Common Mistakes to Avoid While Filing Maternity Insurance Claim

What is a maternity insurance plan? 

Acquiring new parenthood is not only a matter of joy but also that of great responsibility. However, it cannot be solely achieved by love and care. Proper financial support plays a significant role, considering the circumstances. During this vulnerable phase, both the would-be or the new mother and the newborn require expert medical care and support.  

Considering all these aspects, having a comprehensive maternity health insurance policy seems like a plausible solution. As the name suggests, a maternity insurance plan has been specially crafted to cater to the specific requirements of the pregnant mother/new mother and the child. Usually, maternity coverage remains excluded from standard health coverage.  

What is a maternity insurance claim? 

A maternity health insurance claim covers the delivery costs, both normal and C-section, depending on the chosen plan terms. Considering the steep medical inflation rate, childbirth can prove to be an extreme financial burden.  

To avoid such unpleasant circumstances, it is best to ensure reliable maternity insurance plan coverage support. It usually covers the hospitalisation costs, medicine costs, and delivery charges, according to the plan terms.  

How to avoid maternity insurance claim rejection? 

Due to several reasons, maternity insurance claims can get rejected. To ensure a smooth maternity insurance claim settlement, you need to consider the following tips: 

• Plan terms: Remain acquainted with all the relevant terms and conditions of the chosen maternity insurance. Read the policy fine print to know all the relevant details and then make an informed decision. 
• Network hospitals: Try to seek hospitalisation under your insurer’s in-network coverage. This will keep the pregnancy and childbirth-related costs reasonable and ensure a cashless facility, too.  
• Prompt claims: Ensure you submit your relevant claims as early as possible. Any unnecessary delays here might eventually lead to claim rejection.  
• Follow-up: Once you have submitted your claim, ensure to keep following it up from time to time. This will keep your case within the loop and ensure faster settlement, provided all the rules and regulations have been followed. If you find any issue or glitch, inform your insurer immediately about your findings.  
• Writing: Try to document every communication with your insurer, avoiding verbal communication. These documents can be used as evidence in the case of any future disputes.  
• Waiting period: Ensure that you have already served the designated waiting period according to your policy before raising any claim settlement.  
• Incomplete documentation: Try to avoid incomplete documentation in all respects. Collect all the bills, prescriptions, reports, invoices, etc., issued during the phase to support your claim.  
• Exceeding the sum insured amount: Always monitor the optimum sum insured amount and try to follow it because, if this limit is exceeded, you have to settle the dues out of your pocket.  

Maximising the maternity insurance claim benefits 

Understanding the plan terms is the primary key to optimising your maternity claim benefits. However, you need to consider choosing the most befitting healthcare provider and plan your expenses well beforehand. By taking these proactive steps, you can optimise the maternity insurance claim benefits and enjoy optimum coverage considering the terms of your chosen plan: 

1. Network hospital: Try to seek treatment and admission in any network hospital to enjoy cashless benefits. 
2. Plan coverage: Understand the exact coverage extent of your chosen plan and consider all the inclusions and exclusions in detail to proceed accordingly. 
3. Waiting period: Consider completing the waiting period of your policy before any claim settlement. 
4. Organised documents: Organise all your relevant documents well in a convenient file and keep them handy and easily accessible.  

Documents needed for maternity insurance claim settlement 

Submitting relevant documents on time plays a crucial role in maternity insurance claim settlement. The list of documents that prove to be essential to ensure a smooth and hassle-free maternity claim settlement includes: 

1. Discharge summary: This is the detailed final report delivered from the hospital before discharge that outlines the delivery details, health status and the overall treatment procedure. 
2. Hospital bills: All the itemised bills for treatment, surgery, room rent details, etc. are required. 
3. Pre-post-natal reports: All the medical reports before and after delivery are needed. 
4. Policy papers: You need to submit a copy of your active maternity insurance plan.  
5. Identity proof: You need to submit your government-approved identity proof like an AADHAAR card, passport, PAN card, etc.