Urgent!! Son Hospitalised During Matenity Leave, Bajaj Alliance Deny For Reimbursement - CiteHR
Industrial Relations And Labour Laws
Korgaonkar K A
Asst Manager - Hr
+3 Others

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Dear All,
When I was on maternity leave, after delivery, I had to hospitalize my son from 7th to 11th December, 2012 (5 days )when he was 5 months of age.
Post maternity leave, I resumed on duty on 19th December, 2012 and I added my sons name in the policy for medicalim from Bajaj alliance on 19th itself.
Now, the insuring company is denying to give reimbursement for hospitalization saying that my sons name was added after the hospitalisation i.e. on 19th dec.
My query is,as I was on maternity leave till 18th Dec, I could not inform for adding my sons name in mediclaim policy. Now, how can I get the reimbursement for hospitalization?
Pl. share your views.

Dear Seniors!! So many views but, not a single reply. Please help me in getting reimbursement. We female employees cant inform the company immediately after delivery.
There was a negligence on your part, I must say. It is your duty to inform the HR of your delivery at least by email. This age is far far better than the past and the communication facilities are so advanced that you cannot say that you could not do it. For the HR people also communication of your delivery is very important that they can even hold your maternity salary for want of this communication. This is because maternity leave of 84 days is applicable only in the case of delivery and had it been otherwise, they could restrict it to 6 weeks.
I am not sure about what the formalities are regarding the communication to the mediclaim service providers but it should be interpreted that they can not enroll it antedated. But if the service providers are in good terms they should do it for the benefit of the claimant and continuance of business with the establishment you are working.
I hope some body who deals with such cases may be able to post a proper reply. Please post it.

Hai_nitu ji,
In my view, the insurance company is justifying denial of your claim. When there is no contract between you and the insurance company to insure your son for mediclaim, on what ground the insurance company will pass your claim?
You have taken a stand that you could not enrolled the name of your son in the mediclaim policy since you were on maternity leave and you resumed your duty on expiry of maternity leave after the hospitalization of your son. This stand is not sustainable.
Even the insurance company requires intimation of hospitalization within stipulated time.
Enrollment the name of your son in mediclaim policy has no concern with your maternity leave.

Dear Nitu,
As per my knowledge the mediclaim company is right on the part for not reimbursing you for the hospitalization expenses of your son as he is not under the insurance coverage at the time of treatment.
However, you can check from your HR Department the terms of contract. Usually the mediclaim company specify the time period within which the new addition (new born baby after birth) has to be added.
If the liaison is good from your end you may have some chances of reimbursement because usually the claim bills are to be submitted within 30-45 days from the date of dischare from hospital. This would be possible only incase the mediclaim company would be able to enroll your son in the coverage list w.e.f
01st Dec'12.
Lets wait for the comments from seniors of Cite HR.
Have a great day ahead.!
Anshika Sharma

You will have to check the terms and conditions agreement of your Company with the Insurance providers.
Generally the agreement provides for the insurance coverage of the new born baby from day 1, provided you have to intimate the insurance providers, of the birth, within a specified time frame (normally it is 15 days to 30 days from birth, as agreed in the agreement).
In your case you can write to your HR department and the insurance service providers, a letter stating the reason for the delay and request them to reimburse the claim.
In case you have third party agents, please write to them the reason for delay and request for reimbursement. They have good rapport with the insurance providers and they can help a lot.

Yes. The insurance company has full right to deny the claim as all insurance companies have a time limit of 3-6 months after child birth within which you need to inform the insurance company company about the child birth in order to get insurance cover for the child.
The only option is that if your company HR has a very good relationship with the insurance company, then insurance company could agree to process the claim.
If the insurance company is not convinced then there is not other option but to pay the expenses all by yourself. Do ensure to get your son covered by the medical insurance immediately to avoid future issues.
All the best.

Dear Nitu :
The mandatory fact for each Insurance claim process is that the individual should be enrolled during the period for which the claim has been made. If the individual is not enrolled then there is no possibility of the Insurance provider settling the claim. The only bleak possibility could be if your Company HR has good relations with the Insurance provider and can get it done as a rare exception. Again this is driven by the facts that your company is given a high volume of business plus the claims history is not very high etc.
Suggest meet your HR rep and convince them to convince the Insurance provide to treat your case as a rare exception.
Hope this info helps.
- Gia

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