Unlike other hospitalizations, maternity is not covered by many Insurance Companies as maternity cover is so specific in nature that it will witness a 100% claim ratio. Thus there is no standalone maternity Insurance cover in India. Insurance companies do not usually cover expected risks like pregnancy and childbirth. But due to development of the insurance market in recent years there are some options available covering the maternity expenses.

COVER OPTIONS

Group health cover taken by employers usually covers maternity expenses. Few corporates negotiate for and incorporate this cover as an added benefit for their employees. Sanjay Datta, head of Health Insurance of ICICI Lombard General Insurance says that, “In a group cover, the number of claims can be offset by a set people who wouldn’t make any claim related to maternity. Hence, the risk of covering maternity expenses in a group gets diluted”. Maternity cover is also available as a rider (that is, add-on cover) to an individual Mediclaim by few companies.

COVERAGE PERIOD

The cover does not start from the very first day as there is a waiting period of nine months in a group health cover offered by employers. Ideally, the employee should have completed at least nine months in the organisation before hospitalization.

In case of an individual mediclaim, one has to wait for 4 years or more (depending on the policy) to gain from maternity benefits. Apollo DKV has a waiting period of six years for Easy Health-Individual Health Insurance Plan and four years for Easy Health-Family Health Insurance Plan.

ELIGIBILITY

Either a working woman or a home-maker (whose spouse has a group health cover), have access to maternity cover insurance after the waiting period. Every company specifies a limit on maternity benefits under group health, which is usually Rs.50,000 for a Rs.2 lac cover. In case of self-employed professionals, they can only get cover for pre-natal expenses through a general waiting period.

INCLUSIONS & EXCLUSIONS

Maternity insurance should cover all expenses from the pre-natal, hospitalizations to the post-natal phase but group health insurance offered by employers covers only the costs directly related to the delivery of the child.

Exclusions of group cover:

• Pre-hospitalization period, which includes ultrasound, regular check-ups, termination of pregnancy within the first 12 weeks and the doctor’s consultation fee.
• Post-hospitalization expenses such as extra oxygen given to premature baby, etc.

Individual Policy/mediclaim:

• Pre-natal expenses are covered if you have taken the maternity insurance as an additional rider. But not hospitalization, delivery and post-natal charges.

“In case of maternity cover, under individual mediclaim, it covers delivery-related expenses, pre-natal tests and medication expenses. But it comes after a long waiting period,” says Radhakrishna Chamarty, director of India Insure Risk Management & Insurance Broking Services. Each insurance company has its own features and policy wording. Post-hospitalization benefits are usually restricted to 60 days in case of most general insurance companies.

MOREOVER

Under a group health cover, it’s easier to get reimbursed for pre and post-natal expenses through your regular mediclaim. But you have to ensure to opt for an additional rider of maternity cover with the main mediclaim.

In case of a regular Mediclaim Policy, the coverage and ceilings are very low and hardly cover for 1/4th of maternity expenses.

Insurers are correct to claim that the demand for this product is increasing and hence, more players are looking to target this space. But for now, only group health cover seems like a good option.

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