Maternity Health Insurance

Introduction

If you’re planning to start a family or are already on that journey, a key question that might trouble you is: “Will my health insurance cover maternity expenses?” Fortunately, some health insurance policies do offer maternity coverage, and with the rising costs of C-sections, pre and post-natal care, and potential newborn medical needs, this coverage has become increasingly popular.

The next question is which maternity health insurance plan might be the best for you. What features should you prioritise? Are there any drawbacks to consider? And ultimately, is this type of coverage right for you?

Here’s a closer look at our thoughts on finding the right maternity health insurance plan.

Best Maternity Health Insurance Plans

What are Maternity Health Insurance Policies?

From conception through the months after childbirth, expenses for C-sections or normal deliveries, various medical procedures, tests, and follow-ups can add up quickly. Even if hospitalisation isn’t always necessary, these costs can easily impact your savings. Additionally, newborns can sometimes face health issues due to infections or genetic conditions, leading to further medical expenses—which are generally not covered under standard health insurance plans.

Maternity health insurance plans can help cover these expenses, providing financial support for both mother and baby. However, most standard health insurance plans don’t include maternity coverage by default. Maternity health insurance plans offer the perks as an in-built feature or add-on. So, a key question remains: are maternity health insurance plans worth considering?

Here’s an overview of what to expect with these plans -

Should you buy a maternity health insurance plan?

• Delivery Expenses: Maternity health insurance plans typically cover delivery costs for normal and C-sections, which can range from ₹50,000 to ₹2 lakh. This coverage helps ease the financial load, especially since new parents often face additional expenses for both the mother and newborn.
• Vaccination: With the right health insurance plan, vaccination costs for the mother and newborn can also be covered post-delivery, providing extra financial support.
• Assisted reproduction coverage: For couples facing challenges in conceiving, fertility treatments can be an option. However, these treatments can be costly. Some maternity health insurance policies cover assisted reproduction procedures, helping to manage these expenses.
• Pre- and Post-Natal cover:Maternity coverage typically includes expenses incurred before and after delivery, such as necessary tests, medications, follow-ups, and ultrasounds for the mother. This pre- and post-natal care ensures both the mother and newborn receive essential support. Depending on the policy, the duration of coverage for these expenses may vary.
• Surrogacy Cover and Oocyte Donor Cover: Some maternity health insurance plans also extend coverage to surrogate mothers, including medical needs and complications during the pre- and post-birth periods. However, this coverage usually requires adherence to the Surrogacy Act and Assisted Reproductive Technology (Regulation) Act 2021. For oocyte donor coverage, claims are generally allowed from a few days before ovarian stimulation to a few months after the procedure.

• Newborn Coverage from Day 1: Under the standard health insurance plans (family health insurance), the minimum entry age of a child is 91 days. In the case of individual health insurance policies, the minimum entry age is 18 years. Under such circumstances and considering the unfortunate truth about rising complications among newborns that require immediate treatment and incur massive bills, maternity health insurance plans can be quite a blessing.

  Most maternity health insurance policies offer newborn coverage from Day 1. This offered coverage can be deducted from the maternity perk coverage or the base sum insured (generally, it’s the former). This is a substantial perk considering that medical complications among newborns are rising, and the respective financial ask can be taxing. Additionally, having a funding backup for your newborn can be a huge sigh of relief in terms of mental peace.

  While maternity health insurance plans will cover the newest member of your family from Day 1 to Day 91, you can easily include him/her in your family health insurance plan after this and opt for an individual plan when he/she turns 18 (or 25 or 30, based on your insurer’s requirements).

• Coverage for Pregnancy complications: Complications during pregnancy are an unfortunate fact. Such complications (like ectopic pregnancy or miscarriages) can easily take a toll on the physical, mental, and financial health of a couple. In these situations, having a maternity health insurance policy that takes care of the financial angle of the situation is a solid support.

• Comes with a sub-limit: Each maternity health insurance policy, irrespective of the insurer you approach and the policy you opt for, comes with a sub-limit on its maternity coverage. This sub-limit differs based on the total sum insured (that you chose during the policy purchase) on your plan. Such a sub-limit means that you might as well fall short of funding during your claim.

  (Please note: Health insurance providers also have a different sub-limit based on the method of delivery: C-section or normal.)

  Here’s an example to help you understand better:

  Say you have health insurance worth ₹10 lakhs that offers coverage for maternity (₹50k for normal deliveries and ₹75k for C-sections). However, your spouse delivers the baby while you are in a Tier 1 city, and hence, the cost of the C-section delivery goes up to ₹1.2 lakhs. Now, despite having a total coverage of ₹10 lakhs, you will still need to shell out ₹45k from your pocket because your insurer will only cover ₹75k (the pre-determined capped amount).

