Maternity is an important life milestone. While it brings joy and excitement, it also comes with medical and financial responsibilities. This is where maternity cover in group health insurance becomes essential. This guide explains how maternity cover works, who is eligible, what expenses are covered, and how to claim maternity cover in group health insurance through cashless or reimbursement options.
Today, employee benefits go beyond basic healthcare. Maternity cover insurance has emerged as a critical benefit that supports working parents and promotes workplace inclusivity. In India, nearly 73% of women drop out of the workforce after maternity, making employer-supported maternity benefits essential for improving return-to-work outcomes and long-term employee retention.
A group health insurance policy offered by employers often provides maternity cover at a lower cost than individual plans. In many cases, waiting periods are reduced or waived, making maternity cover health insurance more accessible.
Eligibility depends on the terms of the group health insurance policy provided by the employer.
A group health insurance maternity cover plan is designed to support employees through pregnancy, childbirth, and the early days of parenthood. While the exact inclusions vary across insurers and employers, most group health insurance policies offer coverage across three key stages: before delivery, during hospitalization, and immediately after childbirth, including limited support for the newborn.
Maternity cover health insurance typically includes medical expenses incurred before and after delivery, helping employees manage routine pregnancy-related care without financial strain. This usually covers doctor consultations during pregnancy, diagnostic tests such as ultrasounds and blood work, and postnatal follow-up visits after childbirth, within the limits defined by the policy.
Under maternity cover, in-patient expenses related to childbirth form the core of the coverage. This generally includes hospital room charges, normal or caesarean delivery procedures, surgeon, anaesthetist, and nursing fees, and ICU expenses if they are medically required due to complications during delivery.
Depending on the group health insurance policy, maternity cover may also extend limited benefits for the newborn. This can include vaccinations administered during the initial hospital stay, treatment for medical complications identified at birth, and hospitalisation expenses for a defined period, such as the first 30 to 90 days.
In most cases, newborns are not automatically covered under the policy. Employees are required to add the child to the group health insurance policy through an endorsement after birth, usually within a specified timeframe. Once the endorsement is completed, the newborn becomes eligible for coverage as per the policy terms, making it important for employees to inform HR and initiate this process promptly.
There are two ways to claim maternity cover: reimbursement claims and cashless claims.
A reimbursement claim allows the insured to choose any hospital for treatment. However, the employee must pay the expenses upfront and claim them later.
Step-by-step reimbursement claim process
Step 1: Claim intimation
Inform the insurer or TPA about the hospitalization.
Step 2: Hospitalization
The employee can take maternity treatment at any hospital of their choice, except blacklisted hospitals.
Step 3: Bill settlement and document collection
At discharge, all hospital bills must be paid. The insured should collect:
Step 4: Claim submission
Submit the completed claim form along with the required documents to the insurer or TPA.
Step 5: Claim verification and reimbursement
After verification, the insurer reimburses the admissible amount directly to the employee’s registered bank account.
Cashless claims eliminate the need for upfront payments when treatment is taken at a network hospital.
Step-by-step cashless claim process
Step 1: Inform the insurer
Notify the insurer or TPA within the specified timelines for planned or emergency hospitalization.
Step 2: Pre-authorization approval
Fill and submit the pre-authorization form through the hospital. The insurer reviews and approves eligible expenses.
Step 3: Hospitalization at a network hospital
Proceed with maternity-related treatment at a network hospital under the group health insurance policy.
Step 4: Claim settlement
At discharge, the insurer settles the approved expenses directly with the hospital. The employee only pays for non-covered items, if any.
At Pazcare, we help companies design group health insurance policies that truly support working parents. From maternity cover to newborn endorsements and seamless claim support, our team ensures your employees are covered when it matters most.
Talk to Pazcare today to build employee benefits that care beyond the basics.
Marketing Analyst
A maternity cover in health insurance is an add-on cover that one can opt for in an existing health insurance policy to cover the policyholder or the spouse.
In maternity health insurance, maternity related hospitalization, delivery expenses and newborn baby expenses are generally covered.
Maternity is not covered in group health insurance by default. It is an add-on cover that you can buy and add to your base group health policy.
Maternity insurance is insurance that covers expenses related to maternity like hospitalization, C-section, delivery expenses, newborn expenses etc.
You should check with your insurance provider/ company if they provide maternity benefits. However, it can be purchased as an add-on benefit.
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