Reliance Health Gain Health Insurance Plan
Taking care of one's health must be given the utmost priority. Hence, it is a smart decision to invest in an insurance plan for health that covers one's expenditures during an emergency or demanding situations.
Reliance Insurance has various health insurance policies and provides comprehensive plans which will cover almost all the policyholders' health expenses. The plan provides pre and post-hospitalization lifelong, medical cover, reimbursable various health check-ups, and lifelong renewal benefits to ensure that the policyholder gets all benefits under a single plan.
*PaisaWiki does not endorse, rate, or recommend any particular insurer or insurance product offered by an insurer.
What is Reliance Health Gain Health Insurance Plan?
Reliance Health Gain Health Insurance Plan is a health insurance policy that covers an individual and the whole family against hospitalization due to illnesses, accidents, or other medical-related treatment expenses. The policy renews the sum insured if the total amount is exhausted during a particular policy term.
Reliance Health Gain health insurance policy has two comprehensive options: Plan A and Plan B. The two policies are identical except in some features like the amount insured for a particular expense related to the plan. This policy can be chosen on an individual basis or as a family floater policy too.
Features and Benefits Reliance Health Gain Health Insurance Plan
Features of Reliance Health Gain health insurance policy
- The plan reinstates the basic sum insured if all the sum insured is exhausted.
- The plan has a free auto-extension option in which, the policy renews automatically for 1 year if the policyholder is detected with a critical illness.
- The plan covers extended family members of the policyholder.
- The plan provides lifelong renewals to policyholders in the health insurance plan.
- The plan provides a 5% rebate for a girl child or a single woman.
- The plan has a comprehensive cover up to a maximum of Rs 18 lakh.
- For every no-claim year or claim free year, there are special increments offered in the base plan of up to 33.33%, which is subject to a maximum of 100% in the sum.
- The plan covers up to a maximum of 6 people individually, including 2 adults and 4 children in Plan A.
- If the policyholder does not claim in 4 continuous years, the base sum insured is doubled in the policy.
- On the late issuance of the policy for more than 10 days after buying, the policyholder gets an additional sum assured of Rs 10,000 for Plan A.
- Under Option B, if the policyholder is detected with certain specified illnesses within the policy tenure, then the policy can be renewed for free for a full year.
- The plan provides rebates between 10% and 50% on different medicines and diagnosis at certain outlets.
- The plan provides consultation to various specialists and physicians with the person insured on the phone.
- On late issuance of more than 10 days after buying the policy, the policyholder gets an additional sum insured of Rs 20,000 for Plan B.
- The premium is affordable as compared to health insurance policies.
Benefits of Reliance Health Gain health insurance policy
- The plan covers a pre-hospitalization charge on all medical expenses for a period up to a maximum of 60 days and a post-hospitalization charge for a period of up to 60 days to provide coverage against medical expenses.
- The plan offers in-patient treatment on various illnesses if the person insured is hospitalized for greater than 24 hours due to a particular treatment.
- The plan also covers daycare treatments if the policyholder is hospitalized for less than 24 hours for a particular treatment.
- The plan provides domestic road ambulance facilities to the nearest hospital in cases like life-threatening conditions, possibly due to any illness or accident. This plan provides charges up to a maximum of Rs 1,500 under Option A and up to a maximum of Rs 3,000 under Option B.
- The policy covers for organ donor’s expenditures up to a maximum of 50% on the basic sum insured or up to Rs.5 lakh whichever is higher.
- It provides domiciliary hospitalization in case the treatment continues for a minimum of 3 days.
- If the person insured exhausts their basic sum insured and the cumulative bonuses in a particular policy year. If he requires hospitalization for any unrelated or related disease, the policy provider company refills the amount without any extra cost.
- The plan offers a cumulative bonus of 33.33% on the sum insured without any cost if the person insured does not make any claim, i.e., a claim-free year in a particular policy term.
- For policyholders who don't make any claim in continuous 4 policy years, Reliance Health Insurance company provides a cumulative bonus equal to the sum assured. One can use that option in their 5th policy year to double the sum assured.
- The policy provides an accidental death cover rider of Rs 1 lakh under Plan B for every no-claim year i.e., claim free year with the policy provider company.
