Is Abortion Covered in Mediclaim Policies in India?

Posted on: Dec 16, 2024 | 3 mins | Written by: HDFC ERGO Team

Is Abortion Covered in Mediclaim Policies in India?

The news of pregnancy spreads happiness and joy in the family. You leave no stone unturned to get the best medical care, but at the same time, you should also be prepared for the worst. What if you develop any complications and your doctor advises you to terminate the pregnancy? What if the ultrasound shows some foetal abnormality, which can put the child at risk after birth, and the only option is abortion? Such news can be disturbing and staying financially prepared for the hospital expenses can give you some financial relief.

Abortion Law in India

In India, abortion laws are governed by the Medical Termination of Pregnancy (MTP) Act, 2021. The guidelines regarding abortion as laid down in the Act include –

• Abortion is considered legal, but it should be done on the recommendation of a qualified doctor.

• Abortion is allowed till the 20th week of pregnancy, and it must be approved by a registered medical practitioner.

• In exceptional cases, such as victims of incest, rape survivors, minors, or differently-abled women, abortion is permissible up to 24 weeks of pregnancy. This must be approved by two registered medical practitioners.

• Beyond 24 weeks of pregnancy, abortion is allowed only when there are severe foetal abnormalities.

• If pregnancy poses a risk to the woman or child, abortion can be carried out.

• Women can terminate unwanted/unplanned pregnancies due to contraceptive failure.

• The identity and other details of the woman undergoing abortion must be kept confidential.

Reasons for Abortion

Some common reasons why individuals choose or require abortion are –

• Unwanted or unplanned pregnancies

• If pregnancy becomes life-threatening for the mother due to conditions like heart disease, severe preeclampsia, or uncontrolled diabetes

• If there are foetal abnormalities like Down syndrome or Potter’s Syndrome, which can be a risk for the baby after birth

• If the foetus has congenital defects like spina bifida, anencephaly, etc.

• In the case of ectopic pregnancy, where the mother’s life is at risk

• If the membranes have ruptured prematurely

Does Health Insurance Cover Abortion in India

No. Most health insurance plans in India do not cover abortion. They are generally covered under maternity health insurance but only in the below circumstances —

• If termination of pregnancy becomes medically necessary to save the life of the mother due to life-threatening conditions or complications

• If abortion is advised because the baby develops complications, it can be risky for the baby.

• Some plans cover the cost incurred to terminate a pregnancy of more than 12 weeks.

• As with all maternity and childbirth-related expenses, abortion costs are also covered after completion of the waiting period. The waiting period can vary from insurer to insurer.

• Voluntary abortion is not covered.

Waiting Period to Cover Abortion

Abortion is covered under maternity insurance plans, but after you complete the waiting period, which ranges between 9 months and 24 months, depending on the insurance provider. If you have not completed the waiting period, you cannot claim any expenses, whether it is abortion or maternity-related expenditures. As this waiting period can vary across insurers, you must check your policy document to know the waiting period applicable to you. It’s also recommended to check the waiting period before buying the policy or opt for a waiting period reduction.

Cost of Abortion in India

The cost of abortion can vary depending on factors like hospital, doctor, city, patient’s condition, diagnostic tests, ultrasound, consultation fees, etc. It can cost you anywhere between INR 1000 and INR 35,000. The gestation period also affects the cost of terminating a pregnancy. For instance, abortions performed in the first trimester are less expensive than abortions carried in the later stages, i.e., the second trimester.

Conclusion

Maternity insurance covers abortion if it is medically necessary and you have completed the waiting period. Most maternity plans have a waiting period of 9 months to 24 months, depending upon the insurer. During this period, if you have to abort the child due to medical reasons, your insurer will not provide coverage. So, if you are planning to get married or start a family, you must buy maternity insurance well in advance because your standard individual healthcare plan or family health insurance will not provide coverage for abortion..

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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