How to Claim Maternity Insurance?

2024-08-02

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Health emergencies do not see age, sex or income status before arriving. Also, health issues with one family member affect the entire family and their financial status. Thus, a health cover is important not only for the breadwinners but also for the children and other family members.

Having a health insurance policy for yourself and your family is essential. Medical care, especially in the private sector, is expensive. In case of a sudden medical emergency, hospital bills can derail your finances and eat up your savings very quickly.

Health challenges related to maternity also affect a large population in India. Thus, a maternity cover helps take care of any such sudden complexities. The cover also helps you to protect the new born child from healthcare expenses.

Health Insurance with Maternity Cover

One of the best experiences in life is motherhood. You would want to enjoy the phase before and after delivery and not worry about anything else. Although maternity and related expenses are normal addition to your life, you would want to avoid any sudden medical costs.

You don't have to worry about it if you plan it well. Look for health insurance that gives you maternity cover. These insurances are to help you cover pregnancy-related expenses.

You can get the maternity cover as an add-on with your existing health insurance plan. Usually, maternity cover is available with family floater health insurance plans.

What does Maternity Insurance Cover?

Maternity insurance covers most expenses for your delivery up to a specific pre-defined limit. You get coverage for both types of delivery - normal and caesarean. The benefits vary from policy to policy. Below are some benefits most maternity plans offer:

a) Pre-hospitalization expenses include expenses incurred up to 30 days before the date of admission.

b) Other expenses like room charges, doctor's consultation, etc, are covered under a maternity health insurance plan.

c) Some policies also include the cost of termination due to complications.

d) In some cases, the insurance may also cover pre and post-natal expenses with the expenses of newly born baby coverage up to a specific limit.

Check with your insurance provider and look at the benefits that come as an add-on. If it meets your requirement, you can opt for it. If not, get a dedicated maternity health insurance plan.

How to Claim Maternity Insurance?

The claim process for maternity insurance is simple. You can opt for online and offline options depending on the insurance provider and your convenience.

Also, depending on the hospital you have selected, the claim can be made cashless or through a reimbursement manner. When you select a network hospital, the maternity claim gets settled through a cashless process. If you opt for a non-network hospital, you will first have to pay bills from your pocket and later claim the amount.

Option 1 - Maternity Claim - Online Process

Below are the steps you need to follow to claim maternity insurance online:

a) Inform the Insurer:

You should inform the insurer after getting admitted to the hospital for delivery and provide them with the required details.

b) Get the Claim Form:

Once you inform the company, you can download the claim form online from the website. You will need to fill in the details and duly sign them.

c) Submit the Documents:

After submitting the claim, you will have to submit the required documents for the verification process.

d) Submit the Bills:

Keep all the medical bills from the hospital handy. Keep the copy of the originals with you. The bills include bills for doctor fees, hospitalization, etc.

e) Enquiry by the Insurer:

The insurance company may send their representative to the hospital to verify the details regarding the hospitalization and treatment.

Option 2 - Maternity Claim - Offline Process

In the offline process, you can collect the claim form from the nearest office of the insurer. The documents will be the same as discussed above.

Once all the required documents are ready, visit the nearest branch of the insurance company with the required documents and submit the claim.

Documents Required for Claiming Maternity Insurance

To make the claim process smooth, you should keep the required documents with you. Below are the documents you will need:

a) Policy documents

b) Claim form

c) Consultation bill

d) Admission advice

e) Discharge receipt

f) Fitness certificate

g) All original hospital bill

h) Pharmacy bill

Check the policy document to confirm if your insurer has asked for additional documents for claim settlement.

What is not Covered in a Maternity Insurance?

Like any other life insurance, you should know exclusion and inclusion in your maternity health insurance. Below are the general exclusions in maternity health insurance. You should check your policy for exact terms and conditions.

a) Doctor consultation fee for regular check ups
b) Diagnostic tests and doctor's consultation during pregnancy
c) Most doctors prescribe vitamin pills and tonics during pregnancy. These vitamin and tonic bills are excluded from maternity insurance
d) Infertility treatment cost is excluded

While maternity cover is a part of Mediclaim insurance, you should also consider insuring against life-threatening illnesses. The critical health insurance cover provides you with a lump sum amount upon diagnosis of illnesses like cancer, heart ailments and renal failure.

These ailments are unpredictable and may require a large amount of money for treatment. The lump-sum coverage helps you to take care of costs and look after your lost income for the period.