Blog

Pregnancy is a wonderful time, but it also comes with many medical needs—antenatal checks, tests, delivery, postnatal care. Health insurance or maternity insurance helps cover these so families don’t pay too much. If you are expecting or planning for a baby, this guide will help you understand all about health insurance for pregnant women in Nigeria.

What Does “Health Insurance for Pregnant Women” Mean?

Health insurance for pregnant women means a plan or scheme that pays, partly or fully, for medical services needed during pregnancy. This includes:

• Antenatal care (ANC): visits to clinic/doctors for checkups while pregnant

• Ultrasounds and lab tests: to monitor health of mother & baby

• Delivery (normal or caesarean): hospital or clinic costs when baby is born

• Postnatal care: follow‑ups after birth—both mother and baby

• Newborn services: sometimes vaccinations, newborn checkups

These services help reduce risk to mother and child, and reduce the money families spend out of pocket.

Difference Between Maternity Insurance, HMOs, and NHIS

• NHIS (National Health Insurance Scheme) is a government scheme. It includes maternity care (antenatal, delivery, postnatal) for formal sector workers, and in some forms via HMOs.

• HMOs (Health Maintenance Organisations) are private or semi‑private organisations. They often offer maternity coverage in their plans, or as add‑ons. Some plans cover only parts (e.g. tests, doctor visits) but others cover delivery.

• State health insurance or state pregnancy plans: Some states in Nigeria have their own plans for pregnant women (e.g. at subsidized rates). Example: Oyo State’s Pregnancy Plan.

How Health Insurance for Pregnancy Works in Nigeria

Steps of Using Insurance When You Are Pregnant

1. Decide which kind of insurance you will use: NHIS, private HMO, or state scheme.

2. Register/enrol: Fill forms, choose plan, choose hospital/clinics that accept that insurance.

3. Check waiting periods: Many plans have waiting periods before maternity services are active. For example, some plans require you enroll before certain months of pregnancy.

4. Pay premiums: Depending on plan, you pay monthly or yearly. Sometimes separately for pregnancy services or included.

5. Attend antenatal (ANC) visits: Regular checkups, tests, scans. The insurance will cover the approved ones.

6. Delivery: When the time comes, you go to a hospital/clinic in the network. Insurance covers costs either fully or partly.

7. Postnatal care and newborn care: Checkups for the mother, follow up, baby immunisations, etc.

What to Check Before You Enrol (Important Details)

• Which services are included: Are ultrasounds, lab tests, delivery, C‑section, emergency delivery, newborn vaccinations?

• What is excluded: Some plans don’t cover caesarean section unless medically needed, or exclude high‑risk pregnancy complications.

• Waiting period: How many months you must wait after enrolling before maternity benefits start.

• Network hospitals/clinics: Which hospitals are approved under the plan. If your preferred hospital is not in the network, costs may be more or not covered.

• Cost (premium + co‑payments): Not only premium, but whether you still pay part of cost (co‑payment) for drugs or tests.

• Bed type: Standard ward vs private ward. Standard ward often covered; private may cost more.

• Newborn period: How long the baby is covered after birth.

What Does NHIS Cover for Pregnant Women?

NHIS has specific benefit packages for maternity care under the formal sector. Key points:

• NHIS covers antenatal care, delivery, and postnatal care for women in its formal sector programme.

• It covers up to four live births under the scheme for each insured woman.

• Newborn babies are covered for about 12 weeks after birth. Premature babies likewise are covered for that period.

• Cost of drugs/tests included in NHIS’s drug list and diagnostic list.

But note:

• There are exclusions. Some complex care or expensive equipment/tests are not always covered.

• Service quality and hospital access vary widely depending on your location.

What Do Private HMOs & Other Plans Cover for Pregnant Women?

Many private HMOs and state plans offer maternity or pregnancy‑related insurance. Examples:

• Hygeia HMO has maternity‑centred plans (HyMat, etc.), covering antenatal, delivery, postnatal, newborn vaccinations.

• AXA Mansard offers plans with maternity coverage, sometimes at lower or higher price depending on how large or premium the package is.

• Leadway Health, Reliance HMO, Lagos State Health Scheme (LASHMA) also offer antenatal, delivery, newborn care packages.

• The Oyo State Health Insurance Agency (OYSHIA) has a Pregnancy Plan with options for mothers, even covering C‑section, postnatal care, etc.

• MIHEI HMO offers “ReadyMama” type plans; some include full maternity services, ultrasounds, medications, etc.

These private plans often allow more flexibility (choice of hospital, faster service, more extras) but cost more.

Costs: How Much Does Maternity Insurance Usually Cost in Nigeria?