- The policy is eligible for tax benefits, which can be redeemed under Section 80C and 10(10D) of the Income Tax Act 1961, on regular payment of premiums. *Tax benefit is subject to changes in tax laws.
- The plan provides more benefits in comparison with other health plans.
Inclusions of the Reliance Health Gain Health Insurance Plan
The inclusions of Reliance Health Gain health insurance Plan are:
- The plan covers ambulance facilities for up to a maximum of Rs 1,500 under Plan A and Rs 3,000 under Plan B option.
- Medical expenses due to organ donation can be covered up to a maximum of 50% on the sum insured or up to a maximum of Rs 5 lakh, whichever is higher.
- The plan covers medical expenditures for domiciliary treatment.
- There is a waiting period of 3 years for different pre-existing illnesses. During the waiting period, the policy will cover those specific illnesses after 3 years.
- There are specific diseases covered after a policy period of 2 years.
- The policy covers accidental injuries within the first 30 days from the commencement of the policy.
- The policy covers for a room rent for a single occupancy room.
- The plan covers pre-hospitalization charges, which are covered up to a maximum of 60 days before hospitalization.
- The plan covers different injuries or illnesses for a hospitalization greater than 24 hours.
- The plan also covers daycare treatments for specific treatments when hospitalization is not necessary.
- The plan covers post-hospitalization charges, which are covered up to a maximum of 60 days before hospitalization.
Exclusions of the Reliance Health Gain health insurance Plan
The policy doesn’t cover the following:
- Congenital diseases Cosmetic, aesthetic treatment
- Cost of contact lenses, spectacles, and hearing aids
- Dental treatment or surgery
- Diseases from birth
- Diseases such as HIV or AIDS or Sexually Transmitted Disease
- Intentional self-injury or injury under the influence of alcohol, drugs or criminal acts
- Maternity related or fertility-related conditions
- Outside India or Robotic or Stem Cells
- Treatment of mental illness
- War or nuclear or chemical or biological injuries
*This list is only indicative and not exhaustive. For the complete list, one can refer to the policy document
Eligibility Conditions of Reliance Health Gain Health Insurance Plan
The eligibility of Reliance Health Gain health insurance Plan are:
- Minimum entry age of the policyholder of an adult - 18 years
- Maximum entry age of the policyholder of an adult - No limit
- Minimum entry age of the policyholder of a child - 91 days
- Maximum entry age of the policyholder of a child - 21 years
- For children coverage between 91 days and 4 years, at least one member must be above 21 years of age.
- Plan types - Individual basis or Family floater health basic health insurance plan
- Policy Tenure Options - 1 year or 2 years
- Renewability of the policy - Lifelong
- Sum Insured for both plans.
- Plan A: Rs 3 lakh, Rs 6 lakh or Rs 9 lakh
- Plan B: Rs 12 lakh, Rs 15 lakh or Rs 18 lakh
*The above information is subject to change as per the norms of the insurance provider.
Claim Process for the Reliance Health Gain Health Insurance Plan
The policy can be claimed for availing both cashless and reimbursement benefits:
Cashless Claim Process
- As far as initiating a cashless claim process is concerned, it is mandatory to inform the concerned policy provider company 7 days before any type of hospitalization for undergoing any type of surgery (if it is preplanned). On the other hand, in case of emergency hospitalization, the policyholder must inform the company providing insurance within 24hrs of hospitalization.
- On admission to the network hospital, if the policyholder needs to be admitted, all necessary documents must be shown at the helpdesk, i.e., policyholder's health card provided by the insurance company along with ID proof and policy document should be shown for cashless treatment.
- The policyholder needs to fill a form for claim giving the reason for hospitalization. After the claim form is filled and uploaded with all other necessary documents, the policyholder is supposed to wait for the insurance provider company's approval on it.
- Generally, insurance companies notify the policyholder within 5 to 9 hours about the claim's rejection or approval. Although the duration taken may vary from company to company.
- When the person insured gets released from the hospital, all original documents like bills and receipts must be left at the hospital help desk. But care should be taken to pay the amount at the counter, which is not covered by the insurance provider.
If all the procedures mentioned above are taken care of, the insurance provider will pay the remaining outstanding bill.
