How Much Does Health Insurance Cover for Pregnancy?
An insurer provides no fixed amount or percentage of health insurance coverage. This financial benefit changes depending on several considerations, such as the type of policy you are choosing from the insurance provider. Let us see some of these points in detail.
Factors that Determine How Much the Health Insurance Will Cover for Pregnancy
Here are some of the aspects that can influence the coverage of maternity health insurance:
Policy of Insurer
The rate for pregnancy coverage is not the same for all insurance providers. They all have a policy document that can help you to understand the percentage they offer. This record includes services that insurers cover along with exclusions and limitations. For example, some plans may cover the entire prenatal phase while some may put a cap on the number of ultrasounds.
Waiting Periods
Almost all insurers have a policy for waiting periods before you can receive benefits from the plan. This means that if you get pregnant immediately after applying for insurance, you may not get all the advantages. Waiting periods can range from 3 months to 6 years. This range also varies depending on the plan you choose.
Deductibles, Co-Pays and Insurance
These are various mechanisms that involve you paying a part of total expenses. Deductible is the amount that you have to pay in the beginning before you start receiving benefits. A co-pay is the fixed price that you have to pay for services such as doctor’s fees. Co-insurance is a percentage of the amount that you pay after you are done paying deductible.
Network Providers
Health insurance providers have a network of services such as hospitals, ambulances and doctors. Taking help from these providers will minimise the amount you have to pay. Going to service providers outside this network will enhance your expenses drastically. Therefore, before deciding on the plan, check the availability of in-network services.
Pre-existing Medical Conditions
A pre-existing medical condition may affect your pregnancy. Since insurance providers provide maternity coverage for only pregnancy and childbirth, there can be some limitations for pre-existing conditions. For example, if someone is suffering from pre-existing diabetes, she may not be able to receive full benefits from pregnancy insurance.
Insured-sum and Sub-limits
The insured sum is the amount that you will receive during the policy period. It usually covers all the phases of pregnancy and childbirth. However, some insurers put a sub-limit on some procedures. Some insurance providers put a cap on the amount that you can receive for doing a C-section.
Age
Some insurance providers might put age restrictions on maternity coverage. This means that women from a certain age range can apply for financial plans. It is not very common but still, you may want to check the policies properly for such caps. The age of the insured woman from the time of the insurance purchase to benefit reception matters in this process.
Terms and Conditions
The policy document of the insurance contains all the information on the coverage and benefit claims. Therefore, it is necessary to go through each of them and understand the procedures. Focus on the list of exclusions and the claim process to avoid any kind of hiccup during a medical emergency.
The rate of coverage provided varies from one insurance provider to another. This is why proper research is necessary. These factors decide the amount of benefit that you will receive from the insurer. From waiting periods to your age, everything plays a major role here. Not all insurance providers follow the same policy and, therefore, have their own regulations when it comes to offering pregnancy insurance.
Related Health Insurance Products
What is IRDAI
/health-insurance/what-is-irdai/
BMI Health Insurance Premium
/health-insurance/bmi-health-insurance-premium/
Preventive Health Care Checkup
/health-insurance/preventive-health-care-check-up/
Health Insurance for Alzheimer Patients
/health-insurance/health-insurance-for-alzheimers-patients/
Spinal Cord Injuries Treatment
/health-insurance/spinal-cord-injuries-treatment/
Sum Insured In Health Insurance
/health-insurance/what-is-sum-insured-in-health-insurance/
Co-payment And Deductible
/health-insurance/copay-vs-deductible/
Day Care Treatment And Opd Treatment
/health-insurance/difference-between-opd-and-daycare-treatment/
Types Of Health Insurance
/health-insurance/types-of-health-insurance/
Mental Health Coverage
/health-insurance/mental-health-coverage/
Health Insurance for Tuberculosis Patients
/health-insurance/health-insurance-for-tuberculosis-patients/
Cashless vs Reimbursement Claim
/health-insurance/cashless-vs-reimbursement-claim/
Daily Hospital Cash
/health-insurance/daily-hospital-cash/
Hypertension Health Plan
/health-insurance/health-insurance-plan-for-hypertension/
Pros and Cons of High Deductible
/health-insurance/rise-of-high-deductible-health-plans-pros-and-cons/
Porting Health Insurance
/health-insurance/health-insurance-portability/
This FAQ page contains information for general purpose only and has no medical or legal advice. For any personalized advice, do refer company's policy documents or consult a licensed health insurance agent. T & C apply.