7 Differences Between Maternity Insurance and Medical Insurance Plans

Both regular health insurance and maternity health insurance are crucial for financial peace in their own ways. Tap to read what makes one different from another.

Maternity health insurance vs regular health insurance: Decoding the difference

As medical costs continue to rise sharply, keeping a solid health insurance plan is less of a luxury and more of a necessity. However, simply buying a plan isn’t enough. You need to consider the specific emergencies you want your policy to cover. When planning a family, standard medical insurance plans are often insufficient. That’s why insurers offer maternity health insurance, a dedicated coverage that eases the financial burden associated with pregnancy and childbirth.

However, many people are unaware of the purpose of maternity insurance and how it differs from a regular health plan. For instance, the differences extend beyond just pregnancy versus other medical scenarios. These contrasts include waiting periods, premiums, and eligibility criteria. This article explores everything that you need to know to make the right decision.

What is regular health insurance and what it offers?

A regular health insurance plan covers a wide range of medical expenses resulting from unforeseen circumstances such as illness, accidents, injuries, or hospitalisations. This type of health insurance is designed with risk unpredictability in its core. This means the plan operates on the assumption that the health events it covers occur at any time, without warning. It typically provides coverage for:

• In-patient hospitalisation costs
• Pre- and post-hospitalisation medical expenses
• Surgeries
• Specialist consultations
• Diagnostic tests

And more, depending on the specific plan. While they come with extensive coverage, most regular health insurance plans (well, most of them) still don’t include expenses related to maternity. Pregnancy is a planned event and does not fall under what insurers consider ‘unexpected’.

So, here’s the bottom line: Unless your health insurance provider has specifically included maternity coverage in your policy or you’ve added it as an add-on, childbirth and all related costs will need to be borne by you out-of-pocket.

What is maternity health insurance and how it works?

Maternity health insurance is a specialised type of coverage that focuses solely on the financial aspects of pregnancy and postnatal care. This type of insurance either acts as a standalone policy or is typically offered as an add-on to an existing health plan. The scope of this insurance is limited to the coverage for expenses like:

• Normal or caesarean delivery
• Pre-natal consultations
• Hospitalisation during pregnancy
• Postnatal checkups

In most scenarios, this plan also extends to cover newborn-related expenses, typically for the first 90 days. While maternity health insurance provides dedicated protection, it has its own set of caveats. The most important one is the waiting period, which typically ranges from two to four years.

That said, if you are already pregnant or planning to conceive in the near term, purchasing a maternity insurance policy will not help with your current pregnancy. The key is to buy it well in advance, ideally at least two to three years before planning a baby.

Key differences between maternity health insurance and regular health insurance

Here is a list of factors where maternity and regular insurance differ:

Purpose and coverage intent

The whole point of medical insurance plans is to cover a wide range of unforeseen medical expenses, including illnesses, accidents, surgeries, and chronic conditions. This type of insurance acts as a safety net for unexpected health issues. Maternity health insurance, however, is specifically aimed at covering planned medical expenses related to pregnancy, delivery, and immediate postnatal care. It does not offer protection beyond maternity-related needs.

Scope of coverage

Regular health insurance plans include diagnostics, hospitalisations, ICU care, specialist visits, and emergency services. It usually does not offer maternity and childbirth coverage.

On the other hand, maternity insurance focuses only on the stages of pregnancy, such as pre-natal checkups, delivery (both normal and C-section), post-natal care, and in some cases, the first 90 days of the newborn.

Waiting period

Maternity health insurance has a significantly longer waiting period, usually ranging from 2 to 4 years. This makes it important for you to opt for it in advance of pregnancy to actually use the benefits. When it comes to regular insurance, the plans have a short waiting period of around 30 days. Specific conditions (like pre-existing illnesses) may have 1–3 years waiting time.

Premium and cost structure

Premiums for regular health insurance vary based on multiple factors, including age of the individual, their health status, and the coverage amount. In maternity insurance, however, the premiums are relatively higher, owing largely to the fact that pregnancy is a planned event and nearly every buyer is going to make a claim.

Newborn care inclusion

Newborn care is not covered in regular medical insurance plans by default. Parents must add the child to the plan after birth. However, newborn baby care is usually included for the first 90 days in maternity insurance plans. This includes NICU or complications, depending on the insurance provider.

Availability

Regular health insurance is widely available for individuals, families, and senior citizens. It’s a core insurance product. Maternity insurance, however, is mostly available only as an add-on to a family floater or individual plan and cannot be bought standalone from all providers. Also, it’s not available once pregnancy is already confirmed.

Claim approval

Claims for regular health insurance plans are uncertain in nature and vary person to person. An individual may go years without needing to file for any claim. On the other side, claims are almost guaranteed in maternity health insurance, given that people buy this plan specifically when they plan to conceive.

Final thoughts!

Choosing between maternity health insurance and medical insurance plans is all about understanding when and how to use both smartly. Investing in a health insurance plan is non-negotiable as it safeguards you and your family against a range of health-related expenses. Maternity coverage is different and highly specific. It can be really beneficial for couples planning a baby, if purchased timely. Both are important in their own important ways and make a great investment for financial protection and mental peace.

Disclaimer: The above information is for reference purposes only. For any details on coverage, benefits, and exclusions, kindly reach out to your insurer or refer to the brochure, sales prospectus and policy documents carefully.