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Ultimate Guide to Maternity Insurance: What’s Covered, What’s Not

A maternity insurance policy is a type of health insurance specifically designed to cover expenses related to pregnancy and childbirth.

Friday April 4, 2025 8:29 PM, Sana Samad

Planning for a family is an exciting time, but it also brings financial considerations, particularly maternity-related medical expenses. A maternity insurance policy can provide assurance, covering pregnancy, childbirth, and postnatal care costs.

However, understanding the specifics of these policies is crucial. This guide aims to clarify what is generally covered under maternity insurance plans and what limitations or exclusions may apply.

What is a Maternity Insurance Policy?

A maternity insurance policy is a type of health insurance specifically designed to cover expenses related to pregnancy and childbirth. It may be a standalone plan or an add-on to an existing health insurance plan.

This policy typically includes costs such as:

• Delivery expenses (normal or cesarean)
• Pre and Postnatal Care Hospitalisation
• Newborn baby cover (for a specified period)
• Complication expenses (under the sum insured If any)

The objective is to ease the financial burden on expecting parents and ensure access to quality healthcare services without having to worry about out-of-pocket expenses.

What’s Covered Under Maternity Insurance?

A maternity insurance policy from reputed insurers offers wide-ranging benefits that support mothers-to-be through every phase of pregnancy. Here’s a closer look at what’s usually included:

1. Prenatal and Postnatal Hospitalisation

Regular doctor consultations, diagnostic tests like ultrasounds, medications, and vitamins (prescribed by doctors) fall under this category. Most health insurance plans with maternity coverage offer this benefit until the stated amount in the policy schedule is exhausted.

2. Delivery Costs

Whether it’s a normal delivery or a cesarean section, the expenses are covered limited to two deliveries. This includes hospital room charges, nursing, operation theatre fees, and specialist consultations. However, some plans may come with sub-limits depending on the delivery type.

3. Newborn Baby Coverage

Some maternity insurance policies, like the Bajaj Allianz General Insurance Company’s Health Guard Policy, extend coverage to newborns from day one to up to 90 days post-birth. This often includes treatment for congenital conditions, NICU charges, and other emergency needs.

4. Vaccination Cover

Mandatory Coverage for mandatory vaccinations of the newborn, as recommended by the Indian Pediatric Association, will be covered for up to 90 days.

5. Emergency Complications

If unforeseen medical complications arise during childbirth, such as preeclampsia or premature labour, many health insurance plans cover those costs as well.

What’s Not Covered Under Maternity Insurance?

Despite its comprehensive coverage, there are certain exclusions under a maternity insurance policy that you should be aware of:

1. Pre-Existing Pregnancy

Most insurers consider an ongoing pregnancy a pre-existing condition. Hence, if you're already pregnant and try to buy maternity cover, the policy likely won’t be applicable.

2. Infertility Treatments

Expenses related to IVF, IUI, or any assisted reproductive treatments are typically excluded.

3. Non-Prescribed Medicines

Any vitamins or supplements that a certified medical practitioner does not explicitly recommend are not covered.

4. Congenital Diseases (in some cases)

While some plans cover newborns with congenital conditions, others may exclude this unless specifically mentioned.

5. Cosmetic or Elective Procedures

Surgeries or procedures that are not medically necessary are generally not covered.

Key Factors to Consider When Choosing Maternity Insurance

Picking the right maternity insurance policy can be a game-changer for your financial planning. Here’s what to look for:

1. Waiting Period

Most maternity covers have a waiting period ranging from 9 months to 6 years. So, it’s wise to plan early, ideally before conception.

2. Sub-Limits on Coverage

Policies often cap reimbursement for normal and cesarean deliveries. Read the fine print to understand these limits.

3. Network Hospitals

Ensure that the insurance provider has a strong network of hospitals, especially those where you plan to deliver. Insurers like Bajaj Allianz General Insurance Company have a wide network of 18,400+ hospitals so that you can deliver without any worries.

4. Newborn and Vaccination Benefits

If you want coverage that goes beyond just the delivery, pick a plan that includes newborn care and essential vaccinations.

5. Claims Process

A smooth, hassle-free claim settlement process is crucial, especially when your focus should be your baby, not paperwork.

When is the Best Time to Buy Maternity Insurance?

The best time to invest in health insurance plans with maternity benefits is before you start planning a family. This ensures that the waiting period is over by the time you need the policy benefits.

Buying early also gives you a wider range of plan options and affordable premiums.

How to Make a Claim Under Maternity Insurance?

Claiming your maternity insurance policy is a simple process if you follow these steps:

1. Inform the Insurer

Notify the insurance company 48 hours before a planned delivery or within 24 hours in case of an emergency.

2. Submit Documents

Provide all necessary paperwork like medical bills, discharge summaries, diagnostic reports, and your insurance ID.

3. Cashless or Reimbursement

If you're delivering at a network hospital, you can opt for a cashless facility. Otherwise, pay upfront and file for reimbursement later.

Pregnancy is more than a medical event, it’s a transformative chapter of life. But it comes with its fair share of uncertainties and expenses. A maternity insurance policy allows you to focus on the joys of parenthood rather than the stress of hospital bills and medical costs.

By choosing the right health insurance plans, planning early, and understanding what’s covered and what’s not, you can give your growing family the care and protection it deserves.

*Standard T&C Apply

**Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

***Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

****Claims are subject to terms and conditions set forth under the health insurance policy.

*****The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional.

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