What Is Maternity Insurance and Leave in India?

Maternity insurance will assist in managing the costs of eligible pregnancy, delivery, and newborn care. Maternity leave allows eligible women on the job to be absent from work using maternity benefits. It is important to know about the waiting period, eligibility, documentation and the limit of the cover before getting pregnant.

Quick reads

• Maternity insurance and maternity leave are different. Insurance helps cover eligible healthcare expenses, while maternity leave provides time away from work.
• Maternity benefits often come with a specific waiting period, so planning ahead is important.
• Eligible women can generally receive up to 26 weeks of maternity benefit, subject to applicable conditions.
• Medical certificates, leave applications, policy documents, and hospital records may be required for leave or insurance claims.
• A comprehensive health plan can provide broader protection for healthcare needs before, during and after pregnancy.

The insurance for maternity includes expenses which are eligible for payment, while maternity leave is for earning money while on leave to give birth to a child. The maternity benefit scheme has been included in India in the maternity benefit scheme under the Code of Social Security, 2020, where a woman who has two children or fewer is entitled to 26 weeks of maternity benefit.

If you plan to have a family, if you are pregnant already, or if you simply want to know about what kind of benefits you have as a working woman, it makes life much easier to know about maternity & pregnancy insurance & leave. It also helps you plan for medical expenses, leave paperwork and the months that follow childbirth without unpleasant financial surprises.

Maternity Insurance and Maternity Leave are not the Same

It is easy to assume that maternity insurance and maternity leave are part of one benefit. They are not.

Maternity insurance is a health insurance benefit that may cover eligible pregnancy, delivery and newborn-related medical expenses, subject to the policy's terms, limits and waiting period. Maternity leave, on the other hand, is an employment benefit. It gives an eligible woman paid time away from work before and after childbirth.

Think of it this way:

• Maternity insurance helps with the cost of medical care.
• Maternity leave helps with time away from work and income continuity.
• Your employer's group health policy may offer maternity cover separately from your statutory leave entitlement.
• The exact insurance benefits depend on the policy wording, while maternity leave depends on the applicable labour law and employment circumstances.

However, the exact benefits offered by the insurance will be dependent on the terms of the contract, while the maternity leave will be determined by the existing labour law. It is crucial to note that having one does not necessarily mean you have the other.

What is Maternity Insurance?

Maternity insurance is generally a health insurance benefit designed to cover specified expenses related to pregnancy and childbirth. Depending on the policy, it may cover normal delivery, caesarean delivery, pregnancy-related hospitalisation, pre- and post-natal expenses and newborn care.

Maternity cover is hardly available in such a way that you can purchase today and utilise right away. It involves waiting periods which may differ from one insurance plan to another. According to IRDAI, “health insurance waiting periods may apply for certain diseases/treatments with the maximum waiting period being 36 months.” Maternity benefits can have their own specific waiting period under a policy.

This is why buying maternity cover early can be important. If you wait until you are already pregnant, a retail health insurance policy may not cover the current pregnancy because the maternity-specific waiting period has not been completed.

What is Maternity Leave in India?

Maternity leave is the paid leave provided to eligible women employees in connection with childbirth. The provision of maternity benefits in the Code on Social Security, 2020 entitles the employee to the benefit of maternity leave, provided she works for 80 days in the preceding twelve months before her expected delivery.

Women having fewer than two surviving children are entitled to twenty-six weeks of maternity leave, out of which not more than eight weeks can precede the expected date of delivery. Women having two or more surviving children are entitled to twelve weeks of maternity leave, out of which not more than six weeks can precede the expected date of delivery.

Other instances in this regard have also been provided.

How to Apply for Maternity Leave?

Application for maternity leave generally falls under the purview of Human Resources, but it’s best not to do it at the last minute. Your company might have its own internal policy about how far in advance and with what documentation you need to give them.

It is best done as follows:

1. Verify your eligibility according to your company's maternity leave policy.
2. Advise your manager or HR accordingly.
3. Submit a formal leave application, mentioning your expected delivery date and proposed leave period.
4. Attach supporting documents, if required, such as a medical certificate or expected delivery date certificate.
5. Keep the approval and correspondence safely, preferably through email or another written channel.
6. Confirm your return-to-work date and any transition arrangements before beginning your leave.

Keeping a written record is particularly useful if there is any confusion later about the duration or payment of your leave.

What Documents May be Needed?

The exact requirements vary by employer, but you may commonly be asked for:

• Maternity leave application
• Medical certificate mentioning the expected date of delivery
• Pregnancy or antenatal records, where required
• Employee identification or HR details
• Hospital or doctor's documents
• Birth certificate after delivery, where required by the employer

For insurance claims, the documentation can be different. Depending on whether you use cashless treatment or reimbursement, the insurer may ask for the health card, policy details, hospital bills, discharge summary, medical reports and other claim-related documents.

