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What Is Maternity Coverage In Group Health Insurance?

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Hey, have you recently tied the knot with your loved one and are now planning to take the next step in your lives by starting a family? Sooner or later, as you think about this decision, you will likely have questions about how to plan your finances to meet the costs of maternity and hospitalization that come with it.

Let me tell you this: “Babies do not come for free.” Yes, you read that correctly. No parent wants their infant or themselves to suffer in any way due to a lack of resources. Every parent wants their child to receive exceptional pediatric care at a trusted nursing hospital, which inevitably comes at a cost. However, these words are not meant to scare you into not bringing a beautiful life into this world. Instead, they are meant to encourage you to prepare for your beloved child’s arrival. If you truly care for your family and yourself, you will make an effort to gather knowledge by reading further.

Let’s put an end to all your confusion and answer any questions that may be running through your mind.

What is Maternity Coverage?

Maternity coverage is a benefit that covers the cost of pregnancy, childbirth, and postpartum. This coverage can provide cashless or reimbursement treatment of expenses during the maternity period. It’s important to note that not all health insurance plans offer maternity coverage, so it’s crucial to check before purchasing a policy.

Is Maternity Coverage Important?

Maternity coverage is an essential aspect to consider when buying a health insurance policy. Pregnancy and childbirth can be expensive, and without insurance coverage, medical costs can add up quickly. If you have maternity coverage, it can help you focus on your baby, rather than how you will pay for the medical expenses.

When it comes to choosing the best health insurance plan for maternity coverage, there are two options: retail health insurance and group health insurance plans. 

PlanCover suggests that a potential customer carefully check the  inclusions or exclusions while buying the policy. Group health insurance plans often provide more benefits than retail health insurance plans, including maternity coverage from the day of purchase.

What are Maternity Benefits in Health Insurance Plans?

In a retail health insurance plan, also known as an individual health plan, maternity coverage is typically covered but has a waiting period of 9 months. This means that a claim from day one is not possible. Some policies even have a three-year waiting period

Therefore, to the question ‘is there any health insurance that covers maternity’. The answer is, yes. Group health insurance provides maternity coverage from the day of purchase, with maximum benefits. 

What is the coverage limit of both, C-section and normal deliveries?

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The coverage limit for both normal deliveries and C-sections may vary. 

  1. Normal delivery usually costs less as hospitalization is limited to 1-2 days only
  2. C-section delivery involves surgery, and therefore the days of  hospitalisation increase. Yet there is a limit upon the expenditure as per the policy rules.

Is Room Rent at the Hospital Covered Under Maternity?

Yes, the room rent during the maternity process is covered under the policy. However, it’s essential to note that room rent limits are as per those applicable for normal hospitalizations, within the specific terms and conditions of the policy. In case the patient avails of a higher than entitled class of room as specified in the policy, then the difference in the “room rent” will be borne by the insured and not the insurance company.

What is Pre and Postnatal Coverage?

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Prenatal coverage refers to the expenses incurred during the nine-month period of pregnancy, while postnatal coverage refers to the expenditure that arises after the delivery. The expenses pertaining to OPD and medicines are covered in most insurance plans. 

The coverage is for 30 days prior to hospitalization for maternity pre-hospitalization (prenatal) and extends up to 60 days post-hospitalization (post-natal).

Is ‘hospitalization before the delivery date due to complications during pregnancy’ covered?

In most cases, hospitalization before the delivery date due to complications during pregnancy is covered under the maternity section of the insurance policy. If other treatments are required by the mother during the pregnancy period that is before delivery, it will be covered. However, diseases or illnesses unrelated to maternity like COVID-19, dengue, chikungunya, high fever, dehydration, jaundice, kidney issues, heart issues, blood pressure, HTN, DM, anemia, thyroid, and others are not covered under maternity terms.

Is ‘hospitalisation after delivery resulting from post-delivery complications’ covered?

Many women are unsure about what kind of maternity coverage their health insurance plans offer. One common question that arises is whether hospitalisation after delivery resulting from post-delivery complications is covered. The answer is that it depends on the specific terms and conditions of the policy.

According to pre and post-natal coverage, hospitalisation within 60 days of delivery due to complications will be paid by the insurer. However, if pre and post-natal coverage is not included in the health care policy, then complications related to maternity will not be covered.

