How to File a Maternity Insurance Claim

Updated: 09 Apr, 2025 • 0 • min read

Table of Contents

Step-by-Step Guide to Securing Your Benefits Without Stress

Pregnancy is a life-changing experience filled with excitement, anticipation, and responsibilities. Among the many preparations expectant mothers must handle, understanding how to file a maternity insurance claim is crucial. Whether you’re covered through employer-provided insurance, a private plan, or a government scheme, filing your claim correctly ensures you receive the financial support you're entitled to for prenatal, delivery, and postnatal care.

In this article, we’ll guide you step by step through the maternity claim process—helping you avoid common mistakes, understand required documents, and maximize your insurance benefits with ease.

Why Filing a Maternity Claim Matters

Healthcare during pregnancy and childbirth can be expensive. Maternity insurance helps cover the cost of:

Prenatal check-ups
Lab tests and ultrasounds
Delivery expenses (normal or C-section)
Hospital stays
Postnatal care for both mother and baby
Medications and follow-up treatments

Without a successful claim, you may have to bear these costs out of pocket. Filing a maternity insurance claim ensures you get reimbursed or receive cashless treatment, depending on your policy.

1. Understand Your Maternity Insurance Coverage

Before filing a claim, it’s essential to know exactly what your insurance covers. Maternity benefits vary widely across policies. Some plans include maternity coverage as a default, while others require an add-on or rider.

Key Features to Check:

Waiting Period: Most maternity policies have a waiting period of 9 to 36 months before benefits begin.
Sum Insured Limit: Maternity benefits often come with a capped limit (e.g., $3,000 for normal delivery, $5,000 for C-section).
Newborn Coverage: Many policies also cover the baby’s medical expenses for the first 90 days.
Cashless vs. Reimbursement: Some plans allow you to use cashless services at network hospitals, while others require you to pay first and claim reimbursement later.

2. Types of Maternity Insurance Claims

There are two main types of claims:

A. Cashless Claim

You do not pay the hospital bill upfront. The insurer directly settles the bill with the hospital.

When to Use:

If you're delivering in a network hospital (i.e., a hospital partnered with your insurer).

B. Reimbursement Claim

You pay for the treatment first, then submit the documents to the insurance company for reimbursement.

When to Use:

If the hospital is not part of the insurance network.
If you prefer a specific doctor or hospital not listed under your insurer’s partners.

3. Steps to File a Cashless Maternity Claim

Step 1: Choose a Network Hospital

Visit your insurer’s website or app to find hospitals that offer cashless maternity services.

Step 2: Pre-Authorization Request

Inform the hospital’s insurance desk about your intention to file a cashless claim. They will submit a pre-authorization form to your insurance company, ideally 3–5 days before your scheduled delivery.

Details Required:

Policy number
Expected date of delivery
Doctor’s recommendation or medical report
Hospital details

Step 3: Receive Approval

Once approved, you’ll receive confirmation. On the day of delivery, submit your insurance ID card and a government-issued ID. The insurer settles the bill directly.

Step 4: Post-Discharge Formalities

Ensure you collect the hospital’s discharge summary, final bill, and any other reports. These may be needed for record-keeping or in case of additional claims.

4. Steps to File a Reimbursement Maternity Claim

If you don’t use the cashless facility, follow these steps:

Step 1: Pay the Bills

Pay all hospital-related expenses yourself at the time of delivery and discharge.

Step 2: Collect Required Documents

Gather the necessary paperwork. Missing documents are one of the most common reasons for claim rejection.

Commonly Required Documents:

Original hospital bills and receipts
Discharge summary
Doctor’s prescription and admission note
Lab test reports
Ultrasound or scan reports
Pharmacy bills with prescriptions
Maternity claim form (signed by the hospital and insured)
Policy copy and insurance ID
Government-issued ID of the policyholder
Bank account details or canceled cheque (for payment)

Step 3: Submit the Claim

Send the documents to your insurance provider within the stipulated timeframe (usually 15–30 days post-discharge). You can submit claims:

Online (via email or insurer’s portal)
By post or in-person to the nearest branch

Step 4: Claim Assessment

The insurer will review your documents. If everything is in order, the approved amount will be reimbursed directly to your bank account.

5. Timeline and Deadlines

Cashless Claims:

Pre-authorization should be submitted 3–5 days before a planned delivery.
Emergency cases must notify the insurer within 24 hours of admission.

Reimbursement Claims:

Submit within 15–30 days of discharge.
Keep photocopies of all documents before submission.

Missing deadlines or documents can result in delays or denials.

6. Tips to Avoid Claim Rejection

Insurance claim rejections can be frustrating. Here’s how to improve your chances of approval:

Read your policy carefully: Know what’s included and excluded.
Inform the insurer early: Especially for scheduled deliveries.
Keep all receipts: Even minor ones like pharmacy bills.
Avoid non-covered services: Some policies don’t cover ambulance charges, special nursing, or deluxe rooms.
Check hospital category: Some plans cap room rent based on sum insured. Exceeding this may reduce your claim.
Maintain accurate records: Ensure names, dates, and policy numbers match across all documents.

7. What If Your Claim Is Denied?

If your maternity claim is rejected, don’t panic. You can appeal or clarify with your insurer.

Steps to Follow:

Ask for a written explanation of the denial.
Review your policy to check if the reason is valid.
Gather additional documents if required.
File a grievance with your insurer's grievance redressal officer.
Approach the insurance ombudsman if unsatisfied with the response.

Most claims are rejected due to missing documents or non-disclosure—both of which can be rectified.

8. Special Cases: C-Section, Complications, and Preterm Birth

Your insurer may offer extended benefits if:

You undergo a Cesarean section, which typically has a higher claim limit.
You or the baby experience complications, such as preeclampsia or premature delivery.
Your baby requires NICU care after birth.

Ensure you notify your insurer immediately and provide detailed medical reports for these special claims. Some policies also offer complication riders that cover high-risk pregnancies.

9. How to Maximize Your Maternity Insurance Benefits

✅ Plan Early

If you’re planning to start a family, purchase a maternity plan well in advance to fulfill the waiting period.

✅ Choose a Higher Sum Insured

Medical costs are rising. A higher sum insured offers better protection, especially for C-section deliveries or complications.

✅ Compare Plans

Use insurance comparison platforms to evaluate maternity coverage, waiting periods, limits, and network hospitals.

✅ Combine with Other Benefits

Use Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) alongside insurance for tax savings and out-of-pocket cost coverage.

10. Frequently Asked Questions (FAQs)

Q1: Can I buy maternity insurance while pregnant?

Most insurers do not offer maternity coverage to women who are already pregnant. Always plan and purchase before conception.

Q2: Are all pregnancy-related expenses covered?

No. Expenses like cosmetic procedures, dietary supplements, and personal comfort items (TV, luxury rooms) are often excluded.

Q3: Does my insurance cover both normal and C-section delivery?

Yes, but payout limits may vary. Check your policy’s sub-limits for both types of delivery.

Q4: Is newborn care covered automatically?

Some policies include care for the newborn (up to 90 days) under the mother’s plan, but many require a separate child policy.

Q5: What if my delivery happens at a non-network hospital?

You’ll need to file a reimbursement claim and submit all original documents for approval.

Conclusion: Be Prepared, Be Protected

Filing a maternity insurance claim doesn't have to be a stressful process. With the right preparation, a good understanding of your policy, and attention to deadlines, you can navigate the process smoothly. Whether you're opting for cashless hospitalization or reimbursement, knowing the steps ensures that your medical costs are handled efficiently—letting you focus on what truly matters: welcoming your baby into the world.

Information About Pregnancy