How to Claim the Maternity Cover in Health Insurance?

• Written by Care Health Insurance

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With the increasing rate of medical inflation in our country, there has been an increase in maternity care costs. It can be a considerable expense to take for parents-to-be. A family health insurance with maternity cover seems an ideal choice when one anticipates an inevitable increase in the overall expenditures owing to pregnancy.

A maternity cover is available as one of the benefits of a family medical insurance plan. However, some health insurance plans with maternity benefits may cover only the hospitalization expenses related to the delivery. Thus, it is crucial to understand the policy terms and conditions. An affordable solution for getting pregnancy cover is by investing in a maternity insurance policy, such as Joy by Care Health Insurance, that covers various maternity-related expenses, including pre-and-post natal care and newborn baby expenses. A couple can now fulfil their financial responsibilities by taking this smart move.

To prevent any possible delays in getting the coverage, make sure you understand the procedure to file a claim for maternity cover in a health insurance plan.

How to claim the maternity cover?

After getting hospitalized for the delivery, you can file a reimbursement claim as per the specified time. Remember to notify us within 24 hours of hospitalization in case of an emergency. In case it is a planned hospitalization, inform us 48 hours before getting admitted to the hospital.  

Alternately, you can opt for the cashless hospitalization facility, which saves time and keeps you stress-free about paying medical bills during this crucial time. Here are the steps to avail of this feature:

• Visit any of our network hospitals near your location and approach the hospital insurance desk.
• Request for pre-authorization form. Duly fill and submit the form and share the ID proof.  
• The hospital will send us the documents.
• Our claim management team will send an approval letter after verification. 
• One can initiate the treatment.

In the case of reimbursement, you need to follow the below-mentioned steps: 

• Inform us within the mentioned time frame.
• Submit reimbursement claim form with other documents according to the insurance policy’s terms and conditions.
• Our claim management team can raise a query if required.
• An approval letter is shared, after verification, by the claim management team.

Read More: Protect your newborn with an Affordable Health Plan

Documents Required for Maternity Insurance Claim

Under the cashless claim facility, you must submit the duly-filled pre-authorization form and share identity proof at the network hospital's insurance desk. We will take care of your hospital bills and pay them directly to the hospital, subject to policy terms and conditions. 

However, you must know how to claim maternity insurance cover if you have chosen a non-network hospital. Firstly, notify us as per the specified time and submit the following documents: 

• Duly filled reimbursement claim form
• A valid photo identity proof
• Referral letter from a medical practitioner advising hospitalization
• The prescription from a medical practitioner advising drugs/diagnostic tests/consultation
• Original copies of pharmacy, diagnostic test reports, and payment receipts
• Original medical bills/receipt/discharge card from the hospital

To assess the claim and ensure hassle-free maternity expenses reimbursement, you may have to furnish any other documents, as requested by us. 

What are the Factors to Consider before Buying a Maternity Cover?

Mentioned below are the important things that should be considered while opting for a maternity cover:

Coverage: It is advised to check the health insurance for pregnant women. It should be sufficient to meet all the expenses, such as hospitalization, pre-and post-hospitalization, doctor's fees, room rent, ambulance expenses, etc. 

Waiting Period: Most maternity cover policies have a waiting period, in which case you have to wait for some time to avail the benefits. Therefore, opt for a health insurance plan in advance so that you can avail the policy benefits when required.  

Policy Documents: It is advisable to read all the literature attached to the health insurance policy properly. Make sure to analyze all the features, terms, and conditions before opting for it. 

Cases Where You Can’t Claim Maternity Insurance

When getting a maternity cover, do not miss checking the policy documents to know the various features. While you can get a maternity claim for major expenses related to maternity care, including delivery expenses, there may be some expenses that are not covered in the policy, such as: 

• Expenses incurred on diagnosis or treatment related to maternity expenses until the specified period (9 months or 24 months) since the inception of the first policy 
• Medical expenses incurred for infertility treatment/ in-vitro fertilization
• Expenses incurred towards miscarriage, or lawful termination of pregnancy during the policy term

Conclusion

As you would shift the focus on your baby, having a maternity plan is beneficial since it gives you financial support by covering medical expenses right from the delivery stage to post-natal expenses.

Parenthood is the most precious privilege for both men and women. This responsibility brings moments of both happiness and concern. Opting for Joy-Maternity Coverage from Care Health Insurance is of great help during this journey.

Individuals can access the best healthcare facilities in the country as we have more than 22900+ cashless healthcare providers. With convenient claim procedures, one can now get quality maternity care at the right time.

Disclaimer: Underwriting of claims for pregnancy subject to policy terms and conditions.