If a mother has a natural delivery and catches UTI or any other complication due to giving birth, it will be covered under postnatal terms in the policy. Similarly, if sutures develop infections after a C-section delivery, it will be covered only if postnatal coverage is there. Therefore, the coverage of post-delivery complications is dependent upon specific clauses of the policy’s terms and conditions as there are limits defined for pre and post-natal treatments.

Is premature delivery’s expense covered?

Yes, the expense of premature delivery is covered, but the costs will be limited to maternity capping only as per the policy.

Can a newborn be added to a health insurance policy?

Yes, a newborn can be added to a health insurance policy with intimation within 30 days of birth. The newborn can be added with the mother’s name if the name hasn’t been decided yet. Within the given duration, name corrections can be done subsequently.

What is the meaning of ‘Pro-rata’ payment in maternity claims?

If a patient avails a room higher than the entitled class as mentioned in the policy, the expense will be borne by the insured. 

Another case is if the number of days needed to be increased for a patient’s stay at the hospital. In this situation, the insurer will only bear the cost decided in the maternity plan, and the cost of the increased number of days will be borne by the insured itself.

Can I make a maternity claim under two health insurance policies? 

If a person has two medical insurance policies, and both policies have maternity coverage, then a partial claim from each is possible. For instance, if at the time of hospitalisation, the bill is for a lakh and the first policy’s maternity coverage limits to Rs. 50,000 only, then the remaining Rs. 50,000 can be claimed as reimbursement from the second policy if its coverage allows.

It is important to consider certain points while making partial claims. Intimations are not mandatory, and proof of payment (receipt) is the requirement for reimbursement. Therefore, the insured needs to take proof of payment paid at the hospital, discharge summary, results of tests and films along with all other documents. The second claim will be processed only after the settlement of the first claim. A settlement letter from the first insurer is essential to claim the reimbursement from the second insurer.

Is the birth of the third child or the birth of twins on the second attempt covered under an insurance policy?

As per the standard health insurance policy, maternity is not covered for the third child. However, there are some insurance companies that do provide third child maternity coverage under their group health insurance plan but at a higher premium.

If an unfortunate event takes place, and any of the first two children die, the claim cannot be considered for the third-born child. But in the case of twins, both will be covered under the maternity plan.

What is GPLA? What is its meaning and history?

GPLA stands for G- Gravida, P- Preterm, L-Living Child, A-Abortion. Gravida refers to the number of times a woman has conceived so far. Pre-term refers to how many of the earlier children were premature. Then comes the number of living children, and last comes the abortion.

The history of GPLA is as follows: Some policies include only two children to be taken care of in the maternity clause. But it does not specifically mention two living children. This is where the GPLA came into the system. Thus, it prevents fraudulent claims and also decides upon the payability of the claims. Therefore, insurers often insist upon the GPLA history of the client.

How does the GPLA system help the insurer?

If there is a maternity claim, either cashless or for reimbursement, the insurer first confirms the GPLA status of the person. As there could be a condition mentioned in the policy for only two maternity attempts, the third pregnancy will not get covered in the policy.

If complications occur with the newborn post-delivery, will the expenses get covered?

If any complications occur in an infant post-delivery, diagnosis and report expenses will be covered. But the cost of treatment will only be taken care of in the policy only if the baby is added to the policy.

Is there a time limit to add an infant to the policy?

The process is to intimate the insurance company about the addition of the newborn. This must be done within 30 days of the child’s birth. If not added within the timeline, the insurer can either decline the request for addition, or the insured may have to wait till the renewal of the policy to add the child.

Do pre and post-natal clauses cover diagnostic tests?

Yes, certain investigations and tests are covered in the health insurance policy under pre and post-natal sections. As mentioned above, the prenatal clause works 30 days prior to delivery, and the post-natal works 60 days after the delivery. Therefore, any tests required within the frame are covered under the policy.

Does health insurance pay for maternity leave?

Often, a thought or question pops into the head of an employee whether the health insurance company pays for the maternity leave or the company. The answer is that the company is liable to pay for the duration of maternity leave. Whereas the health insurance is responsible to pay for the expenses of delivery and for the pre and post-delivery. To manage all this, group health insurance maternity coverage is the best support plan.

I’m sure PlanCover’s guidance will be of use to you while deciding on your group health insurance plan focused on maternity benefit.

We at PlanCover will be delighted to serve you and solve your queries if you have any at your convenient time. We are available at, connect with us to know more about insurance benefits and choose the policy that meets your needs.

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