Maternity Expenses shall include (a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections) incurred during hospitalisation (b) expenses towards lawful medical termination of pregnancy during the policy period.
Maternity Expenses. We will cover Maternity Expenses up to limits for Maternity Sum insured specified in the Schedule for the delivery of a child and/ or Maternity Expenses related to a Medically Necessary and lawful termination of pregnancy up to maximum 2 deliveries or terminations during the lifetime of an Insured Person between the ages of 18 years to 45 years. You understand and agree that:
(a) Our maximum liability per delivery or termination is subject to the limits specified in the Schedule.
(b) The Insured Person should have been continuously covered under this Policy for at least 48 months before availing this Benefit, except in case of opting for ‘Reduction in maternity waiting’ where the limit will be relaxed to 24 months of waiting.
(c) The cover under this Benefit shall be restricted to two live children only.
(d) The payment towards any admitted claim under this Benefit for any complication arising out of or as a consequence of maternity or child birth will be restricted to limits specified in the Schedule however any restored amount will not be available for coverage under this section.
(e) Pre or post natal Maternity Expenses will be covered within the Maternity Sum Insured under this Benefit however; any Pre or Post – hospitalisation Expenses paid under Section II.2 and II.3, above will not be covered under this Benefit.
(f) Maternity Sum Insured available under Maternity Expenses will be in addition to Sum Insured.
(g) Applicable Deductible or Co-pay under the applicable plan shall also apply to this benefit. Any claim under this benefit shall not impact Cumulative Bonus.
(h) We will not cover the following expenses under Maternity Benefit:
i) Medical Expenses in respect of the harvesting and storage of stem cells when carried out as a preventive measure against possible future Illnesses.
ii) Medical Expenses for ectopic pregnancy. However, these expenses will be covered under the In- patient Hospitalisation under Section II.1. All Claims under this benefit can be made as per the process defined under Section VII 4 & 5.
Maternity Expenses. The policy provides automatic maternity cover upto 10% of the Sum Insured. The Company shall pay the Medical Expenses incurred as an inpatient for a delivery (including caesarean section) or lawful medical termination of pregnancy during the policy period limited to two deliveries or terminations or either, during the lifetime of the Insured Person. Cover under this section is not available to those insureds who already have two living children. This benefit is available only to the Insured or his spouse provided that this policy has been in force for a continuous period of minimum 12 months in respect of both the Insured and his/her spouse. However, miscarriage due to accident or abdominal operation for extra uterine pregnancy (ectopic pregnancy) which is proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner, if left untreated, is not part of maternity coverage and hence no waiting period would apply in such cases.
Maternity Expenses a) The Company will indemnify for the Medical Expenses incurred in respect of the Hospitalization of the Insured Member up to the Sum Insured for treatment taken in a Network Provider arising from pregnancy including Normal Delivery / Caesarean/ Miscarriage and / or abortion induced by accident or other medical emergency. Specific Conditions applicable to this Benefit:
i. Claims under this benefit are admissible only if the expenses are incurred in Network Provider for Normal Delivery / Caesarean/ Miscarriage and or abortion induced by accident or other medical emergency as an in-patient.
ii. Claims under this benefit are admissible only after the completion of waiting period of 9 months as specified in clause 3.1 (b) (Maternity wait period).
iii. The Company shall cover pre-natal and post-natal expenses under this benefit, provided that the condition necessitates treatment in a Network Provider and the Insured Member is hospitalized.
iv. Claim in respect of only first two living children will be considered in respect of any one insured member covered under the policy or any renewal thereof.
v. Congenital Diseases (internal & external) of new born child is covered under this Benefit.
b) Exclusions applicable to Benefit-2.
Maternity Expenses i. Expenses incurred in connection with the voluntary medical termination of pregnancy during the first 12 weeks from the date of conception shall not be admissible under this Benefit except induced by accident or other medical emergency to save the life of mother.
Maternity Expenses. Charges incurred due to pregnancy will be treated in the same manner as charges incurred due to any other condition.
Maternity Expenses. Expenses incurred due to pregnancy will be considered in the same manner as expenses incurred due to any other condition.
Maternity Expenses. Expenses incurred due to pregnancy will be considered in the same manner as expenses incurred due to any other condition.
Section III - Dental Benefit for employees and their eligible dependents
Maternity Expenses. Major Medical expenses incurred due to pregnancy will be considered in the same manner as expenses incurred due to any other condition. The Company will provide a Vision Care Plan for an employee and his covered dependents. When prescribed by a physician or an optometrist, the Plan will cover frames, lenses and the fitting or prescription glasses, including contact lenses, up to a total payment of $150.00 per family member in any two consecutive calendar years. If, while insured, you incur Covered Dental Expenses for yourself or for an Insured Dependent, you will be paid benefits as specified in the Schedule of Insurance, subject to the following provisions. "Calendar Year" means a dental expense period from January 1st to December 31st. "Co-Insurance" is the percentage of eligible expenses which will be reimbursed under this Plan. "Covered Dental Expenses" mean expenses incurred for Covered Dental Procedures listed herein, which are reasonable, necessary and customary and are performed, recommended or approved by a Dentist legally licensed to practice dentistry, excluding any charges in effect on the date the service is performed, which are in excess of the amount recommended in the Dental Association Fee Guide specified in the Schedule of Insurance herein. Where a Covered Dental Procedure does not appear in the prevailing Fee Guide, the amount of Covered Dental Expense for such procedure will be determined by the Insurance Carrier on a reasonable and customary basis.
Maternity Expenses. The routine expenses (doctor, examination, diagnosis) related to check-up examinations during pregnancy and expenses related to ailments caused by pregnancy and miscarriages will be paid in the scope of this coverage if the pregnancy occurs 3 months after the insured joins this Group Health Insurance.
