Are maternity benefits covered under group health insurance? – Mint
Does group health insurance policy cover maternity benefits? Are there any exclusions? What is the process to get a claim?
—Name withheld on request
Group health insurance is used by companies to cover their employees, and family members.
Maternity is one of the common benefits offered under group health insurance.
In a group health insurance policy, you can customize maternity benefits in many ways. One, you can set a limit for maternity within the overall sum assured.
This limit can be different for normal and caesarean delivery, and for metro and non-metro hospitals.
Typically, the limit is set between ₹25,000 to ₹100,000.
Two, you can specify a waiting period to avail maternity.
In such a case, the employee or spouse will be able to avail of the maternity benefit after the expiry of the waiting period.
Most companies cover maternity from day one of a person’s joining. Some companies apply a waiting period of 9 months.
Third, you could specify, if you would like to cover newborns or not.
In a standard policy, the newborn is not covered for the first 90 days.
In group insurance, you can cover newborns immediately after birth.
You can also set a limit for which the newborn will be covered that is, up to the maternity limit or the full sum assured of the family.
There are some common exclusions related to maternity and newborns.
However, these can also be covered through customization, this includes pre-post natal expenses and coverage for internal congenital diseases.
The process to make a claim for maternity is similar to other treatments, and hospitalizations.
In case the delivery is carried out in a network hospital, then the employee can apply for cashless.
The claim would be directly processed between the insurer and the hospital.
If the treatment is done in a non-network hospital, then the employee should intimate the claim to the insurer on hospitalization.
Insurers will typically specify a short time period within which you must intimate them of a claim.
After discharge, all bills, receipts and medical papers can be submitted to the insurer for reimbursement of the claim.
Abhishek Bondia is principal officer and managing director at SecureNow.in.
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