Group Health Insurance

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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.

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

Let us illustrate how the coverage works through an example –

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 the policies for a claim.

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