Can I claim maternity if I am covered under both my own and my spouse's corporate health insurance policies?

Yes. If you are covered under both policies, you can generally use your own employer's policy first and then submit a secondary claim under your spouse's corporate policy for any remaining eligible expenses, subject to policy terms.

Can I use a top-up or super top-up policy for maternity expenses?

In many cases, top-up and super top-up health insurance policies exclude maternity expenses and are primarily designed to cover high-value hospitalizations beyond a specified deductible. It is important to review the exclusions in the policy document.

Is it possible to claim for pre-natal and post-natal check-ups under maternity insurance?

Yes. Pre-natal and post-natal expenses are often included within the overall maternity sub-limit of the policy. The total payable amount depends on the available sub-limit after accounting for delivery-related expenses.

Maternity claims from multiple Health Insurance Policies

Q: What happens if the hospital is not in the network of my second insurer?

If the hospital is not part of the second insurer's network, the claim is usually processed on a reimbursement basis. You would typically pay the remaining bill yourself and then submit the required documents to the second insurer for reimbursement, subject to policy conditions.

Q: Does maternity insurance cover a C-section differently than a normal delivery?

Many maternity health insurance policies have separate sub-limits for normal delivery and cesarean section. For example, the coverage amount for a cesarean delivery may be higher than that for a normal delivery, depending on the policy schedule.

Group Health Insurance

1 3 2 4 5 6

It is common for insurers to cover maternity-related expenses in a health insurance policy. However, since maternity claims are frequent, insurers cover them for a restricted policy sub-limit, which is commonly between INR 50K – INR 1L.

Key Takeaways

No “Double Benefits”: While you can use two policies, the total payout cannot exceed the actual hospital bill. Claiming full amounts from both insurers for the same bill is considered fraud.
The “Cashless + Reimbursement” Combo: The most efficient method is to use Policy A (Primary) for a cashless settlement at the hospital and then file a Reimbursement claim for the remaining balance with Policy B (Secondary).
Documentation is Key: To claim from the second insurer, you must provide their team with a Claim Settlement Summary from the first insurer along with attested copies of all bills and the discharge summary.
Waiting Periods: Personal maternity policies often have a waiting period of 2 to 4 years, whereas corporate/group policies often cover maternity from Day 1. Use the corporate policy as your primary to avoid waiting period rejections.
Section 80D Benefits: Premiums paid for these policies (if paid via non-cash modes) are eligible for tax deductions of up to ₹25,000 for self, spouse, and children.

Can you claim maternity expenses from multiple health insurance policies?

The total expenses incurred in maternity far exceed the limit offered by insurers in an individual policy. Therefore insurers allow policyholders to claim total maternity expenses they have incurred from multiple policies. However, the total value of the claim cannot exceed the total expenses incurred for the maternity claim.

Additional Read: Things to remember when choosing group health insurance

Here’s how to share maternity claims between multiple health insurance policies –

Suppose a policyholder is covered under 2 insurance policies – policy 1 and policy 2 in which the maternity limit is 75K and 50K respectively. In case the claim expense incurred by the policyholder is INR 1L, the policyholder has the choice to claim it from either policy 1 or policy 2, both individually and jointly. In the scenario described here, the policyholder can do either of the following –

1. Use policy 1 to settle INR 75K and use policy 2 to settle the remaining INR 25K
2. Use policy 2 to settle INR 50K and use policy 1 to settle the remaining INR 50K

It is worthwhile to note that the contribution clause is not applicable to health insurance claims. Hence the policyholder can utilize any one or both policies for a claim.

Summary: Claiming Maternity from Multiple Policies

Feature	Explanation
Sub-limits	Most policies cap maternity claims at ₹50,000 to ₹1,00,000, regardless of total Sum Insured.
Contribution Clause	No longer mandatory; you choose which policy pays first and how much.
Max Claim Value	Limited to the actual medical expenses incurred; you cannot profit from claims.
Settlement Letter	The primary insurer issues this after payment, acting as the bridge for the second claim.
New Born Baby Cover	Often included for 90 days as part of the maternity benefit.

Log on to SecureNow to compare insurance quotes online for making the right selection of individual or group insurance policies.

Frequently Asked Questions (FAQs)

Q1: Can I claim maternity if I am covered under both my own and my husband’s corporate policies?

A) Yes. You can use both corporate policies. Generally, it is advised to use your own employer’s policy first and then claim the balance from your spouse’s policy as a secondary claim.

Q2: What happens if the hospital is not in the network of my second insurer?

A) That is perfectly fine. The second claim is almost always done on a reimbursement basis. You settle the remaining bill at the hospital yourself and then submit the paperwork to the second insurer for a refund.

Q3: Does maternity insurance cover a C-section differently than a normal delivery?

A) Most policies have different sub-limits for both. For example, a policy might cover up to ₹50,000 for a normal delivery and ₹75,000 for a C-section. Ensure you check your policy schedule for these specific caps.

Q4: Can I use a “Top-up” or “Super Top-up” policy for maternity claims?

A) Typically, no. Most Top-up plans in India exclude maternity expenses and only cover major hospitalizations that exceed a specific deductible. Always read the “exclusions” list in your Top-up policy document.

Q5: Is it possible to claim for pre-natal and post-natal checkups?

A) Yes, but they are usually part of the overall maternity sub-limit. If your sub-limit is ₹50,000 and the delivery bill itself is ₹50,000, you won’t have any room left to claim for your monthly scans or consultations.

About The Author

Mayank Sharma

MBA Finance

He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.