Reliance Mediclaim insurance

Reliance mediclaim health insurance overview

• Key features of Reliance health insurance

  • Room Rent : No Room Rent Restrictions across all plans
  • Co-pay : NIL co-pay for all treatment
  • Restoration : Upto 100% of Base SI per year under certain plans

  1. Family floater option.
  2. Coverage of Pre-Existing Diseases after 2nd / 4th year of renewal.
  3. Pre and Post-hospitalization.
  4. No Capping/ sub limits.
  5. Wider Sum Insured options.
  6. Up gradation of Plan - Allowed subject to No Claim Cases & subject to U/w approval.
  7. Addition of member-Mid Term - Allowed for new born baby and new wed spouse.
  8. Change in Plan with Increase / decrease in SI - Allowed subject to No Claim Cases & subject to U/w approval.
  9. No Copayment.
  10. No room rent or ICU cost restriction.
  11. Cashless Facility.
  12. Policy without Medical test till 45 yrs for clean medical proposals.
  13. Renewal Reward - No Claim Bonus.
  14. Income Tax Benefits.
  15. Reimbursement of Cost of Health Check up after 4 claim free years.
  16. Extended coverage till 75 years in the case of Renewals.
  17. Maximum entry age - 65 years.
  18. 5% discount for every claim free year on renewal premium up to maximum of 20%.
  19. Choice of TPA at Renewal.
  20. No deductions in Non Network hospitalizations.

  Basic features

  • Hospitalisation Expenses. Covers hospitalisation expenses incurred as an in-patient in a Hospital which will include.
    • Room, Boarding and Operation Theatre charges.
    • Fees of Surgeon, Anesthetist, Nurses, Specialists.
    • The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs etc
  • Day-Care treatment Due to advancement of technology, hospitalisation expenses for certain treatments / diseases like the following are also covered, when he/she is admitted in the hospital and even though the hospitalisation is for less than 24 hours
    • Dialysis
    • Chemotherapy
    • Radiotherapy
    • Eye surgery
    • Dental surgery
    • Lithotripsy (kidney stone removal)
    • Tonsillectomy
    • Dilatation & Curettage
    • Cardiac Catheterization
    • Hydrocele surgery
    • Hernia repair surgery
  • Domiciliary hospitalisation Medical Treatment for a period exceeding three days, which in the normal course, would require hospitalisation, but treatment is actually taken at home, under any of the following circumstances: -
    • the condition of the patient does not permit him/her to be removed to Hospital or
    • the patient cannot be admitted to Hospital for lack of accommodation therein
    This benefit also covers expenses on employment of a qualified nurse, as recommended by the attending Doctor.
  • Pre- and Post-hospitalisation Policy also covers relevant medical expenses incurred during a specified period, before & after hospitalisation (for which a claim is payable)

    Health Gain	Gold plan	Silver plan	Standard plan
    Pre hospitalisation
    60 Days	60 Days	60 Days	30 Days
    Post hospitalisation
    60 days	90 days	90 days	60 days

  • Coverage of Pre-Existing diseases Hospitalisation expenses incurred on treatment towards Pre-existing diseases / condition can be covered:
    • HealthGain: after completion of 3 consecutive years of the policy period.
    • Gold Plan: after completion of 2 consecutive years of the policy period.
    • Silver Plan: after completion of 2 consecutive years of the policy period.
    • Standard Plan: after completion of 4 consecutive years of the policy period.
  • Donor expenses Covers hospitalisation expenses towards donor in case of major organ transplant(only for silver and gold plan).