• Has a waiting period associated with it: Maternity health insurance plans almost always have a waiting period associated with it. This waiting period may vary from 9 months to 4 years. Having such an extensive waiting period means you must plan for your child well in advance. Unfortunately, not everything in life can be planned. So, there is a high chance that this waiting period requirement might not be met by policyholders, who will then end up losing out on this perk.

Maternity health insurance policy with no waiting period

If you opt for a maternity claim via your corporate health insurance plan (provided by your employer), you are not required to undergo any waiting period. You can claim from Day 1 of your policy.

On the other hand, the lowest waiting period in the industry for maternity coverage in individual health insurance policies is 9 months. Currently, there are no health insurance policies with a 0 waiting period.

• The ROI against the additional premium is pretty low: In the case of maternity health insurance policies, the premium hike (compared to the standard plans) is substantial. However, due to a sub-limit on the maternity cover, policyholders will have limited access to the funding. Such sub-limits can be quite financially restraining, and you might as well need to shell out a substantial amount for antenatal, post-partum, and delivery treatments despite having a proper health insurance plan in place.
• Lifetime add-on with no chance to drop out: Maternity health insurance plans offer coverage for at the most 2 deliveries. However, since maternity add-ons, like any other health insurance rider, can't be dropped once it has been purchased, you will end up paying the premiums towards the add-on, even though you won't be able to claim it any further.
• High Premiums: Maternity health insurance claims are almost always guaranteed (at least once or at most twice). Naturally, insurers are inclined to demand a higher premium compared to standard health insurance plans (where the risks of payout are spread thin). Now, you need to figure out if the additional premiums you pay justify the coverage bandwidth for the maternity perks (as offered by the plan you have chosen).

• Both the husband & wife must stay on the plan across the waiting period: Maternity health insurance plans require both parents to stay on a policy and complete the pre-decided waiting period. So, even if you have been on a plan for 5 years, get married, and add your spouse after that, you will still have to wait for another 9 months to 4 years to get access to maternity perks.

  Exception: In the case of Niva Bupa Aspire (M-iracle) or Star Super Star, some add-ons offer you the unique benefit of individually waiting out for the maternity perk. So, if you have opted for this plan and rider and completed the pre-decided waiting period, once you add your spouse to the plan, you won’t need to complete the waiting period as a couple. You can claim the maternity perk as per your requirement.

How to choose the best maternity health insurance plans?

• Choose a plan with a low waiting period: A shorter waiting period is important in maternity insurance, as many policies require you to wait two to four years before covering maternity. Plans with shorter waiting periods allow you to access this benefit sooner, especially if you're planning for a family in the near future. Before committing, always review these waiting periods to make sure they align with your timeline.
• Opt for a policy with high maternity coverage: Maternity expenses can quickly add up, from prenatal visits to hospital stays and follow-ups. Selecting a policy with a higher maternity coverage limit will ensure you have enough financial support when it’s most needed. Many plans have sub-limits for maternity benefits, so look for one that offers coverage adequate for both regular and cesarean deliveries.
• Check out the details of the pre and post-hospitalisation coverage: Maternity policies often include pre and post-hospitalisationexpenses, covering doctor consultations, diagnostic tests, and follow-up visits within a specified period before and after delivery. This usually lasts from 60 days before hospitalisation to 90 days after hospitalisation. Ensuring that your policy provides generous coverage here can ease the financial burden during and after your pregnancy.
• Take a quick look at the details of the newborn coverage: Take a look at if and when the coverage kicks in for your infant. Good maternity plans extend coverage for the newborn right from birth, covering expenses such as vaccinations and initial childcare. Policies offering immediate newborn coverage can be particularly valuable as they allow you to focus on the well-being of both mother and child without worrying about costs.
• Ensure comprehensive coverage across the pre and post-natal period: Comprehensive maternity policies go beyond hospitalisation to cover prenatal and postnatal care. These policies provide financial support throughout your pregnancy, including regular check-ups and any follow-up care needed after delivery. A policy that covers the entire pre and postnatal period not only offers peace of mind but ensures better healthcare access for both mother and child.

What are the best maternity health insurance plans?

