Written By: Simran Kaur Vij

Simran Kaur Vij

Health and Term Insurance

Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.

|
Reviewed By: Bijendra Singh

Bijendra Singh

Term Insurance

Bijendra Singh with his 9 years of experience in the term insurance sector, has been instrumental in designing customer-centric sales programs. His passion towards innovation strives to achieve organizational objectives while driving sustainable growth in the competitive insurance landscape.

Updated on Dec 15, 2025 5 min read

How To File A Maternity Health Insurance Claim?

The arrival of a new baby is a momentous occasion, filled with joy and anticipation. However, amidst the excitement, the practicalities of healthcare costs can sometimes feel overwhelming. Preparation is key when it comes to parenthood. Buying and understanding how to file a maternity claim is necessary to ensure a financial safety net for your growing family.

This article is your guide for filing a maternity health insurance claim, whether you’re opting for a cashless or reimbursement maternity claim.

Best Maternity Health Plans

Before we move ahead, let us take a look at the best maternity health plans available in India:

What Are The Steps To File Maternity Health Claims?

Follow the steps given below to file a maternity health insurance claim

1. Cashless Maternity Claims

   • Inform your health insurance provider 48 hours before your due date or scheduled c-section surgery. In case you experience labour pain, inform your insurer within 24 hours of hospitalisation.
   • Approach the TPA desk at the cashless network hospital and provide important identification documents and the policy card.
   • Fill out the pre-authorised form at the TPA desk to claim cashless hospitalisation.
   • The health insurer will verify all the details with your cashless network hospital related to your treatment.
   • Post-childbirth, upon receiving discharge from the hospital, the insurer will settle the hospital bills directly with your health insurer as per your health insurance sub-limits.
   • Pay the out-of-pocket expenses not covered by your health insurer.

2. Reimbursement Maternity Claims

   • Notify your insurance company about your scheduled delivery date or notify them about the hospitalisation within 24 hours of experiencing labour pain.
   • Undergo the process of your delivery, and other pregnancy-related treatments, and pay all the hospital bills directly.
   • At the time of discharge, make sure you pay all the bills directly to the hospital.
   • Make sure to collect all original bills, receipts, discharge summaries, and other relevant medical documents.
   • Submit all the important documents to your health insurance provider when filing for a reimbursement claim.
   • Your health insurance provider will verify all the documents submitted by you and pay the claim amount as per the sub-limits.

Common Reasons for Maternity Health Claim Rejection

Common rejection reasons for maternity health claims are:

• If your maternity waiting period is not over, the chances of claim rejections are higher.
• In case you fail to inform your health insurer in time about your planned or emergency hospitalisation.
• If your maternity health plan has not been renewed or you missed paying timely premiums, your health plan will lapse, and any claim will be rejected.
• Not disclosing pre-existing conditions transparently to your health insurer may lead to claim rejections.
• Submission of incomplete or inaccurate claim forms or missing essential documents like original hospital bills, discharge summaries, or medical reports may lead to maternity claim rejections.

How To Avoid Maternity Claim Rejection?

No one wants a claim rejection, especially when welcoming a new member into the family. Here are some tips to avoid maternity claim rejection:

• Read the policy brochure carefully to understand the terms and conditions of your maternity health plan. Make sure to thoroughly go through the inclusions and exclusions.
• Be clear about the waiting period applicable to maternity benefits. Plan your pregnancy or policy purchase accordingly to ensure the delivery falls after the waiting period.
• Understand the sub-limits of your maternity health plan. Know the extent of your coverage for specific expenses like room rent, doctor’s fees, or delivery type, and more.
• If you do not want the hassle of reimbursement claims, find out all the cashless network hospitals in your vicinity.
• Fill in all the details carefully. Provide all the required information truthfully and ensure no errors are made. Double-check all details before submitting.

What Are The Documents Required For Maternity Health Insurance?

The following documents are necessary when filing a maternity health insurance claim.

• Properly filled claim form
• Health policy card
• Identification proof
• Hospital discharge summary
• Pharmacy bills
• Medical investigation reports
• Diagnostic test results
• Any other documents required by your health insurance provider

Maternity Health Plans Waiting Periods

The waiting period in maternity health insurance refers to the time you need to wait after purchasing the policy before you can claim benefits related to pregnancy and childbirth. Waiting periods are set by health insurance providers to prevent the misuse of the policy. Generally, the maternity health plan waiting period varies between 9 months to 4 years, depending on the health insurance you purchase.

What Is The Eligibility Criteria For Maternity Health Plans

Maternity health insurance plans have an eligibility of 18 to 45 years. On investing in maternity health policy, maternity benefits often become effective after a waiting period, which can vary from a few months to a couple of years.

What Is Covered Under Maternity Health Plans?

Let us take a look at the treatments and coverage features of a maternity health plan:

• Prenatal and Postnatal Care: Maternity health insurance covers healthcare expenses before and after birth, including doctor appointments, diagnostic screenings, medications, and more.
• Delivery Expenses: Both normal and C-section delivery charges, including surgeon fees, operation theatre costs, room rent, and nursing charges.
• Newborn Coverage: Medical expenses for the newborn baby for a specific period (usually up to 90 days), including vaccinations and treatment for congenital disorders. Some policies might even cover the newborn from day one.
• Hospitalisation Expenses: Investing in a maternity health plan covers hospitalisation expenses, including room rent, nursing charges, and other inpatient services.
• Birth Ailments: Birth ailments include cleft lip, Down syndrome, cystic fibrosis, and others. Maternity health insurance coverage for unexpected complications during pregnancy or childbirth is covered, depending on the plan you invest in.
• Outpatient Expenses: Some policies might cover outpatient expenses like diagnostic tests and doctor consultations related to pregnancy.

Conclusion

Purchasing a maternity health plan plays a vital role in preparing for parenthood. Responsible for financially safeguarding your hard-earned money, it is ideal for expectant parents in Gurugram, Delhi, Mumbai, Chennai, and all over India. Maternity health plans are offering coverage for various expenses associated with pregnancy, childbirth, and postnatal care. Understanding the nuances of these plans, including the coverage, exclusions, waiting periods, and claim processes, is paramount for making an informed decision and ensuring a smooth experience when the need arises.

To understand maternity health plans in detail, connect with PolicyX health insurance experts.

We offer No Spam, No Gimmicks, Only Expert Insurance Advice.

Consult for Personalized Insurance Advice

But how does it work?

Schedule a call with India’s number 1 trusted advisor with a 4.5+ rating on Google. We are not your average insurance agents. Our advisors are experts in their insurance knowledge and will give you the right information at the right time. The service is free of cost! Don’t worry, we won’t spam as we value your time.

Schedule a 30-minute call now

Health Insurer Network Hospitals