Learn To Claim Maternity Health Insurance - Cashless and Reimbursement Process

Planning your pregnancy and giving birth to a child is a wonderful event and a big celebration for you and your family. However, it is important to keep in mind that with this joyful moment, your family is also covered financially. Nowadays medical expenses are increasing rapidly and the most important thing is that the cost of delivery charges in any good hospital is around INR 1.5 lakh. In some hospitals it can also be higher than that. After delivery there may be a chance of complications to a newborn like jaundice or other virals. In that case health insurance for maternity can cover the health of both the mother and a newborn. A maternity health Insurance provides financial security as well as peace of mind. Here you will learn about benefits, ways to claim your maternity health insurance, best maternity health insurance plans in the market etc.

What is Maternity Health Insurance?

It is a tool that safeguards you from all pregnancy-related expenses and helps you in providing your newborn baby with a premium quality treatment. You can buy maternity health insurance either as a rider with a basic insurance policy or as a dedicated standalone health plan. In both plans, you will get coverage for hospitalization expenses related to both baby delivery options, that are, normal delivery and cesarean delivery.

Some of the benefits of maternity insurance include coverage for pre and post natal and pre and post hospitalisation expenses. Pre Hospitalisation includes expenses incurred upto 30 days before the date of admission. Other expenses such as room charges, doctors consultation etc are also covered under a maternity health insurance plan.

Benefits Of Maternity Health Insurance

Maternity health insurance gives you financial security during the happiest moment of your life. Here are some benefits to keep in mind:

1. Covers Maternity Related Expenses - Maternity health insurance covers your pre-hospitalisation and post hospitalisation expenses. It can cover the expenses of medications and consultations as well.

2. Covers Your  Newborn Baby’s Health Expenses - Maternity health insurance covers expenses of your new born baby if a baby suffers from any critical disease or virals.

3. Expenses of Caesarean Delivery - Maternity health insurance covers the expenses of c-section including all the cost of medications and hospitalisation.

Ways To Make Claim For Maternity Health Insurance 

1. You need to fill the claim settlement form properly at the time of hospitalisation. Name of the patient must be the same as in the policy.
2. You need to send the claim form to the insurance provider with all your medical reports. Note that you must inform your insurer at least 72 hours before hospitalisation in case of planned delivery. 
3. In case of an emergency hospitalisation you need to inform the health insurance company within 24 hours.
4. You need to submit all the documents for verification (along with KYC documents). Documents like medicine bills, hospital bill, ambulance bill, OPD consultation etc should all be submitted.

How To Make A Maternity Health Insurance Claim?

How to Make A Claim - Cashless Process

Step 1: Visit any network hospital of your choice

Out of all the network hospitals, visit the one that suits your requirements and in which you are comfortable.

Step 2: Take The Pre-authorisation Form

From the hospital’s TPA desk, take the pre-authorisation form and fill it. You can also take this directly from your insurer or check with us at InsuranceDekho. 

Step 3: Submit Details to TPA

After filling the form, submit the details to the TPA officer along with your KYC or ID proof and your health e-card or cashless card.

Step 4: Bill Paid

Once the TPA checks all the documents and if they are in order, your bill at the hospital will be closed by your insurer.

How to Make A Claim - Reimbursement

Step 1: Procure The Claim Form

Take the TPA claim form from the TPA desk at the hospital.

Step 2: Settle All Bills

Once you have been discharged from the hospital or ordered fit to go, pay all the bills from your pocket. Ensure that you have collected the discharge summary, all bills and receipts.

Step 3: Fill Out The Claim Form

Fill out the details in the claim form. Make sure you have entered all details correctly. Now submit this claim form to your insurance company along with all supporting documents like prescriptions, bills, discharge summary, your KYC details etc.

Step 4: Get The Payment

Once you submit the details, the insurer will review them and in case everything is fine, they will then settle the claim. This money will then be transferred to your bank account.

Documents Required for Maternity Health Insurance Claim

In order to file an insurance claim you should have the required documents in hand at the time of emergency. Given below are the documents needed to claim a maternity insurance policy.

• Duly filled in claim form
• Policy documents
• Admission advice
• Discharge summary
• Fitness certificate
• KYC documents
• Consultation bill
• Original hospital bill
• Pharmacy bill

Best Maternity  Health Insurance Company And Plans

Check best health insurance companies and health plans offering maternity and pregnancy health insurance covers below:

1. Care Health Insurance (Care Joy)- It is one of the most popular maternity insurance plans in the market. You can buy care joy maternity insurance plan at the age of 18 till the age of 65 years. It covers both maternity and newborn expenses. It can cover the sum insured of INR 3 Lakh to 5 Lakh. Maternity waiting period within this plan is 9 months.

2. Niva Bupa Health Insurance (Aspire Plan)- It is a modern type of maternity health insurance that covers the expenses of maternity including IVF treatment, surrogacy, adoption and more. Maternity expenses are covered along with newborn and vaccination. Minimum age is 18 years  to buy this policy with no maximum age bar. This niva bupa aspira health insurance plan has a  24 months of maternity waiting period and covers the sum insured of INR 5 Lakh to 1 crore.

3. Star Health Insurance (Star Women Care Plan)- It is a unique maternity health insurance plan which you can buy at the age of 18 till the age of 75 years. It can cover the expenses of IVF treatment and surrogacy. It also covers the expenses related to miscarriage due to accidents. The sum insured within this star women care insurance policy is INR 5 lakh to 1 crore. 

For more information or any assistance regarding your Maternity Health Insurance or in case you want to buy or renew your policy connect with an InsuranceDekho advisor - 

Email: support@insurancedekho.com

Call: 7551196989

Cases Where You Can’t Claim Maternity Insurance (Exclusions)

Before buying a health insurance plan, it is advisable to go through all the exclusions and inclusions of the policy in detail. Some of the common exclusions of health policy that you should be aware of are mentioned below:

• Expenses incurred on vitamin pills and tonics not mentioned in the plan
• Doctor’s visit for regular checkup
• Diagnostic tests and doctor’s consultation during pregnancy
• Treatment costs regarding infertility treatment

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

FAQ Maternity Health Insurance

Ques 1. Does Maternity Health Insurance cover the newborn?

Ans. Yes,Maternity Health Insurance covers the expenses for a newborn for a certain time period.

Ques 2. Are Daycare Treatments covered under Maternity Health Insurance?

Ans. Yes, Daycare Treatments are covered under Maternity Health Insurance which includes minor surgeries and treatments

Ques 3. Is there an age limit to purchase Maternity Health Insurance?

Ans. Yes, there is an age limit from 18 to 45 years to purchase Maternity Health Insurance but some insurance companies provide these insurance plans till the age of 75.

Ques 4. Can I buy a Maternity Health Insurance plan if I am already expecting?

Ans. Yes, a pregnant woman can also buy a maternity health plan after submitting the scan report of 12 weeks to 20 weeks pregnancy. Note that you will only be able to avail benefits after the waiting period is over.

Ques 5. Are waiting periods mandatory for all maternity insurance plans?

Ans. Yes, waiting periods are mandatory for all maternity insurance plans.