Maternity claim rejected or cut?
Maternity cover is an optional benefit in many Indian health policies, so the answer usually sits in your own policy wording. Here is what to check before you accept a rejection.
Your policy decides
The IRDAI rules we rely on don’t set a standard maternity benefit. Whether delivery, complications and newborn care are covered, after what waiting period and up to what limit, is set by your policy wording or add-on. Group policies from an employer often have their own maternity terms, so read the group policy or your certificate of insurance.
What to check
- Is maternity in your plan at all, either in the base policy or as an add-on?
- What waiting period applies, and from when is it counted? Ask the insurer to show how it counted any earlier years of cover with it or a previous insurer.
- Is there a sub-limit for normal or caesarean delivery? Sub-limits must be clearly stated in the policy.
- Are pregnancy complications or the newborn covered separately?
Rules that still apply
- A rejection or partial payment must refer to the specific clause it relies on.
- No claim can be rejected or closed only because documents are missing or the claim was intimated late.
- Reimbursement claims must be settled within 15 days of submission.
What to do
- Get the full policy wording or group policy terms, and the maternity section and schedule.
- Compare the insurer’s reason with the wording, line by line.
- Write to the Grievance Redressal Officer with what you found, then go to the Insurance Ombudsman if needed.