Typical Premiums & What Affects Cost

The cost for maternity insurance varies a lot depending on:

• The insurance provider (NHIS, private HMO, state scheme)

• Level of services covered (just ANC vs full delivery + newborn)

• Type of delivery (normal vs C‑section)

• Hospital class (general, private, specialty)

• Waiting period and risk factors (if a pregnant woman has health risks the cost may be higher)

Some Sample Prices

• Private HMOs: Some maternity‐inclusive HMO plans start at ₦12,000 for 6 months (basic level) in certain HMOs like AXA Mansard.

• More complete maternity plans with delivery, postnatal, newborn coverage may cost much more — annual costs in tens of thousands of naira.

• State scheme example: Oyo State Pregnancy Plan is quoted around N18,250/year for some plans.

Pros & Cons: Advantages and Disadvantages for Pregnant Women Using Insurance

Pros

1. Saves Money: Reduces the burden of high delivery costs, lab tests, drug costs.

2. Access to Better Care: If you choose a good hospital, you may get better doctors, equipment, safer delivery.

3. Peace of Mind: Less worry about “What if something goes wrong?”

4. Newborn Protection: Some packages include care for baby after birth (vaccinations, checkups).

5. Encourages Early and Regular ANC: Knowing it’s covered can push women to start antenatal care early.

Cons

1. Waiting Periods: Some plans only activate maternity cover after a waiting period—if you are already pregnant, you may not benefit.

2. Limited Coverage in Some Plans: Some private HMOs may exclude C‑section, high risk pregnancies, expensive scanning/tests.

3. Out of Network Costs: If your hospital is outside network, you may pay extra or all of it.

4. Extra Costs and Co‑Payments: Even when insured, there may be co‑payments or costs for optional services.

5. Quality Issues: Differences exist in quality of hospitals, clinics, and in how well HMOs or NHIS deliver.

6. Low Uptake / Access: Some pregnant women do not have or enrol in insurance early; NHIS coverage among pregnant women is still low in some studies.

Comparison: NHIS vs Private HMOs vs State Pregnancy Plans

Real‑Life Examples & Case Studies

Case 1 – Pregnant Woman Under NHIS Formal Sector

Let’s say Maryam works in a federal government office in Abuja. She is covered under NHIS formal sector.

• She has access to antenatal care—monthly checkups, lab tests included under NHIS.

• When it’s time to deliver, she goes to an NHIS‑accredited hospital. Normal delivery is covered; if a C‑section is needed she checks if it’s medically indicated.

• After birth, her baby is covered for 12 weeks (newborn checkups and care). Vaccinations part of government immunization schedule also apply.

• She might still pay small out‑of‑pocket for some tests not on the NHIS diagnostic list, or for medicines not fully stocked.

Case 2 – Option via HMO/Maternity Plan

Chioma lives in Lagos and has a private HMO plan that includes maternity. She registers before she becomes pregnant.

• Her plan took care of ultrasounds, anomaly scan, lab tests.

• She selected a private hospital for delivery. The HMO covered most of the hospital admission, drugs, and delivery costs. She had to pay some co‑payments for extra comfort (private ward) and for some brand‑name drugs.

• After delivery, her baby got immunizations, postnatal care for mother, etc.

Case 3 – State Scheme (Pregnancy Plan in Oyo State)

Aisha is from Oyo State. She joins the State Pregnancy Plan under OYSHIA.

• She paid about N18,250 / year for a plan that includes antenatal, normal delivery, some postnatal care, and option for C‑section if medically needed. oyshia.oy.gov.ng

• She used clinics in the state scheme’s network; no travel far.

• The plan had co‑payments for some specialized surgery or extra hospital stay, but overall cost was much lower than private hospital quotations outside plan.

Is Health Insurance for Pregnant Women Worth It in Nigeria?

This section helps you decide whether maternity insurance is good for you.

When It Is Worth It

• If you want to avoid large bills at delivery time.

• If you expect medical complications or high risk pregnancy (e.g. age, previous C‑section, existing health conditions).

• If you prefer a private hospital or better facility.

• If you have a family to support and want newborn coverage.

• If you want regular checkups without worrying about cost.

 When It Might Be Less Useful

• If you can’t enrol before pregnancy or waiting period is too long.

• If your local health facility isn’t in network.

• If you plan to use only public hospitals where costs are low anyway.

• If premium + co‑payments are too high for your budget.

How to Choose the Right Maternity Health Insurance Plan

Key Features to Look For in a Plan

1. Inclusive coverage: Does it cover delivery (normal & C‑section), newborn care, immunizations, postnatal?

2. Waiting period: Shorter waiting period is better. If you are already pregnant, you want plans that activate maternity benefits quickly.

3. Network of hospitals: Include hospitals you trust, or close by.

4. Cost vs benefit: Premium, co‑payment, extra charges. Understand total cost.

5. Quality of service: Reviews, testimonials, how easy claims/referrals are.

6. Extra perks: Ambulance service, dietary advice / nutrition counselling, ultrasound scans, anomaly scans.

7. Flexibility for risk: If you have risk factors, check whether plan considers them (they might increase cost or exclude some parts).

