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What is maternity coverage in a Group Health Insurance Policy and how it works and its benefits?

By December 9, 2021December 10th, 2021No Comments
What is maternity coverage in a Group Health Insurance Policy and how it works and its benefits 1

Know More About the Maternity Coverage and Benefits in a Group Health Insurance Policy

A group health insurance, as you may know, is insurance that the organization offers to the employees. The employers buy the policies and pay the premium through which the employees can enjoy the plan benefits. With different policies, the features vary. Most group health policies offer plan coverage for the employee’s family members(spouse, children, and dependent parents). 

Maternity coverage also falls under the employer health plans, where the insurance bears the cost for maternity and childbirth expenses. Maternity coverage is an essential part of the health plans that offers a comprehensive package. 

Who are eligible for the plan coverage?

Maternity plan coverage is valid for the female employees and also the spouse of the male employees. The employee does not pay the insurance premium to enjoy maternity coverage. Although the plan features for maternity expenses may vary depending on the insurance company you pick, there are a few fixed coverage rules across all the leading policies.  

Know how it works

The maternity benefits in group health insurance plans cover the medical expenses related to childbirth. In some insurance companies, you may have to pay an additional charge to include the maternity benefits in the group healthcare plan. 

The expense coverage tenure is usually valid till the next 90 days of child delivery. As the policy is offered by the employer of the organization, thus the other associated rules are similar for maternity coverage. The benefits are valid till the service tenure of the employee and the employer pays the premium for the policy

It acts as a boon for couples who are in financial uncertainty. The group coverage helps manage the cost of childbirth and associated medical expenses. But to understand how the plan works with the coverage and non-coverage aspects. 

Maternity coverage in group plans

Maternity coverage is a common feature across all group health plans in India. Almost every group health insurance offers similar benefits. It is highly beneficial for the employee as they do not have to bear the expenses. Unlike other disease coverage, maternity coverage offers greater benefits for the mother and the child. The policy also manages the costs related to complicated pregnancy and childbirth. Read along to know about the premium features of the group health plan in maternity coverage. 

  • Sum assured in group policies.

Organization heads and employers decide the sum insured for the group health policies. All small to mid-size enterprises and companies offer such benefits of maternity coverage.  In a group policy, the maternity sum for coverage is distinct from the rest of the policy coverage. There is a maternity sum that gets assured alongside the policy sum. The actual figure of the sum varies with the different policies. The maternity sum insured value is included within the overall family floater sum insured. 

  • C-section and normal delivery coverage

The assured policy sum varies with the type of delivery. The average coverage expense for normal delivery is around twenty-five thousand rupees. In the case of cesarean section delivery, it is about thirty-five thousand. The overall limit or insurance capping differs from the plan chosen by the employer. In either type of delivery, the plan offers complete coverage. 

  • Cashless coverage for delivery

Every group healthcare policy has a network of hospitals in which the employees can enjoy cashless facilities. The offers are the same for maternity expenses as well. The female employee or the wife of the male employee can enjoy a cashless treatment at the hospital with the health card. There are also rules for reimbursement with all the policy plans from the leading IRDAI-approved insurance companies. 

  • Waiting period for group policies

Group health insurance plans usually have a waiting period for treatment coverage with most ailments and pre-existing conditions. But with maternity coverage, there is no waiting period. Most group health insurers offer maternity coverage benefits from day-1 of the policy tenure. However, it is better to check the policy coverage norms to be sure about the waiting period for maternity coverage.  

  • Late pregnancy coverage

Group health insurance plans also cover late pregnancy expenses. The complications may be more in late pregnancies(35 years and above) for which the expenses rise. The group policies do not limit the coverage and, the plan benefits are the same as that of regular maternity expenses. 

  • Cover for a newborn child

Maternity coverage in group healthcare plans is a comprehensive plan for the mother and the baby. In most plans, there is extended medical coverage for the newborn child. The coverage is valid till a period of 90days from birth where the policy offers treatment costs for childcare and any complications. 

