Health Insurance for Pregnancy 2024 - Covered & Not Covered

 

Health insurance for pregnancy and birth is a crucial aspect of comprehensive healthcare coverage. It provides financial protection and support to expectant mothers by covering the costs associated with prenatal care, delivery, and postnatal care. 

 

What is Covered in Pregnancy Health Insurance?

Pregnancy health insurance covers a wide range of medical services and expenses related to pregnancy, childbirth, and postpartum care.

Some common aspects that are typically covered:

• Prenatal care: This includes regular check-ups, doctor visits, laboratory tests, ultrasounds, and any necessary prescription medications during pregnancy.

• Hospital stay: Health insurance often covers the cost of hospitalization for labor and delivery, including the services of physicians, nurses, and medical equipment.

• Obstetric and gynecological services: Coverage may extend to services provided by obstetricians, gynecologists, midwives, and healthcare providers specializing in pregnancy care.

• High-risk pregnancy management: If a pregnancy is considered high-risk due to certain medical conditions or complications, health insurance may cover additional tests, monitoring, and consultations with specialists.

• Childbirth services: This includes the costs associated with childbirth, such as delivery room charges, anesthesia, and surgical interventions if required.

• Cesarean section (C-section): If a C-section becomes necessary, insurance can usually cover the procedure, including surgeon fees, anesthesiology, and post-operative care.

• Postpartum care: Health insurance often covers follow-up visits, medication, and any necessary medical procedures during the postpartum period.

• Newborn care: Some insurance plans provide coverage for the newborn, including hospital care, pediatrician visits, and necessary vaccinations during the first few weeks after birth.

Note: Contact Our Experts to Know What is Covered!

 

What is Not Covered in Pregnancy Health Insurance?

While pregnancy health insurance typically covers various medical expenses related to pregnancy and childbirth, certain things are generally not covered. 

Here are some examples:

• Pre-existing conditions: Pregnancy health insurance generally does not cover expenses related to pre-existing conditions, such as a mother's chronic illness or conditions that were present before becoming pregnant.

• Fertility treatments: Most insurance plans do not cover fertility treatments, such as in vitro fertilization (IVF) or other assisted reproductive technologies.

• Elective prenatal procedures: Procedures that are not medically necessary, such as gender determination ultrasounds or certain genetic tests, are typically not covered. 

• Non-medical expenses: Pregnancy health insurance typically does not cover non-medical expenses, such as prenatal vitamins, over-the-counter medications, or cosmetic treatments unrelated to health.

• Abortion: Generally, insurance plans do not cover the cost of abortion, except in cases where the pregnancy poses a danger to the mother's life or in certain other specific circumstances.

• Dental and vision care: Routine dental and vision care related to pregnancy, such as teeth cleaning or eye exams, are often not covered by pregnancy health insurance. 

Note: Contact Our Experts to Know What is Not Covered!

 

Do You Need Health Insurance for Pregnancy?

While health insurance for pregnancy is not mandatory, having health insurance during pregnancy is highly advisable.

Several reasons why health insurance is important during pregnancy:

• Medical Expenses: Prenatal care, routine check-ups, ultrasounds, and other medical expenses related to pregnancy can accumulate. Health insurance helps cover these costs, reducing the financial burden on the expectant parents.

• Hospitalization Costs: The hospitalization costs associated with childbirth, including delivery charges, room charges, and other related expenses, can be substantial. Health insurance provides coverage for hospitalization, making it more affordable.

• Emergency Situations: Complications during pregnancy or unexpected emergencies may arise. Health insurance ensures that you have financial support in such situations, covering emergency medical procedures and treatments

• Postnatal Care: Health insurance can extend coverage to postnatal care, including follow-up visits, vaccinations for the newborn, and any additional medical requirements after childbirth.

• Medication and Tests: Health insurance can cover the cost of prescribed medications, laboratory tests, and diagnostic procedures related to pregnancy and childbirth.

• Maternity Coverage: Some health insurance plans offer specific maternity coverage, which includes expenses related to pregnancy, delivery, and postnatal care. Maternity coverage is designed to address the unique healthcare needs during this period.

• Preventive Care: Health insurance often covers preventive care and wellness programs, which are crucial during pregnancy to ensure the health of both the mother and the baby.

 

Can I Buy Health Insurance After Pregnancy?