Practical Steps to Enroll and Use Well

• Begin early, ideally before conception or very early in pregnancy.

• Read plan documents carefully. Ask for details in writing.

• Ask about what is not covered. Don’t assume everything is.

• Keep good record: clinic cards, payment receipts, test results.

• Use network providers.

• Follow antenatal schedule. Delays can cause risk and reduce benefit of insurance.

Challenges, Barriers, and Ways Forward

Common Challenges for Pregnant Women Getting Insurance

1. Low awareness: Many pregnant women don’t know about health insurance or maternity packages.

2. Delays and bureaucracy: Waiting periods, delayed approvals, or rejection of claims.

3. Cost concerns: Even insurance may be expensive for families with low income.

4. Limited hospital access: In rural areas, few accredited hospitals or clinics. Poor facilities sometimes.

5. Exclusions: Some plans exclude high‑risk pregnancies or special tests (e.g. anomaly scan) or do not cover C‑sections unless justified.

How Government, Insurers, NGOs Can Improve

• Public education about maternity health insurance and financial benefits.

• Subsidies or sliding‑scale premiums based on income.

• More state‑level or local schemes to make services nearer to people.

• Strong regulation of HMOs to ensure promises are kept.

• Improving network reach: more hospitals, especially in rural zones.

• Reducing waiting periods for maternity care cover.

Summary Table: Key Points at a Glance

Here is a summary table to help you compare and decide.

Conclusion

Health insurance for pregnant women in Nigeria can be very helpful. It is often worth it if you plan well, enrol early, and pick a good plan. Whether via NHIS, a private HMO plan, or a state pregnancy scheme, good insurance can reduce financial stress, improve care, and protect both the mother and newborn.

If you are pregnant or planning to be, here are key takeaways:

• Start early; don’t wait too long to enrol.

• Compare plans; what is covered vs what you will pay yourself.

• Choose hospitals that are in network.

• Ask lots of questions. Don’t assume everything is covered.

• If cost is a worry, state schemes or lower‑cost HMOs may help.

With the right plan, you and your baby have a better chance for a healthy, safe pregnancy and birth.

Frequently Asked Questions (FAQs)

Here are answers to common questions about health insurance for pregnant women in Nigeria.

1. Does NHIS cover pregnancy and delivery?
   Yes, under the formal sector NHIS program, pregnant women get antenatal, delivery, and postnatal care. NHIS also covers up to four live births per insured woman. Nigerian Health Blog+2Bariboost+2

2. Can I join a maternity insurance plan after I become pregnant?
   It depends. Many plans have waiting periods. Some private HMOs or state schemes require you join before a certain stage for full maternity cover. If you are already pregnant, check carefully if maternity benefits are active for you.

3. How much does maternity health insurance cost for a pregnant woman?
   Costs vary. Some basic plans may cost tens of thousands of naira per year; premium plans cost more. For example, Oyo State plan has options around N18,250/year. Private maternity‑inclusive plans often cost more depending on hospital, services and risk.

4. What if I need a C‑section? Will insurance cover that?
   Some plans do cover C‑section (especially if medically necessary). But not all do, or only under certain conditions. Check your plan’s terms. State schemes or HMOs may require evidence that C‑section was necessary.

5. Are newborn services included?
   Yes for many plans. NHIS covers newborns for around 12 weeks after birth. Many private HMOs or state schemes include newborn immunization, checkups.

6. What happens if my clinic/hospital is not in the insurance network?
   If it is not in network, you may pay extra or the insurance may refuse to cover. Always pick a hospital in the network or check if plan allows out‑of‑network service with additional cost.

7. Do I pay co‑payments or extra charges?
   Often yes. Even with insurance, some services, drugs, or amenities (private room, brand name medicines) may need extra payment. Read plan documents carefully.

8. How many antenatal visits are covered?
   Varies by plan. Basic plans may cover a few; better plans include more visits. At least the minimum required under Nigerian standard is recommended (usually monthly until late pregnancy, then more frequent).

9. How early should I enrol?
   As early as possible. Best is before pregnancy or very early in first trimester. This helps avoid missing waiting periods and ensures full maternity benefits.

10. What documents are usually needed to register?
    Usually: Identification (national ID, voter’s card, etc.), proof of residence, any medical history (if required), payment information, select hospital / clinic.

11. Is insurance always better than paying cash out of pocket?
    Not always in every case, but for many families insurance reduces risk of high unexpected costs. If you expect many medical needs (pregnancy checkups, tests, etc.), insurance tends to be safer financially.

12. Are there government or NGO support for pregnant women without insurance?
    Yes. Some state schemes, NGOs, or free maternal health programs exist (e.g. free immunization, antenatal services). It helps to ask local government clinics.