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How Does Health Insurance Help to Cover Pre and Post-Natal Expenses?

  • Author :
  • TATA AIG Team
  • Published on :
  • 29/01/2024
  • 2 min read

Family planning is an important milestone in an individual’s life. The magical experience of having a baby comes with the need to carefully plan for the varied aspects of both motherhood and childbirth.

In this endeavour, a medical insurance plan with maternity coverage comes in handy. It can offer financial assistance to cover your pregnancy expenses in India.

What is Maternity Insurance?

Maternity insurance is a type of medical insurance plan or add-on cover that can be added to your basic health insurance plan. It covers all medical expenses that soon-to-be mothers incur during pregnancy and childbirth (up to a specific limit).

They generally come with a waiting period ranging between 9 months to 6 years, depending on your insurance provider. No pregnancy-related expenses can be claimed during this waiting period.

Therefore, it is advised to invest in maternity coverage at least a few years before you start a family so you can claim policy benefits when you actually need them. Without maternity coverage on your health insurance, you will have to bear the expenses on your own, which can put a dent in your savings.

To acknowledge the importance of health insurance with maternity coverage, it is important to understand the scope of pre and post-natal expenses that to-be parents must prepare for.

Also Read: Waiting Period in Maternity Health Insurance

What are Pre and Post-Natal Expenses?

In medical insurance plans, pre-hospitalisation expenses meaning is expenses that are incurred before you get admitted to the hospital – so diagnostic tests, consultations, etc, that have led up to your hospitalisation.

Similarly, in maternity insurance, pre and post-natal expenses refer to medical costs related to pregnancy incurred before and after childbirth.

To give you a better idea of what pre-postnatal expenses are, here are the expenses you can expect coverage for under maternity health insurance:

Pre-Hospitalisation Expenses: These expenses are incurred prior to childbirth. They include health consultations, blood tests, urine tests, ultrasounds, medicines, etc.

Most maternity policies cover pre-natal expenses up to 30 days before hospitalisation.

Hospitalisation Expenses: These are pregnancy-related expenses that are incurred during hospitalisation for delivery. It covers expenses such as room rent, anaesthesia charges, nursing and doctor fees, operation charges, prescribed medicines, etc.

Typically, your insurance provider will cover both normal and C-section deliveries.

Post-Hospitalisation Expenses: These are healthcare expenses post-delivery. They include follow-up consultations, tests, and medicines. These expenses are generally covered for a period of up to 60 days after hospitalisation.

New-Born Baby Expenses: Once you bring your bundle of joy into the world, you will need to take care of the baby and ensure proper treatment. This includes vaccinations, immunisations, congenital disability treatment, etc. Insurance companies will incur these expenses for up to 90 days following childbirth.

Now that we understand post-natal expenses and pre-hospitalisation expenses meaning let’s explore the policy inclusions and exclusions for an informed investment purchase.

Inclusions and Exclusions in Maternity Health Insurance Plans

Maternity Insurance Inclusions Maternity Insurance Exclusions
Hospitalisation expenses for childbirth Costs for infertility treatment or assisted reproduction
Costs for prenatal and postnatal consultations  Surrogacy and regular health check-ups unrelated to the pregnancy
Pregnancy-related expenses, including medical examinations, throughout labour and delivery. Miscarriages (unless they result from an accident; ectopic pregnancies*)
Delivery and surgeon fees Cosmetic procedures or plastic surgery
Expenses concerning newborn care Pre-existing health conditions or any other health problems
Cost of hospitalisation during the maternity period Costs for treating any other health ailment that is not related to pregnancy 

Ectopic Pregnancies are excluded from maternity insurance coverage. However, you can get coverage for them under basic health insurance plans. Most insurers will cover them since they are considered medically necessary.

You must also note that the features and exclusions of the policy are subject to change based on your insurance provider and the kind of medical insurance plan you choose.

So, we highly recommend insurance seekers carefully analyse health insurance plan coverage and policy wordings to ensure they have the best maternity insurance that incorporates their necessary healthcare needs.

How to Claim Maternity Expenses

Inform Your Insurance Provider: Once you have conceived, you will need to inform your insurance provider. As mentioned earlier, there could be a waiting period on your maternity insurance, so you should check that to avoid unpleasant surprises.

Get Pre-Authorisation: You must get prior approval from your insurance provider prior to seeking medical therapy. You will need to fill out a claim form and submit all the supporting materials, such as any invoices/hospital bills/receipts and doctor's notes about your maternity treatment.

Get the Necessary Medical Care: Once the pre-approval has been accepted, you can acquire the necessary care and save all the receipts, invoices, and doctor’s notes concerning your treatment.

Raise a Claim: When raising a claim, you will have to fill out the claim settlement form and submit all the supporting documents that you have collected during the treatment procedure.

Wait for Processing: Once you submit the claim, your insurance provider will authenticate the claim and verify whether the expenses are covered under your policy.

Get the Reimbursement: If the claim is granted, your insurance provider will ensure pre and post-natal expenses are covered within maternity limits. Any out-of-pocket pregnancy expenses in India will have to be cleared upfront before receiving the reimbursement.

It is important to carefully review the policy specifications to understand the exact claim settlement procedure of pre and post-natal expenses under your maternity insurance.

In Conclusion

It is important for soon-to-be parents to plan carefully before starting a family because pre and post-natal expenses can be a hassle to sort through.

To prevent financial worries from getting in the way of your magical moment, it is advised to invest in maternity insurance a few years before starting a family. This ensures that you are well-prepared to welcome your baby to the world and ensures that the soon-to-be mother receives the best medical attention.

At Tata AIG, we highly recommend comparing health insurance plans and maternity covers before purchase to ensure you find a policy that meets your requirements.

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Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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