Group Health Insurance Maternity Coverage

Maternity coverage within a Group Health Insurance Policy enables you to reimburse expenses associated with childbirth. This coverage extends to additional costs such as pre and post-natal expenses. Maternity Health Insurance serves as a valuable support system for individuals planning to start or expand their families, alleviating their financial strain during this significant life event.

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Maternity Cover under Group Health Insurance

Maternity Health Cover within a Group plan mainly includes expenses related to childbirth. Newborns are typically covered by health insurance for up to 90 days, after which they can be added to the base plan.

Charges for maternity coverage under employer employee insurance are different. It includes two kinds of charges for pregnancy. The first refers to normal delivery and the other refers to cesarean charges. Normal delivery expenses are less than cesarean delivery expenses.

However, the additional premium charge to cover maternity might be high as it requires the insurer to bear the cost of hospitalization along with the nursing charges, surgeon charges (in case of cesarean delivery), room rent, etc.

What is Covered under Maternity Benefits in Group Health Insurance?

Maternity Cover within a Group Mediclaim Policy is among the various benefits provided under such plans. It serves to alleviate the financial strain on you and your spouse during family planning. With Maternity Insurance, you can concentrate on caring for your newborn without worrying about bearing a significant portion of the hospital bill. Here are the inclusions covered by this policy.

  • In-patient hospitalization - Maternity Cover in Group Health Insurance Policy includes expenses related to hospitalization, such as doctor's fees, surgical procedures, and room charges.
  • Lawful termination of pregnancy - Costs associated with lawful termination of pregnancy are covered under the Maternity Cover in Group Health Insurance Policy.
  • Type of delivery - Both normal and cesarean deliveries are covered. The cost of normal delivery is typically lower.
  • Vaccination costs - Vaccinations for the newborn, as per the WHO schedule, are covered under the Maternity Cover in Group Health Insurance Policy.

*Note: Coverages under maternity benefits in group health insurance policy varies from one insurer’s policy to another.

Excluded Maternity Expenses under Group Health Insurance.

Every group health insurance, whether it is individual health insurance or a group insurance scheme, exclusion of specific diseases or aspects are part of these policies. Under maternity coverage of group health insurance, certain costs are excluded from the insurance policy.

Listed below are some costs which are not covered under the group health insurance policy.

  • Consultation fees: Charges incurred for medical consultations related to maternity care.
  • Birth control procedures: Costs associated with procedures aimed at preventing pregnancy.
  • Surrogate or vicarious pregnancy: Expenses related to pregnancies carried by a surrogate or another individual on behalf of the intended parents.
  • Hormone replacement therapy: Costs for therapy involving the administration of hormones to address hormonal imbalances or alleviate menopausal symptoms.
  • Non-allopathic treatment costs: Expenses for alternative or complementary medical treatments not falling under conventional allopathic medicine.
  • Ectopic pregnancy: Medical expenses arising from pregnancies where the fertilized egg implants outside the uterus, typically in the fallopian tube.
  • Termination of pregnancy before 12 weeks: Costs associated with the lawful termination of a pregnancy within the first trimester.
  • Regular check-ups: Expenses for routine prenatal and postnatal medical check-ups during pregnancy and after childbirth.
  • Medical expenses arising out of a complication in assisted conception: Costs incurred due to complications arising from assisted reproductive technologies such as in vitro fertilization (IVF).
  • The cost of harvesting and/or storing stem cells: Charges for collecting and preserving stem cells from umbilical cord blood for potential future medical use.
  • Infertility treatments: Expenses for medical procedures and therapies aimed at addressing infertility issues and improving fertility.
  • Voluntary termination of pregnancy: Costs related to the elective termination of a pregnancy beyond the legally permissible period.

*Note: Exclusions under maternity benefits in group health insurance policy varies from one insurer’s policy to another.

Difference between Maternity Sum Insured and Overall Sum Insured

Here's a table outlining the variance between Maternity Sum Insured and Overall Sum Insured in Group Health Insurance:

Parameters Maternity Sum Insured Overall Sum Insured
Definition Claimable amount for maternity expenses. Predetermined claimable amount for all covered medical treatments.
Coverage Scope Limited to maternity expenses. Includes all covered medical treatments.
Amount Usually lower than Overall Sum Insured. Generally higher than Maternity Sum Insured.
Childbirth Expenses Covered. Not covered.
Newborn Baby Expenses Covered up to 90 days. Covered from 90 days up to 25 years (dependent child).

Conclusion

It must be noted that the medical coverage for a group health insurance policy is only available for a policyholder for two deliveries. Hence, if two children already exist to the policyholder, the insurance claim could be rejected by the insurer.

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Written By: PolicyBazaar - Updated: 15 March 2024

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