  • Emergency or life-saving abortions

Abortion charges do not get included in the plan coverage for group health insurance. But during childbirth, there may be some medical complications for which the doctors recommend terminating the pregnancy. The termination usually takes place after twelve weeks and is due to unavoidable medical criticalness. Maternity coverage under the group plans offers expense support for such emergency pregnancy termination and treatments. 

  • Pre- and post-natal expenses

Employer health plans offer expense coverage for pre-and post-natal essentialities. The coverage is valid for a period – 60 days before the day of hospitalization and 90 days after the delivery. The expense includes ultrasound charges, doctor checkups, medicine prices, and many more. The mentioned period of 60 days and 90 days is common for most group health policies offering similar benefits. 

  • Hospitalization costs

Maternity coverage also includes in-patient hospitalization costs. There are several charges other than the delivery charges and doctor fees. The hospitalization costs may include surgery expenses, hospital room rent, visiting doctor’s fees, nursing fees, and much more. However, the limits for the additional costs for childbirth-related hospitalization are different with the different policies. It is better to check the policy norms before claiming for such in-patient hospitalization expenses. 

Know about the exclusions

Now that you have seen what features are within the plan, it is time to review the exclusions. For knowing how the group policies work for maternity benefits, you also have to learn the exclusions. Following are some common medical expenses that fall outside the plan coverage in most insurance policies. 

  • Infertility treatment before pregnancy

Infertility treatment is not a part of maternity coverage. Even if you show the treatment costs as a pre-pregnancy expense, the plans will not provide any support for the treatment cost. The employer healthcare policy across all insurance companies does not bear the cost for this kind of treatment in any way. 

  • Expenses for assisted conception

Assisted conception is also a part of infertility treatment. Here, you need medical intervention to get pregnant. The insurer also considers such treatments distinctly and do not include them in the maternity coverage sphere. 

  • Hormone therapy for pregnancy

During pregnancy or before pregnancy, some doctors make the patient undergo hormone treatments. The hormone therapies may be an additional part of the pregnancy but the policymakers do not consider it during the coverage benefits. Thus, you cannot claim reimbursement of the charges for such therapies, even with a valid prescription. 

  • Homeopathy or ayurvedic treatment

Group health insurance plans do not cover the treatment cost of any alternate medicine line. You get coverage only for allopathy treatment. The same is valid for maternity coverage. Even if you undergo homeopathy or allopathy treatment during your pregnancy tenure, the policies will not grant any cost for it.

However, in recent times some insurers are offering plan coverage for such alternative medical treatment and practices. You may consult with the insurance company representative to be sure about this expense. 

  • Abortion before 12 weeks

Abortion due to medical complications during pregnancy falls under the coverage for most group health plans. But the plans do not offer expense coverage for abortions and pregnancy termination before twelve weeks. 

Additional benefits for maternity coverage

Apart from the regular plan coverage features, some insurance companies also offer additional coverage. The following policy features are among the common benefits that the leading IRDAI-approved companies are offering their customers. But, you have to consult with the insurance representative to be sure about the following policy features – 

  • Consultation expenses

Depending on the policy, the expense coverage for doctor consultation may get included in the coverage plan. The policy bears the cost of the doctor’s fees throughout the pregnancy period, on the production of valid prescriptions.

  • Checkup expenses

The pathological test and other medical checkups that the mother undergoes during the pregnancy tenure get full coverage with some of the policy plans. Most policies provide checkup expense coverage for a specific period before delivery, but with some policies, you may enjoy complete coverage. 

The right insurance for you

Finding the right group policy coverage is not so easy if you do not know which features to look for. Reading this will help you get an overall idea about how maternity coverage works and the associated benefits to the policy coverage. As an employee, you can enjoy similar benefits if your employer offers a comprehensive group health plan as a service benefit.

PlanCover – Bringing the best policies

PlanCover is a high-rated insurance broker that offers group health insurance plans to employers of small to midsize organizations. They help you buy the best policy among the multiple plans available with the leading IRDAI-approved insurance companies in India. They offer you the best prices and explain the features of all the plans to help you find the right one among so many alternatives. Get in touch with their team and get started. 

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