, and newborn baby expenses.

Pregnancy Cover

Maternity insurance covers expenses incurred pre- and post-natal to help mothers and their children recover faster.

Newborn Baby Cover

Maternity insurance covers the newborn baby's expenses from the day of delivery to 90 days to ensure good health.

Congenital Diseases Cover

The insurance will pay a lump sum if the newborn is diagnosed with Down's Syndrome or Cerebral Palsy.

Pre- and Post-Hospitalisation Cover

Maternity insurance covers related medical expenses 30 days before and 60 days after hospitalisation.

Hospitalisation Charges

Maternity insurance covers room, nurse and surgeon fees, anaesthetist consultation, medical practitioner and emergency ambulance charges.

Vaccination Cover

Maternity insurance covers the cost of vaccinations for the newborn that need to be completed within the first year of birth.

Medical Termination of Pregnancy

Maternity insurance covers the medically necessary and legally valid termination of pregnancy.

Infertility Treatment

Maternity insurance does not cover treatment expenses related to infertility.

Pre-Existing Diseases Affecting Pregnancy

Maternity insurance does not cover pre-existing diseases such as high blood pressure or epilepsy.

Diagnostic Tests and Doctor's Consultation Charges

Maternity insurance does not cover diagnostic tests and doctor's consultation charges incurred during pregnancy.

Supplements and Vitamins

Maternity insurance does not cover the cost of supplements and vitamins unless prescribed by a doctor.

Non-Allopathic Treatment

Maternity insurance does not cover non-allopathic treatments.

What is not covered by maternity insurance?

Maternity insurance is a type of health insurance that covers expenses related to pregnancy and childbirth. While it is a valuable form of coverage, there are some aspects that are not typically covered by maternity insurance. Here are the key exclusions you should be aware of:

• Pre-existing diseases affecting pregnancy: Maternity insurance generally does not cover pre-existing medical conditions such as high blood pressure or epilepsy that could impact your pregnancy.
• Congenital diseases: Inherited medical conditions that occur in children before or at birth, such as heart disease, Down syndrome, or spina bifida, are typically excluded from coverage under maternity insurance.
• Treatment expenses relating to infertility: Infertility treatments like IVF are not usually covered by maternity insurance plans.
• Medicine costs not prescribed by a doctor: Maternity insurance may only cover medicines that are specifically prescribed by your doctor. Any other supplements, vitamins, or non-allopathic medicines may not be included.
• Doctor's check-up expenses and consultation fees: Regular visits to your OB-GYN during pregnancy are generally not covered under maternity insurance.
• Diagnostic tests: Diagnostic tests and medical scans performed during pregnancy may not be covered.
• Stem cell harvesting and storage: Costs related to harvesting and storing stem cells, even if done as a preventive measure, are typically excluded.
• Waiting period exclusions: Any pregnancy-related costs that occur during the waiting period, which can range from 9 months to 6 years, are generally not covered by maternity insurance.

It is important to carefully review the specific exclusions listed in your maternity insurance policy, as there may be additional limitations or variations depending on the insurer and the plan chosen.

What are the benefits of maternity insurance?

Maternity insurance is a type of health insurance that covers pregnancy-related medical expenses. It is often provided as an add-on to standard health insurance policies and is designed to cover the costs of childbirth. The benefits of maternity insurance include:

• Coverage for a wide range of pregnancy-related expenses, including prenatal care, childbirth (both normal and caesarian deliveries), and postnatal care.
• Financial stability and peace of mind for expectant mothers, as maternity insurance can help cover the costs of delivery and newborn baby expenses.
• Access to skilled gynecologists and other medical staff, ensuring a better health experience without having to pay out of pocket or with minimal out-of-pocket expenses.
• Tax benefits in some countries, where the premium paid for maternity insurance may be tax-deductible.
• Coverage for newborn babies, including expenses incurred for the treatment of congenital disorders and other complications post-birth.
• Coverage for vaccination charges for the newborn, which need to be completed within the first year of birth.

Maternity insurance provides expectant mothers with the necessary financial support to ensure a healthy pregnancy and childbirth. It helps to minimise the financial burden associated with pregnancy and childbirth, allowing mothers to focus on their health and the well-being of their babies.

Frequently asked questions