Maternity Insurance Explained: Coverage, Caps, And Waiting Periods

Maternity plan usually covers hospitalisation for normal or cesarean delivery, along with pre- and post-natal check-ups and newborn care; some policies also cover vaccinations for the baby during the hospital stay.

“Furthermore, some of the common exclusions that families should watch out for include fertility treatments, surrogacy, cosmetic procedures, and complications arising from pre-existing conditions. It is vital to read the fine print to avoid any surprises during the claim process,” says Sarita Joshi, head of health and life insurance, Probus.

Understanding Caps And Sub-Limits 

It is essential to understand that sub-limits and caps are predefined limits within an insurance policy. The policyholder must be aware of these. Your insurer may set limits on specific medical expenses.

“For example, for maternity benefits, the insurer may cap the amount paid per delivery. If there is a cap of Rs 75,000 for a normal delivery, even if the hospital bill exceeds this amount, the insurer will only pay up to the specified limit. Similarly, expenses related to prenatal and postnatal hospitalization, as well as surrogacy, are reimbursed only up to this capped amount,” says Bhaskar Nerurkar, head- health administration team, Bajaj Allianz General Insurance.

Understanding Caps And Waiting Periods

In the case of waiting periods, it refers to the duration during which the insurer will not pay any amount to the policyholder, even though the policy is active. For example, maternity and baby care benefits may have a waiting period of one to three years from the date the first policy is issued. 

It means delivery of the baby and any maternity benefits will only be covered post the waiting period is over. “Some policies offer a reduction of the waiting period by one year in case of a long-term policy and the entire premium payment,” says Nerukar.

On the other hand, if the insured switches from another policy that did not include maternity coverage, a fresh waiting period will apply, regardless of how long the previous policy was held. Hence, it is important to carefully review the maternity policy and understand the limitations.

Why Buying Early Matters

Just like any other health insurance policy, opting for a maternity insurance policy at the right age is equally important. This is because most maternity plans come with a waiting period of up to four years.

“In order to meet the required waiting periods, it is best to buy maternity health insurance in advance of planning a pregnancy, typically two to three years beforehand. But as insurance products have developed, some insurers now offer flexibility to adjust the waiting period based on individual requirements,” says Dinesh Mosamkar, senior VP - consumer underwriting, TATA AIG General Insurance.

Early purchase ensures that coverage will be in effect when required. Given that individual circumstances and family planning timelines differ, potential policyholders should carefully assess their plans and select a policy that fits their needs to maximize financial security during maternity.