Are maternity benefits covered under group health insurance?

—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 the maternity benefit in a number of ways. One, you can set a limit for motherhood within the total sum assured.

This limit may be different for normal and cesarean deliveries and for metro and non-metro hospitals.

Usually, the range is determined between from 25,000 100,000.

Second, you can specify a waiting period for availing maternity benefits.

In such a case, the employee or the spouse will be able to avail the maternity benefit after the waiting period is over.

Most of the companies offer maternity cover from the very first day a person joins. Some companies enforce a waiting period of 9 months.

Third, you can specify whether you want newborns covered.

In a standard policy, the newborn is not covered for the first 90 days.

With group insurance, you can cover newborn babies immediately after birth.

You can also set a limit for which the newborn will be covered i.e. the maternity limit or the entire sum assured of the family.

There are some common exclusions relating to motherhood and newborns.

However, these can also be covered through adaptations, including coverage for prenatal expenses and internal congenital diseases.

The process of claiming for motherhood is similar to other treatments and hospitalization.

If the delivery is done in a network hospital, then the employee can apply for cashless.

The claim will be processed directly between the insurer and the hospital.

If the treatment is carried out in a non-network hospital, the employee must report the claim to the insurer when hospitalized.

Insurers will usually specify a short time period within which you must notify them of the claim.

After discharge, all bills, receipts and medical papers can be presented to the insurer for reimbursement of the claim.

Abhishek Bondia is the Principal Officer and Managing Director of SecureNow.in.