Motherhood is one of the most blessed moments in every woman’s life. Maternity is a crucial stage of life that involves various healthcare procedures intended to protect the mother and baby. It is therefore advised to wisely plan this crucial life stage and ensure adequate health coverage in the form of a maternity insurance policy.
While all health insurance plans are subject to certain waiting periods, maternity insurance policy is no exception. The waiting period in maternity health insurance is a crucial aspect that prospective policyholders must understand thoroughly. It refers to a specified duration during which a new insurance policy does not cover certain medical conditions or treatments, including maternity-related expenses.
This article will guide you through the concept of the waiting period in a maternity insurance policy and how to wisely plan maternity coverage.
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Why is there a waiting period in a maternity insurance policy?
Health insurers impose waiting periods in the maternity insurance policy to prevent individuals from purchasing a policy just after becoming pregnant and immediately claiming benefits, which would pose a significant financial risk to the insurer.
Given below are two broad rationales for the waiting period in a maternity insurance policy:
- Risk management: Pregnancy is a predictable event. Without a waiting period, individuals might purchase insurance for pregnancy and then cancel it, causing adverse selection and threatening insurers’ business sustainability.
- Cost control: It enables insurers to manage financial liabilities effectively and keep premiums affordable for everyone.
By fulfilling the above two objectives, the waiting period clearly defines the parameters for maternity coverage and makes it more effective and justifiable.
How does the waiting period affect the maternity insurance policy?
Due to the waiting period clause attached to the maternity insurance policy, no coverage is available during the waiting period. Any maternity-related costs, such as consultations, diagnostic tests, delivery, or pregnancy complications, will not be reimbursed by the insurance policy during this time.
Coverage begins after the waiting period. So, after successfully completing the waiting period, you become eligible to claim the maternity benefits according to the terms and conditions of the policy.
What should you consider while buying a maternity insurance policy?
As a responsible parent-to-be, you always seek the best health insurance in India with maternity benefits. However, keep in mind the waiting period clause; you must prepare and choose your coverage wisely.
Here are some key considerations in this regard:
- Plan your coverage: Keeping in mind a considerable waiting period, it’s always advisable to purchase a maternity health insurance policy well in advance if you plan to start a family.
- Compare waiting periods: When comparing different policies, always check and compare the waiting periods. A shorter waiting period might seem appealing, but it’s essential to also assess the coverage scope and premium.
- Understand sub-limits: Beyond the waiting period, be aware of any sub-limits on maternity expenses (e.g., cap on normal delivery vs. C-section costs) and co-payment clauses, which also affect the out-of-pocket expenses.
- Inclusions and exclusions: Carefully read the policy document to understand what specific maternity-related expenses are covered and what is excluded, even after the waiting period is over.
- Portability: If you port your health insurance policy, some insurers may offer credit for the waiting period already served with your previous insurer, but this varies.
Is group maternity coverage better than individual maternity insurance policy?
While extremely rare, some group health insurance policies, provided by employers, might offer maternity coverage with a reduced or no waiting period, as the risk is spread across a larger, diverse group of employees.
- Group health insurance policies offer immediate maternity benefits, covering both standard and C-section deliveries for you and your spouse from day one of employment.
- It includes hospitalisation costs like doctor’s fees, OT expenses, room rent, and medicine.
- Pre-hospitalisation and post-hospitalisation are also covered under such plans.
- Besides, group maternity insurance plans cover newborns for 90 days from birth, with all vaccination expenses during hospitalisation.
- Above all, employer-sponsored mediclaim policies for delivery are typically cashless.
Yet, group health insurance plans often fall short in fully covering pregnancy and maternity-related costs, though they might initially appear appealing. Group mediclaim policies typically include sub-limits for maternity expenses, rendering the provided coverage insufficient. Moreover, companies usually offer their employees group health insurance with very low sub-limits. Often, sub-limit is up to ₹50,000, which includes hospitalisation expenses, surgeon’s fee, room rent and newborn baby care.
Hence, it is ideal to go with a dedicated individual maternity insurance policy that provides comprehensive coverage for maternity expenses.
To sum up
From above, you can understand that a full-fledged maternity insurance policy is essential for overall coverage of maternity expenses without sub-limits. This ensures adequate coverage of out-of-pocket expenses and some unanticipated costs that may go beyond your financial limits. However, the only significant condition that applies to maternity health insurance plans is that they come with a considerable waiting period. It is therefore advised to preplan your pregnancy and buy a maternity insurance policy well in advance to ensure timely coverage.
Disclaimer: Verifying the policy details and coverage with the official policy documents is essential. Also, kindly consult a professional medical expert to verify the details of your health concerns.
