What is the Process for Claiming Maternity Benefits?

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To claim maternity benefits, you must notify your insurance provider 1-2 days before your due date. There are two procedures to file a claim for maternity benefits: the cashless claim and the reimbursement claim. Let us have a look at both the cashless claim and reimbursement claim procedures to get maternity benefits.

How to Claim Maternity Benefits in a Health Insurance?

You get the maternity benefits in health insurance; you can either file a cashless claim or a reimbursement claim with your insurance provider. Here is the step-by-step to file both cashless and reimbursement claims for maternity benefits:

Cashless Claim

Step 1:Notify your insurance of your intended hospital stay at least 2 days before your due date. Within 24 hours of being admitted to the hospital, report any emergency labour pain to the insurance company.

Step 2:Provide your cashless card or health ID card at the hospital insurance desk.

Step 3:Your spouse or family can complete the pre-authorisation form for a cashless claim and submit it to the hospital administration.

Step 4:The authorities will submit the pre-authorisation to the third-party administrator (TPA) or your insurance provider for approval.

Step 5:After confirming all the information, your insurer will authorise your request for a cashless claim.

Step 6:Get the necessary pregnancy-related treatment.

Step 7:At the time of discharge, sign all the documents and pay the costs that your insurance does not cover. The hospital will get payment from the insurance company.

Reimbursement Claim

Step 1:Notify your insurance provider within 24 hours of experiencing labour pain and going to the hospital for an emergency. Give the insurer at least 48 hours' notice if you want to stay in the hospital before your due date.

Step 2:Provide your health ID card at the hospital insurance desk.

Step 3:Undergo the necessary pregnancy-related procedure or treatment.

Step 4:Pay the entire hospital fee and get all medical records at the time of release.

Step 5:Send the insurer or TPA any necessary paperwork.

Step 6:Your insurance provider will pay you the acceptable claim amount after verifying all of your documentation.

Documents Needed to File a Claim for Maternity Benefits

Whether you go for a cashless claim or a reimbursement claim, you need to provide some essential documents to get maternity benefits. Some of them are:

Completed maternity insurance claim form

Summary of hospital discharge

A copy of the health card

Payment receipts and hospital bills

Reports from medical investigation, including ultrasound reports

Bills for medical consultations

Pharmacy bills backed by KYC documents and a doctor's prescription

Any additional paperwork requested by your insurer

Final Thought

Before considering starting a family, women should get maternity health insurance as soon as possible to fulfil the required waiting period. In India, the majority of maternity insurance plans have a waiting period that can be as short as three months, during which time pregnancy-related costs are not covered.