Reimbursement Claim Process
- If the treatment needed by the person insured is not being done at any of the network hospitals, the policyholder has to go in for reimbursement. Under this process, the insured can be admitted to any hospital for the required treatment. But one should notify the insurance providing company in advance. As far as emergency or accidental hospitalization is concerned, the insurance providing company must be intimated within 24hours of hospitalization.
- After the completion of surgery and discharge of the insured, it should be ensured that all original medical receipts and bills, prescriptions, discharge sheets, and any other remaining medical bills are collected, and the amount due to hospital for hospitalization and surgery undergone are paid by the insured.
- A claim form is to be filled, and the insurer has to be informed about the claim initiation. It should be ensured that all necessary documents, as requested by the insurance provider, are included for the claim. The documents to be submitted by the policyholder are medical prescriptions, bills, all receipts and invoices for availing the claim.
- When all required documents are uploaded, the policy provider company will verify and check them. After a thorough examination, it will either reject or accept and approve the claim. In some cases, the policy provider company can ask the policyholder to submit more documents as required for acceptance of the claim.
- After thorough scrutiny of submitted documents in a fixed period, the insurance providing company will notify the policyholder about rejection or approval through SMS and registered email address.
If the claim amount is accepted by the insurance providing company, hospital bills will be processed by the insurer, and the money will be transferred to the policyholder's bank account through NEFT.
Documents Required for the Claim Process
The documents required for claim submission are:
- A medical report
- First consultation letter
- FIR copy of the accident
- Indoor case paper
- Hospital bill
How to Buy the Reliance Health Gain Health Insurance Plan?
Below is mentioned the process to purchase the plan
- For buying of the said plan, the official website of paisawiki.com (paisawiki.com ) should be visited.
- The policy to be bought should be selected, and the 'Buy Now' option should be chosen.
- On the page that follows, the phone number is to be confirmed & email address should be provided using an OTP option by the policyholder.
- After filling in the above details, the person to be insured can compare this plan with any other health insurance plans online, and the 'continue' option has to be clicked.
- All policy-related personal details like the name of the person to be insured, age and medical details, etc. are to be filled. The duration of the required policy and the sum insured, etc. should be chosen from the menu and entered.
- The person to be insured can add riders for availing greater coverage. Then the 'proceed' option is to be selected.
- Extra details or any other information asked are to be added.
- Then the KYC document of the policyholder is to be uploaded if asked.
- All the terms & conditions of the plan are to be agreed upon by clicking the agree button.
- Add bank details to pay the premium.
On successful submission of the form and payment, the person insured will get the policy documents.
Or the policy can be bought offline by visiting the branch office of the insurer and completing the paperwork there.
Documents Required for Buying the Reliance Health Gain health insurance Plan
To apply Reliance Health Gain health insurance Plan, the eligibility conditions are:-
- Colored photograph
- KYC: Birth Certificate, School Leaving Document or College Leaving Certificate, Voter Card, Permanent Account Number Card, Passport, Aadhar Card, Driving License
Renewal Process of Reliance Health Gain Health Insurance Plan
Renewal process of the policy is as follows:
- Visit the paisawiki.com website mentioned above.
- Then the user ID & password are to be filled in.
- Then "the policy renewal" option is to be selected.
- Herein the policy number is to be filled & the continue tab to be clicked.
- Then all the policy details like mobile number, policy tenure, email id, etc. need to be filled.
- Now the "renew plan" option needs to be clicked.
- Here the policyholder can add or remove any other family members to be insured and riders too.
- If one is adding family members, then their necessary details need to be filled & if any document is asked to be uploaded, then it should be done.
- After adding riders/new members, the new premium should be calculated by using the health premium calculator.
- In the end, the person insured needs to click "agree to the new policy terms & conditions" and then make the payment of renewal premium by adding details of the bank.
Once the payment of the renewal premium is made, the policy is renewed. The new policy document will be sent to the e-mail id of the insured.
Ans: Yes, it is available.
Ans: The wellness program offers discounts from chemist stores, passes to luxury spas, health helpline, etc.
Ans: There is no exit age for the plan. There is life renewability available with the plan.
Ans: The waiting period is 18 months.
Ans: There is a co-payment of 20%.
Written By: Paisawiki - Updated: 09 April 2021