What is the Cost Impact of Maternity Sub-limits on Actual Delivery Expenses in a Metro in India?

Maternity insurance offers financial coverage against pregnancy-related expenses, ensuring protection and peace of mind. However, they come with sub-limits which influence the actual maternity coverage offered by your health insurance plan.

Sub-limits are the capped amount that your insurance company will cover for the expenses incurred in maternity-related treatments, regardless of the sum insured amount. The rising maternity expenses in metro cities and comparatively low sub-limits create a gap that leads to higher out-of-pocket expenses for the insured. Keep reading to know more.

What are Maternity Sub-Limits in Health Insurance?

Sub-limits are the maximum expenses that your insurance company will bear regarding your maternity-related expenses. Usually, maternity cover is capped between ₹25,000 and ₹1,00,000, based on the plan you select.

There can be different sub-limits for C-section and normal delivery, i.e. it comes with a fixed coverage ceiling. Actual hospital expenses may exceed the sub-limits, burdening you with excessive out-of-pocket expenses. So, before selecting a maternity health plan, consider these factors to avoid additional costs.

What are the Actual Delivery Expenses in Indian Metro Cities?

When choosing maternity cover, most individuals underestimate the actual costs of childbirth. This misconception may keep you underinsured, and you may need to bear a higher out-of-pocket expense.

In tier-1 cities, normal delivery in private hospitals costs around ₹80,000 to ₹1.5 lakh, based on the city you stay in, the hospital you choose, and the duration of stay. On the other hand, the cost of a C-section in private hospitals can range between ₹2 lakh and ₹3 lakh or more in case of complications or extended hospitalisation.

Now, if you select a maternity sub-limit of ₹50,000, any other expenses apart from this amount shall be paid by you. This may include anaesthesia, surgeon fees, room charges, medicines, etc. Most families face financial challenges due to the gap between the maternity sub-limit and actual expenses.

Though maternity coverage does not eliminate your out-of-pocket expenses completely, choosing adequate coverage helps reduce your financial burden.

What is the Impact of Sub-limits on Actual Maternity Expenses?

Your insurance company imposes a sub-limit on the maternity coverage, which is far below the actual maternity expenses. Here is a table of comparison for the sub-limits of different delivery types to understand how it impacts the actual maternity expenses:

Maternity sub-limits do not cover the actual expenses entirely, leading to out-of-pocket expenses for the policyholder. However, there are a few plans that offer higher sub-limits, up to ₹1–2 lakh for C-section.

Usually, group maternity coverage offers a higher sub-limit than individual health insurance plans. So, when choosing maternity coverage in metro cities in India, check whether the sub-limits align with actual expenses.