• Features: Aditya Birla Activ Fit Preferred is a comprehensive health insurance plan tailored for young families planning for maternity. The policy does not impose room rent restrictions, allowing you to choose any hospital room without additional charges. You benefit from no disease-wise sub-limits other than for maternity, ensuring complete coverage for various treatments. The plan covers daycare procedures and domiciliary treatments, providing flexibility for treatments that don't require extended hospital stays. The insurer offers up to ₹60,000 for C-Section and ₹50,000 for regular delivery (maximum of 2 deliveries or terminations) after a waiting period of three years, exclusively available in family floater policies.

  The policy also extends its maternity coverage to include pre- and post-natal expenses, newborn coverage from birth (from day 1), specified vaccinations until the child turns two, and stem cell preservation for the newborn. All of these make it well-suited for families seeking good maternity support.

• Drawbacks: Aditya Birla, as a health insurance provider, has solid metrics across CSR, ICR, annual business income, and diversity and comprehensiveness in the product portfolio. The only hiccup is its slightly high complaint volume. However, since the insurer is new to the industry, they have plenty of opportunity to rectify any shortcomings. The plan is also missing coverage for assisted reproduction procedures/treatments, surrogacy, oocyte donor, or adoption expenses. Moreover, the plan falls a tad bit short when it comes to maternity expense coverage.
• Final Verdict: In our opinion, Aditya Birla Activ Fit Preferred is a good option if you're seeking comprehensive health coverage with decent maternity benefits. Unlimited restoration and wellness rewards add significant value to the policy. While there are minor concerns regarding the insurer's slight spike in complaint volume, the plan's extensive benefits make it a strong contender if you prioritise maternity coverage.

• Features: Tata AIG Medicare Premier offers wide-ranging coverage, including significant maternity benefits. The policy imposes no room rent restrictions and requires no copayment, reducing your out-of-pocket expenses during claims. You will receive comprehensive coverage with no sub-limits for any illness. The plan covers daycare procedures and domiciliary treatments, catering to treatments that don't require extended hospital stays. Maternity coverage is substantial, providing up to ₹60,000 (₹50k for a boy & ₹60k for a girl child – This can be higher depending on the cover amount chosen). However, this is only after a waiting period of four years. One unique feature of this policy is international coverage, offering medical emergency coverage worldwide (except the US & Canada), which is beneficial if you travel frequently.
• Drawbacks: The waiting period of four years for maternity coverage is relatively longer than other plans, and you can only add your child to the policy after it is at least 91 days old. While most insurers issue maternity coverage in only family floater policies, adding a spouse is not allowed after the policy is issued, which is unusual. Apart from this, Medicare Premier is relatively expensive compared to other plans, which might not suit people under a budget.
• Final Verdict: Tata AIG Medicare Premier is a good option if you seek extensive health coverage with significant maternity benefits and global protection. While the higher premium and certain policy restrictions are considerations, some benefits, such as international coverage, may be useful. If you’re purchasing this plan solely for maternity coverage, we feel the 4 year waiting period is slightly longer than usual.

• Features: ICICI Lombard Elevate offers extensive coverage with several features. Maternity coverage is available as an add-on, providing up to 10% of the base sum insured, capped at ₹1 lakh. However, you must wait 2 years to avail of this coverage. Meanwhile, you can benefit from the policy’s wellness programs and rewards, which encourage a healthy lifestyle and provide several discounts and benefits. Another unique feature of this policy is the inflation-adjusted cover amount add-on, which keeps your coverage in line with the inflation rate.
• Drawbacks: The room-rent limit is restricted to a single private room unless you purchase an add-on. While the plan offers robust features, maternity coverage is only available as an add-on, so you must shell out additional premiums.
• Final Verdict: We believe ICICI Lombard Elevate is a solid health insurance plan offering comprehensive coverage with valuable perks like air ambulance coverage and wellness rewards. The relatively shorter waiting period for maternity coverage is advantageous. However, you should consider the additional costs for add-ons and assess whether the extensive features align with your needs and budget.

• Features: Star Super Star offers customisable coverage with noteworthy features. The policy provides comprehensive add-ons that cover childbirth, newborn expenses, and Assisted Reproduction Treatment (ART), which might help some couples. A unique perk is the Future Shield benefit, where your premium will only increase based on age once you make a claim, potentially saving you money over time. The policy also imposes no room rent restrictions and requires no copayment, giving you freedom in room selection without extra costs and reducing out-of-pocket expenses. You receive full coverage with no disease-wise sub-limits other than for maternity. Super Star has over 20 add-ons available, and you can extensively customise the plan to suit your needs.
• Drawbacks: The insurer's claim settlement ratio is below the industry average, and operational efficiency needs improvement. This can potentially affect claim processing and customer service.
• Final Verdict: Star Super Star offers robust features and extensive customisation options, making it attractive if you're seeking a personalised health insurance plan. However, the insurer's claim settlement and performance are cause for concern.

