Know about Group Health Insurance Maternity Cover

Group health insurance is a customized policy that is usually provided by the employer in order to cover the health-related expenditure of the employees. The scope of this insurance may extend to the families of the employees. However, in this article, we will tell you about group health insurance maternity cover.

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Maternity Cover under Group Health Insurance

Group insurance scheme offers pregnancy coverage under which the insured may avail maternity coverage from day one as there is no waiting period in group health insurance. However, it is at the discretion of the employer to include maternity coverage under group health insurance.

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.

Benefits of Group Health Insurance Maternity Cover

  1. Delivery Expenses

    The costs of normal and C-section deliveries are covered by group health insurance. However, one must pay attention to the fact that premium charges may cost more as the C-section delivery costs are considerably high due to the surgery or operations included.

  2. Miscellaneous Expenses

    Other maternity expenses, such as visiting charges, room rent, and surgery expenses, are covered by group health insurance.

  3. Newborn Baby Coverage

    A maternity cover also offers medical coverage to a newborn baby for 90 days from birth. Hence, the policyholder is allowed to claim a wide range of bills incurred in the treatment of an infant.

Excluded Maternity Expenses under Group Health Insurance.

Every 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.

  1. Consultation Fee

    Every consultation fee that may occur during the counseling session is not covered under group medical insurance.

  2. Vicarious Pregnancy

    Vicarious pregnancy does not cover under group health insurance.

  3. Therapy of Hormone Replacement

    A situation may arise during pregnancy where an insured may undergo therapy to replace the hormone. However, the therapy cost is not covered under the group health insurance policy.

Case Study on Addition of Member

New members can be added to a group health insurance scheme by intimidating the insurer and paying additional amounts.

Mr. Sultan Ali Khan is a member and beneficiary of a group health insurance policy. Recently, he got married and wishes to include her wife in the group health scheme. The addition can be done by paying an additional premium. However, the beneficiary is not required to wait as this policy has no waiting period. Hence, the period starts from day one.

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: 11 August 2023

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