Recent reports have revealed a surge in maternity health insurance claim rejections due to a lesser-known clause — the two-child rule. While maternity cover is designed to support women during pregnancy and childbirth, several insurers restrict benefits beyond the second delivery. This rule, embedded in policy fine print, has caught many families off guard, raising questions about fairness and transparency in health coverage for growing households.
Understanding the two-child clause
Many maternity health insurance policies in India include a condition that limits coverage to the first two childbirths. This means that if a policyholder or their spouse has already claimed maternity benefits twice, the insurer is not obliged to pay for subsequent deliveries. The clause is justified as a cost-control measure — maternity-related claims are among the most frequent and expensive for insurers, often including pre- and post-natal care, hospitalisation, and newborn expenses.
However, this restriction is not always clearly communicated at the time of policy purchase. Policyholders often discover it only after submitting a claim for a third child, resulting in rejection despite years of consistent premium payment.
Why insurers enforce the limit
Insurers argue that the two-child cap helps keep maternity coverage affordable and sustainable. Frequent or multiple childbirth claims significantly increase costs for health insurers, particularly under family floater plans. By restricting claims to two deliveries, companies can maintain balanced premium pricing for all policyholders.
Additionally, maternity health insurance is often bundled within comprehensive health insurance plans as an add-on benefit. These packages typically treat maternity as a one-time or limited-use feature rather than recurring coverage.
Impact on families
The two-child rule disproportionately affects families who have unplanned pregnancies, adopt flexible family planning, or face medical complications requiring multiple deliveries. In such cases, even if the policyholder has paid premiums for several years, insurers may reject the third claim citing policy terms.
The issue becomes more complex when families change insurers mid-policy. Some expect a reset of benefits with a new insurer, only to find that the new plan still adheres to the same two-child restriction. This has led to frustration among parents who view the clause as inconsistent with modern family choices and realities.
Awareness gap in policy documents
One of the main reasons behind the controversy is the lack of clarity in policy communication. While the two-child rule is mentioned in the exclusions section, it is often buried among dense policy language. Customers frequently overlook it during purchase or renewal.
Unlike waiting periods or sum-insured details, which are prominently advertised, family-size restrictions are rarely discussed by agents or highlighted in marketing material. This lack of visibility has led many families to believe that maternity benefits continue for every childbirth.
Precedents and claim disputes
Insurance grievance forums have seen a steady rise in disputes over maternity claim denials. In several cases, families argued that they were unaware of the rule or that it was not explained during policy renewal. Although regulators encourage insurers to simplify policy language, the rule remains legally valid as long as it appears in the policy terms.
Most insurers process only two maternity claims — regardless of whether they occurred under the same plan or across different insurers — unless the policy specifically allows more.
Link to population and cost control policies
Some experts point out that the two-child clause indirectly aligns with broader public policy objectives related to population control. While not a government mandate, the rule is consistent with industry efforts to manage long-term cost exposure.
Given that maternity benefits are a non-emergency, high-frequency claim category, insurers treat them differently from unpredictable hospitalisation expenses such as accidents or critical illnesses. This approach allows companies to keep maternity health insurance premiums reasonable for the wider customer base.
Exceptions and evolving trends
A few insurers have begun offering flexible maternity coverage that does not impose a hard limit on the number of claims but instead caps total maternity benefits per policy term. For instance, instead of restricting the number of deliveries, the policy may define an overall maternity expense ceiling.
Such products are gaining popularity among younger urban families who prefer greater autonomy in family planning. However, these plans typically come at a higher premium and often require longer waiting periods.
Importance of reading the fine print
Families planning to expand should carefully read maternity clauses within their health insurance. Checking terms related to claim limits, waiting periods, and newborn coverage can prevent confusion later. Some comprehensive family plans now explicitly state their two-child restrictions in summary documents, making it easier to identify limitations.
Before renewing or porting a policy, buyers should ask insurers directly whether maternity coverage will apply for additional children and under what circumstances.
Regulatory and consumer perspectives
The Insurance Regulatory and Development Authority of India (IRDAI) has encouraged insurers to simplify wording and improve disclosure in policy documents. While it has not intervened directly in the two-child rule, it requires insurers to ensure that customers are fully informed of exclusions before purchase. Consumer advocacy groups continue to push for greater flexibility, arguing that limiting maternity coverage contradicts the spirit of comprehensive healthcare access.
Conclusion
The ongoing debate over the two-child rule exposes a gap between consumer expectations and policy design in maternity health insurance. Although insurers defend the restriction as necessary for cost control, the lack of clear communication has led to confusion and resentment among policyholders.
As families evolve and reproductive choices become more individualised, health insurance products may need to adapt with clearer, more inclusive maternity benefits. Until then, understanding policy exclusions and seeking written clarification before relying on coverage remain the only ways to avoid unexpected claim denials.
