What is the waiting period for maternity benefits in group insurance?

Most group health insurance policies in India waive the maternity waiting period, offering coverage for normal and Caesarean delivery from Day 1 of the policy year. Individual retail policies typically apply a maternity waiting period of 9 months to 4 years. This is one of the meaningful advantages a group policy provides to employees over a comparable individual policy.

What is a maternity waiting period?

A maternity waiting period is the time between policy start and the date from which pregnancy-related expenses become claimable. In individual health insurance policies, this waiting period typically ranges from 9 months to 4 years, depending on the insurer and the specific product. Any maternity claim during the waiting period is not payable.

What waiting period applies under a group policy?

Most Indian group health policies waive the maternity waiting period entirely, meaning an employee can claim delivery expenses from Day 1 of enrolment. This waiver is negotiated between the employer and the insurer as part of the group underwriting arrangement, and reflects the risk-pooling logic of group cover: across a large workforce, the insurer has predictable maternity exposure and does not need a waiting period to manage adverse selection.

Are there any group policies that still apply a waiting period?

Yes, in specific structures:

• Very small employers: Policies for groups closer to the 7-employee minimum may retain a shortened waiting period (typically 9 months) to manage insurer risk on small pools.
• Voluntary top-up maternity riders: Where maternity is offered as a rider on top of a base policy without maternity, the rider itself may have a 9-month waiting period.
• Newly added dependants: A spouse added to the policy mid-year may face a shorter waiting period specifically for maternity, even if the employee has Day 1 cover.

What does a maternity benefit under a group policy actually cover?

A typical maternity benefit under a group policy covers:

• Delivery costs for normal and Caesarean delivery, up to a stated sub-limit (commonly Rs 50,000 to Rs 1 lakh).
• Pre-natal and post-natal expenses for a defined period (usually 30 to 60 days before and after delivery).
• Newborn baby cover from Day 1 for a stated period, often covering congenital conditions.

Cover typically applies to the first two children only, and expenses beyond the stated sub-limit are payable from the employee's pocket or the sum insured, depending on policy structure.

How does the group waiver compare with individual policy waiting periods?

Under IRDAI's Insurance Products Regulations, 2024, individual health insurance products cannot have PED waiting periods longer than 36 months, and maternity waiting periods are separately governed by product design. Group policies routinely waive maternity waiting entirely, giving employees who are family planning meaningful protection that would take years to build up in a retail policy.

Are there statutory obligations on maternity benefits?

The Code on Social Security, 2020, effective from 21 November 2025, consolidates the Maternity Benefit Act, 1961 and its 2017 amendments. It provides 26 weeks of paid maternity leave for the first two children (12 weeks for the third and beyond), for establishments with 10 or more employees, along with medical bonus and creche facility requirements for establishments with 50 or more employees. Group health insurance sits alongside these statutory benefits and covers medical treatment costs during and around delivery.

How Plum approaches this

Plum negotiates Day 1 maternity cover as a standard feature across group policies placed for eligible employers, since the waiting-period waiver is one of the most immediately noticeable benefits for young workforces. Across Plum's group book, claims NPS runs at 79 and cashless pre-authorisation for delivery claims clears in a median of 45 minutes. Plum places group cover from a minimum of 7 employees, working with partner insurers including ICICI Lombard, HDFC ERGO, Bajaj Allianz, Star Health, Niva Bupa, and Aditya Birla Health Insurance, and confirms the specific maternity sub-limits and newborn cover with each employer at proposal.

Frequently asked questions

Can an employee claim maternity in the first month of a new job?

Yes, if the group policy waives the maternity waiting period. Most Plum-managed policies allow this.

Is Caesarean delivery treated differently from normal delivery?

Both are covered under the maternity benefit, though the sub-limit may differ between them in some policies. Caesarean claims are usually higher because the treatment cost is higher.

Does the group policy cover complications of pregnancy?

Yes. Complications requiring hospitalisation are typically covered under the main sum insured, separately from the maternity sub-limit.

What happens if an employee changes employer mid-pregnancy?

Cover under the new employer's group policy applies from the date of enrolment, provided the policy has a Day 1 waiver. Continuity depends on the new employer's policy structure.

Does maternity cover apply to surrogacy?

Standard maternity benefits do not cover surrogacy expenses. Some larger employers add a separate surrogacy benefit through the insurer.

Are twins covered?

Yes. Delivery of twins is covered under the same maternity benefit, though the newborn cover may need to be extended to both children.