Maternity coverage a crucial part of health insurance for younger women

With each delivery costing Rs 50,000 - Rs 2.5 lakh, maternity coverage is key in such plans, besides reproductive health issues, menopause, and women-specific diseases

Bajaj Allianz General Insurance recently launched ‘HERizon Care,’ a health insurance plan designed specifically for women. Other insurers also offer women-centric plans, riders, or add-ons. Star Health has Women Care, Niva Bupa offers Aspire with maternity benefits, Tata AIG provides the EmpowerHer rider, and ManipalCigna includes the Women+ package in its Lifetime Global Plan.

“Such plans cover critical illnesses, maternity care, and reproductive health,” says Shilpa Arora, co-founder and chief operating officer (COO) of Insurance Samadhan.

“Maternity expenses have increased significantly, with normal deliveries costing Rs 50,000 – Rs 1 lakh and Caesarean deliveries ranging from Rs 1 lakh – Rs 2.5 lakh in metros, excluding complications,” says Anuradha Sriram, chief actuarial officer, Aditya Birla Health Insurance.

 

How women-centric plans are different

 

Regular plans may not adequately address women’s specific needs, which women-centric plans do. “Women-centric plans provide tailored coverage for reproductive health, maternity, menopause, women-specific cancers, check-ups, and consultations,” says Dinesh Mosamkar, senior vice president of consumer underwriting at Tata AIG.

Such plans cover critical illnesses that young women may encounter. “Comprehensive health insurance policies could include preventive screenings, tests, and diagnostics often missing from standard plans,” says Arora.

 

Must-have features

 

Young working women should opt for plans with comprehensive coverage and maternity benefits, even if the latter is not needed immediately. For women aged 25–30, whether married or planning to, maternity and newborn coverage are essential.

“Some plans let a single woman start a policy and add a spouse later, ensuring maternity benefits after three to four years,” says Siddharth Singhal, head of health insurance at Policybazaar.com.

“Coverage for gynaecological conditions like fibroids, PCOS (polycystic ovary syndrome), and endometriosis is crucial for long-term well-being,” says Ashish Yadav, head of products and business operations,  ManipalCigna Health Insurance.

Arora says plans should also include annual check-ups, diagnostic support, and mental health services.

“If a plan lacks reproductive health or postnatal care, riders can provide extra coverage for an additional premium,” says Arora.

Today, in-vitro fertilisation (IVF) treatments are part of maternity coverage.

“Many insurers offer free consultations with gynaecologists or obstetricians,” says Singhal.

Mosamkar adds that riders may also cover infertility treatments, dermatology, and screenings for breast, ovarian, and cervical cancer, plus cervical cancer vaccination,” says.

 

Why maternity cover matters

 

Maternity coverage, though possibly needed only once or twice in a lifetime, reduces financial stress. “Some plans allow you to drop this cover later,” says Mosamkar.

Most plans cover at least one delivery, while some cover two. “Coverage includes up to Rs 2 lakh for maternity expenses, newborn care, neo-natal ICU stays, and prenatal and postnatal costs,” says Singhal.

 

What to avoid

 

When selecting a health plan, avoid co-payment, deductibles, or hidden supplements unless specifically required. “Understand that opting for deductibles means paying part of the expenses out of your own pocket,” says Singhal.

“Women should avoid features that do not match their healthcare needs or lifestyle. Coverage for illnesses typically affecting older populations may not be necessary for younger women,” says Arora.

 

Ideal sum insured for young women in metros

 

Living in a metro increases the risk of illnesses and accidents.

“A Rs 1 crore cover, combining a Rs 10 lakh base policy with a Rs 90 lakh top-up, keeps premiums affordable. For example, a Rs 10 lakh policy costing Rs 12,000 annually, with a top-up adding Rs 1,500, is cost-effective,” says Singhal.

According to a report by PwC’s Health Research Institute, healthcare costs in India may rise by 8 per cent in 2025. “With medical inflation at 14 per cent, women in Tier-I cities should have coverage of Rs 5 lakh to Rs 10 lakh,” says Arora.

 

Exclusions to watch out for

 

Exclusions can significantly affect claims. “About 69 per cent of grievances we receive relate to health insurance exclusions,” says Arora. She suggests understanding the exclusions to avoid last-minute surprises.

“Pre-existing diseases typically have waiting periods before coverage. Cosmetic procedures are excluded unless medically necessary due to an accident,” says Yadav.

“General exclusions include non-disclosure of medical conditions, substance abuse, injuries from drunk driving, and self-harm,” says Singhal.

 

Key checks you must run

 

Check the insurer’s claim settlement ratio. “Choose an insurer with a settlement ratio exceeding 90 per cent,” says Arora.

“Choose deductibles and co-pays if you can afford the expenses, especially during emergencies. Consider add-ons like women-specific coverage, outpatient department (OPD) care, and mental well-being or wellness programmes,” says Mosamkar.

Evaluate the insurer’s hospital network. “A preferred network hospital may offer up to 15 per cent discount,” says Singhal.

Understand the waiting periods for maternity benefits and pre-existing conditions. “IRDAI now mandates a maximum three-year waiting period for existing illnesses. Insurers cannot reject claims for pre-existing diseases after this period,” says Arora.

“Sub-limits on room rent and specific procedures should also be reviewed to avoid extra costs,” says Sriram.

 

Dos and don’ts

 

Read policy documents thoroughly. “Compare policies to evaluate benefits and premiums effectively,” says Sriram.

Add OPD coverage. “OPD add-ons cover Rs 20,000 – Rs 25,000 annually for doctor visits, tests, and pharmacy expenses,” says Singhal.

“Do not overlook discounts like long-term and floater discounts for family cover,” says Mosamkar.

Underinsurance is risky, given rising medical costs, so select an adequate sum insured.

Do not delay enrolment if you plan to have children soon. “Early enrolment can take care of waiting periods and improve coverage,” says Sriram.  Comprehensive plans that offer maternity benefit 

Premiums are for a 25-year-old female living in a metro (maternity benefit included) for a Rs 10 lakh sum insured
Insurer	Plan	Premium (Rs)
Bajaj Allianz	My Health Care	7,598
Niva Bupa	Aspire Gold+ Value Direct	7,686
Star	Super Star	7,931
ICICI Lombard	Elevate	8,083
Care	Ultimate Care	10,126

Source: Policybazaar.com