• Features: Niva Bupa Aspire Titanium + has no room rent restrictions and requires no copayment, minimising your out-of-pocket expenses during claims. You receive coverage for daycare procedures and domiciliary treatments, accommodating treatments that don’t need prolonged hospital stays. Maternity coverage is available, with limits that depend on your chosen sum insured. For example, with a 3L cover, the sub-limit is ₹4,000, while for a 1Cr cover, it’s ₹25,000. Additionally, any unutilised maternity sum insured is carried forward up to the Booster+ limit, allowing you to maximise coverage over time. The policy also covers surrogacy, adoption, and Assisted Reproductive Treatment (ART). The Future Ready feature enables you to include your ‘future spouse’ (before you get married) to start the waiting period early, ensuring continuity in coverage. You can also add a child aged up to 90 days and a newly wedded spouse to the policy after issuance. This option is highly beneficial as it provides coverage for the newborn in case of post-delivery complications.
• Drawbacks: While the inclusion of ART and surrogacy support is beneficial for couples facing challenges with natural conception, the maternity sub-limits may still leave some out-of-pocket expenses, depending on the sum insured chosen. Additionally, the policy is relatively expensive compared to other options in the market, which might be a concern if you’re budget-conscious.
• Final Verdict: In our opinion, Niva Bupa Aspire Titanium + is a well-rounded health insurance plan, particularly suited for couples seeking comprehensive maternity perks through its Miracle Benefit and Future Ready add-on. While the premium cost and operational metrics may give pause, the plan’s extensive features make it a strong choice for those prioritising maternity coverage.

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Tips to choose the top maternity health insurance policy

• Claim Settlement Ratio: This is one of the primary metrics used to determine an insurer's credibility. It measures the number of claims settled by an insurer across a year against the number of claims raised to the insurer for the year. A credible insurer’s rating should be 90 or above. On the other hand, any insurer with a CSR of 80 or below is not worth approaching!

  While CSR is a crucial metric, it can often be misleading if considered solely when determining the top health insurance providers.

  Here is a quick look at the CSR (average of the last 3 years) of all the health insurance players in the industry -

  

  
• Incurred Claim Ratio (ICR): When choosing a health insurance provider, a quick look at the company's incurred Claim Ratio (ICR) can save time and help you consider the insurer's future financial sustainability and claim settlement potential.

  The ICR of a health insurer is computed by dividing the total amount paid in claims by the total amount earned by the insurer in premiums over a year.

  A credible insurer with transparent and steady future sustainability should have an ICR between 50 and 70; any number below 50 indicates that the insurer is heavily leaning towards setting its business profits straight, and that would indicate higher chances of partial or rejected claims. Again, any provider with an ICR of 80 or higher might seem like an excellent choice for the short term since they are settling claims in full, but in the longer run, such brands (unless they have an extensive track record that proves otherwise) might run into some financial crunch.

  Here is a quick look at the ICR (average of the last 3 years) of the current health insurance players in the industry -

  

  
• Complaint Volume: The complaint volume of a health insurance provider records the number of claims filed against the insurer across a year per 10,000 claims. This can be the perfect metric that will help you gauge the quality of the claim settlement experience for the existing policyholders of the insurer (since most complaints stem from issues across the claim settlement process/amount).

  In short, the lower the complaint volume (preferably lower than 20), the better the insurer. Here is a quick look at the complaint volume of the health insurance providers across the industry -

  

  
• Annual Average Business Income: Now, traditionally, an insurer's annual average business income is not listed as its credibility-checker. Nevertheless, this metric sheds light on the insurer’s business vertical - whether you are dealing with a small-sized, medium-sized, or large-sized company. A larger business capital-holding insurer can seem more promising, considering it appears to be financially stable to clear your claim settlement requests.

  However, as mentioned before, multiple other metrics must be considered before finalising that choice.

  Here is a look at the top health insurance providers with their annual average business income (average of the last 3 years) -

  

  

• Choose a plan with a low waiting period.
• Ensure the chosen plan has a higher cap on the sub-limit for maternity perks.
• Prioritise your corporate health insurance plan for the maternity claim to ensure smoother claim processing and lower out-of-pocket expenses.
• Opt for a plan with extensive days of coverage for pre and post-natal care.
• Ensure that your plan covers newborns from day 1.
• Choose a plan that covers vaccinations, follow-up visits, diagnostic tests, and more.
• Opt for a plan that covers assisted reproductive procedures, Surrogacy and Oocyte Donors.