Maternity covers in Health Insurance plans – Fashion or Function?

Maternity covers are not new for India. Insurance companies through group health insurance policies have been offering maternity covers to their client for some years now. For individuals, in 2009, Apollo Munich Health Insurance extensively marketed “pregnancy covers” in their individual policies that was soon followed by Max Bupa. Recently L&T Insurance too has introduced the MediSure Prima Insurance health insurance plan with maternity benefits.

I have always questioned the necessity of having a pregnancy or maternity cover in a health insurance policy. Is it a consumer essential or just a marketability check? For one, I believe that insurance policies should be aimed at future & unplanned risks such as sickness or accidents. Pregnancy is neither or either of these i.e. –
- It is not unplanned (mostly)
- It is definitely not classified as a risk as we know it
- It is not a disease or sickness or injury

In this post, I shall cover some key areas pertaining to maternity covers offered by some health insurance companies that consumers should consider.

Fact 1 : Men do not need a maternity cover

L&T Insurance’s Medisure Prima Insurance plan is a hospitalization plan that offers a number of benefits including the maternity and new born baby cover for all insured members. This means if a 30-year old man or a 10-year old child were to enroll for this health insurance policy – they too will carry with them the maternity and new born baby cover – which they would not be using.

Apollo Munich Health Insurance offers maternity cover in individual polices in their Easy Health Individual Exclusive and Easy Health Individual Premium plans. Again men who are a part of this plan will not be availing the maternity cover although the premiums have factored in this benefit aswell. The maternity covers are offered by Apollo Munich in their family floater plans namely, Easy Health Family Floater Exclusive and Easy Health Family Floater Premium plans.

Max Bupa’s Individual policies donot offer maternity benefits in individual policies. This means although no man can buy one for himself, no woman can also purchase a Max Bupa policy just for herself. Max Bupa does offer maternity benefits in a family floater plan. Their Heartbeat Family First plan offers maternity benefit albeit with a caveat that the benefit will be available only if a minimum of three adult members (including atleast one male person) is included in the same policy. Max Bupa’s Family Floater plan is a bit less restrictive where an individual and spouse (2 members) have to be included in the plan to avail the maternity benefits.

Fact 2 : Maternity covers come with longer waiting periods

L&T Insurance’s Medisure Prima Insurance Plan carries a waiting period of 4 years from the date of issuance of first policy, to be eligible for the maternity cover. (L&T Insurance Policy Wording of Medisure Prima Insurance Policy)

Apollo Munich’s Easy Health Individual Exclusive and Easy Health Individual Premium plans have a waiting period of 6 years from date of inception of policy. However in case of the Easy Health Family Floater plans, the waiting period is 4 years from inception of policy.

Max Bupa’s Family Floater and Family First plans provide for maternity benefits after 2 years of continuous coverage and having paid three continuous premiums.  (Max Bupa Heartbeat Brochure)   

Fact 3 : Maternity covers are limited to a small %age of the sum insured

L&T’s health plan offers a maximum of 5% of Sum Insured or Rs. 25,000 for a normal delivery. And in case of a caesarean, the plan covers upto 10% of Sum Insured or Rs. 50,000, whichever is lower.

Apollo Munich too offers different sub-limits for normal and caesarean delivery and it ranges from 3% to 8% of the sum insured. The insurer has different amount for different sum insured. 

Max Bupa has a sub-limit ranging from 10% to 2% of the sum insured. While in lower sum insured like Rs. 2 lacs Silver Plan, it is 10% (Rs. 20,000), in higher plans like 50 lacs Platinum Plan, the maternity benefit is Rs. 1,00,000 (2% of sum insured)

Fact 4 : Maternity cover will cost more premium

This should not come as a surprise at all. The fact that there are waiting periods, sub-limits and other restrictions on the application of maternity cover gives hints that this is an expense which is frequent and insurance companies have baked the high utilization of it in their premium calculation.

In case of Apollo Munich, we shall compare the Easy Health Individual Standard and Exclusive plans to have an estimate of the additional premium that an insured member has to pay to avail maternity benefits. While this isn’t an exact science, it will give us a fair idea.


Standard : Annual premium for a 27 year old woman comes to Rs. 3,451 for a 3-lac plan


Exclusive : Annual premium for a 27 year old woman comes to Rs. 4,517 for a 3-lac plan


This is a jump of 33% in the premium. However, please note that there is a 6-year waiting to avail the benefit that means you will be expected to pay this extra premium of around Rs. 1,000 for the next 6 years (Rs. 6,000). Also, premiums are expected to rise every 2 years owing to medical inflation and other factors. This will push up the premium further, say to about Rs. 10,000 before you hit year 6. Now a 3-lac plan offers a normal delivery benefit of Rs. 15,000. Realistically speaking, the insurance company is expecting a 65% utilization of this maternity benefit!

In my opinion, unlike sickness or accidents, pregnancies offer enough time for families for preparation of expenses and it is better to have it outside the insurance benefit set. Discuss with your friends and relatives on the expenses related to child birth and delivery expenses and start planning for it (and a buffer) when the thought of starting a family crosses your mind. Key instruments that provide capital protection and appreciation include fixed deposits, recurring deposits and your savings account.

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