It may be wise to enquire from your insurance company the exact list of documents required before hospitalisation. Given that you are dealing with pregnancy and the birth of a baby, the last thing you need is extra paperwork.

How to Claim Maternity Insurance Benefits?

The process depends on whether your treatment is cashless or reimbursement-based.

For Cashless Treatment

If you choose a network hospital, you generally need to:

• Inform the insurer or claims administrator about the planned hospitalisation.
• Provide your policy and identification details.
• Ask the hospital to initiate the pre-authorisation process.
• Wait for the insurer's approval, subject to policy terms.
• Complete the hospital's discharge formalities after treatment.

For Reimbursement

If the treatment is eligible but you pay the hospital yourself, you can generally submit a reimbursement claim with the required documents after discharge.

These processes can vary between insurers, so check the policy's claims procedure rather than relying on assumptions.

What Should You Check Before Buying Maternity Insurance?

Pregnancy can already bring enough uncertainty. Your insurance should not add to it. Before buying a policy, look closely at:

Maternity Waiting Period

This is one of the most important factors. A plan may have a waiting period before maternity expenses become claimable. Buying a policy shortly before planning a pregnancy may therefore not provide immediate protection.

Maternity Sub-limit

A policy may cover maternity expenses but restrict the amount payable for normal or caesarean delivery. Compare this limit with the likely cost of treatment in your city.

Coverage for Complications

Ask whether complications arising during pregnancy or childbirth are covered and whether separate limits or exclusions apply.

Newborn Coverage

Check when the newborn becomes covered, for how long and what medical conditions or treatments are included.

Pre- and Post-natal Expenses

Some policies cover specified expenses before and after hospitalisation, while others may have restrictions. Read the policy wording carefully.

Network Hospitals

A wide network can make cashless treatment more convenient, particularly when you are close to your delivery date.

Exclusions and Conditions

Do not focus only on the benefits listed in the brochure. Understand what is excluded, the claim limits, waiting periods and documentation requirements.

Can Maternity Insurance Cover an Existing Pregnancy?

Usually, you should not assume that it will. Individual maternity insurance policies commonly have a maternity-specific waiting period. If you are already pregnant when you purchase a policy, the current pregnancy may not qualify for maternity benefits because the waiting period has not been completed. Some employer-provided group health insurance policies can have different terms, including maternity coverage from the start, so it is important to check your employer's policy.

For example, Niva Bupa states that maternity benefits and waiting periods vary across its products, with some products offering shorter waiting periods than others. Its maternity insurance information also highlights coverage for delivery and certain newborn-related expenses under applicable plans.

The important takeaway is simple: never buy a policy based only on the words "maternity cover". Check the exact product terms.

Concluding Thoughts

Planning for a baby involves much more than simply getting ready with a nursery and hospital. It also requires being prepared for the expenses and unexpected events that will occur in your financial life as well.

Maternity insurance and maternity leave solve different parts of that equation. Understanding your insurance waiting period, maternity limits and claim process can prevent last-minute financial stress, while knowing your maternity leave rights can help you plan your time away from work with greater confidence.

Whether you are comparing policies today or simply planning ahead, providers such as Niva Bupa offer health insurance policy options with maternity benefits under select products. The important part is to compare the actual coverage, waiting periods, limits and exclusions rather than choosing a policy based on the name of the benefit alone.

A little planning before pregnancy can go a long way towards making one of life's biggest transitions feel financially more manageable.

FAQs

Is maternity insurance included in every health insurance policy?

No. Maternity coverage is not necessarily part of all health insurance policies. It is best to make sure that you understand the policy details when you purchase an insurance product if you need maternity coverage.

How many weeks of maternity leave are available in India?

Women with less than two surviving children can be entitled to 26 weeks' maternity benefit, of which eight weeks may be taken before the delivery. For a woman having two or more living children, she can have 12 weeks' maternity leave.

Can I buy maternity insurance after becoming pregnant?

It is possible to purchase a health insurance policy; however, the present pregnancy might not be covered due to the remaining maternity waiting period. Group insurance provided by an employer might have other conditions.

Does maternity insurance cover both normal and caesarean delivery?

Most maternity benefit plans cover both normal deliveries and caesarean deliveries, but the benefits for each delivery type might be capped separately. Always review the policy schedule and wording for such plans.

Is maternity leave paid in India?

Eligible women covered by the applicable maternity benefit provisions are entitled to maternity benefit during the prescribed leave period, subject to the eligibility requirements. The Code on Social Security, 2020 provides for payment based on the woman's average daily wage.