In most cases, buying health insurance after becoming pregnant may be challenging, and coverage for maternity-related expenses might not be available immediately. Insurance companies typically have waiting periods for maternity coverage to prevent adverse selection, where individuals only purchase insurance when they know they will incur significant medical expenses.

Points to consider:

• Waiting Periods: Many health insurance policies have waiting periods, especially for maternity coverage. These waiting periods can range from a few months to a few years. During this time, the policyholder is not eligible to claim maternity-related expenses.

• Pre-Existing Conditions: Pregnancy may be considered a pre-existing condition, and some insurers may not cover expenses related to pre-existing conditions for a certain period after the policy is purchased.

• Special Maternity Plans: Some insurers offer special maternity plans that can be purchased separately. However, these plans may still have waiting periods, and coverage might take time.

• Group Health Insurance: If you are part of a group health insurance plan, such as one provided by your employer, check whether maternity coverage is included. 

• Explore Government Schemes: In India, government-sponsored health insurance schemes may cover maternity expenses. Check whether you are eligible for any such schemes.

 

How to Get Health Insurance When Pregnant?

Getting health insurance while pregnant can be challenging, as many insurance companies have waiting periods before covering maternity-related expenses. It is always recommended to buy health insurance from the best health insurance companies in India.

Steps you can consider:

• Review Existing Policies: Check your existing health insurance policy to see if it covers maternity expenses. Some policies may have a waiting period, and you may need to have the policy for a certain period before maternity benefits kick in.

• Add Maternity Cover: If your current policy doesn't cover maternity, inquire about the possibility of adding maternity coverage. However, keep in mind that there might be waiting periods associated with this addition.

• Consider Special Maternity Policies: Some insurance companies offer specific maternity insurance policies. These policies are designed to cover pregnancy-related expenses. However, they also may have waiting periods.

• Group Health Insurance: If you are part of a group health insurance plan, such as one provided by your employer, check whether maternity coverage is included. Group policies may have more lenient terms for maternity coverage.

• Purchase a Maternity Insurance Plan in Advance: If you are planning to have a child in the future, it's advisable to purchase a maternity insurance plan well in advance. This ensures that you fulfill any waiting periods before needing the coverage.

• Compare Plans: Research and compare different health insurance plans that offer maternity coverage. Look for plans with shorter waiting periods and comprehensive coverage.

• Full Disclosure: When applying for health insurance, be transparent about your pregnancy status. Providing accurate information ensures that you are properly covered and avoids potential issues with claims in the future.

 

How to Buy Health Insurance for Pregnancy from Okbima?

Buying health insurance for pregnancy from okbima is a simple and easy step process that you can follow to make an informed decision.

Step 1: Visit the website of Okbima, and click on the “health insurance” icon.

Step 2: Once you are redirected to the health insurance page, fill in basic details such as your name,  mobile number, email, DOB, and the coverage amount.

Step 3: Choose the best plan according to your needs and complete the payment process.

Step 4: Once your payment is completed, you will get the policy details on your email ID.

 

Conclusion

In conclusion, health insurance for pregnancy plays a crucial role in ensuring the well-being of both the mother and the baby. Comprehensive healthcare coverage during this important phase of life is essential to address the various needs and risks associated with pregnancy and childbirth. 

 

FAQs

Can I buy health insurance for a pre-existing pregnancy?

Unfortunately, most health insurance won't cover existing pregnancies due to waiting periods.

 

Can I change health insurance during pregnancy?

Generally, you can't switch health insurance plans during pregnancy outside of open enrollment. Special enrollment periods may apply due to life events like marriage or job loss.

 

Does health insurance pregnancy cover a waiting period?

Some plans have waiting periods for maternity coverage. It's crucial to check your policy details. Employer-sponsored plans often don't have waiting periods, but individual plans may vary.

 

Is pregnancy covered under health insurance?

Many health insurance plans cover pregnancy-related expenses. It's crucial to review your policy to understand specific coverage, including prenatal care, delivery, and postnatal care.

 

Is pregnancy covered in HDFC Ergo?

HDFC Ergo likely offers maternity coverage, but specifics vary by policy. Review your plan documents or contact HDFC Ergo directly to understand the extent of pregnancy coverage provided.

 

What does 12-month waiting period mean for pregnancy?

A 12-month waiting period implies that the insurance policy requires you to wait a year from the policy start date before accessing maternity benefits. During this time, pregnancy-related expenses may not be covered.