  Value added features

  • Expenses on Accompanying Person Payment towards expenses incurred by an accompanying person at the hospital while Insured is hospitalised for a minimum period of 5 days.
    • Gold Plan : Rs. 300/- per day for a maximum of 5 days (i.e. from the 6^th day to the 10^th day of hospitalisation)
    • Silver Plan : Rs. 250/- per day for a maximum of 5 days (i.e. from the 6^th day to the 10^th day of hospitalisation)
    • Standard Plan : Rs. 200/- per day for a maximum of 5 days (i.e. from the 6^th day to the 10^th day of hospitalisation)
  • Local road ambulance services Reimbursement of Expenses incurred for necessary transportation of the insured to the Hospital in an ambulance for hospital admission and requiring immediate treatment. Maximum limit:
    1. HealthGain(Plan A) - Up to Rs.1500/-
    2. HealthGain(Plan B) - Up to Rs.2000/-
    3. Gold Plan - Rs. 1000/-
    4. Silver Plan - Rs. 750/-
    5. Standard Plan - Rs. 500/-
  • Recovery benefit In an unfortunate event, if the Insured is hospitalised for more than 10 consecutive days, a lump sum benefit of Rs. 10,000 will be paid . This condition is applicable for all the members of the floater separately irrespective of the number of occurrences during the Policy period subject to overall limit of Sum Insured. This benefit is available only for gold plan.
  • Cost of health check up This benefit provides for reimbursement of cost / charges incurred for medical check up. In case of accepted proposals the Insurer shall reimburse 50% of the total medical costs.
  • Nursing allowance Payment of Nursing Allowance for expenses towards employment of registered nurse at the residence of Insured or during the period they are hospitalized provided such services are:
    • Confirmed as being necessary by the treating Physician.
    • Relate directly to a disease / illness / injury for which the Insured has been hospitalised.
    Allowance is payable for 5 days.
    • Gold Plan Rs. 300/- per day
    • Silver Plan Rs. 250/- per day

  Additional features

  • Income Tax Benefit Premium paid for Reliance HealthWise Policy is eligible for tax deduction under section 80 D of the Income Tax Act, subject to the condition that the premium amount is paid by cheque/DD by the customer from his bank account.
    • The proposer will get tax benefit upto Rs. 15,000/-
  • Pre-insurance health check up
    • No medical tests required at enrollment stage for family members under the age of 45 and the Policy is issued within 2-3 business days based on proposal form and declaration.
    • Applicants above 45 years will be covered only after completion of medical tests, submission of reports and the approval of Underwriting team.

  Reliance health insurance - Eligibility

  • Anyone between the age of 3 months to 65 years can be covered under the 3 plans as per the eligibilty under each plan.
  • 3 months - 45 years can be covered without Pre-insurance medical tests.
  • 46 years & above Mandatory medical test & necessary approval from the Under Writing team.
  • Renewal is available till 75 years.

  Requirement for different age groups

  3 months to 18 years:
  Covered only along with either of the parents without any medical examination (clear proposals without pre-existing disease/ with nil claims history / with clear medical history)
  18 - 45 years:
  Covered without any medical examination (clear proposals without pre-existing disease/ with nil claims history / with clear medical history)
  46-65 years:
  Covered subject to satisfactory medical examination.
  
  

  Exclusions under the Reliance health plans

  First year exclusions
  There are certain ailments which are not covered for the first year of inception of health insurance cover, but are covered subsequently -

  • Cataract.
  • Benign Prostatic Hypertrophy.
  • Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy.
  • Dilation and curettage.
  • Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis.
  • Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant /adenoids and hemorrhoids.
  • Dialysis required for chronic renal failure.
  • Gastric and Duodenal ulcers.

  Permanent exclusion
  

  • Disease/ Injury existing before inception of health insurance policy being pre-existing disease (however, these will be covered after 2 / 4 year, depending on the choice of plan).
  • Any disease contacted during the first 30 days of inception of policy - accidents excluded and roll over cases excluded.
  • Naturopathy treatment, any other form of nonallopathic treatment on local medication.
  • Treatment arising from or traceable to pregnancy & childbirth complications.
  • Intentional self-injury / injury under influence of alcohol, drugs.
  • Diseases such as HIV or AIDS.
  • Suicide, self inflicted injury or illness, mental disorder, anxiety, stress or depression, use of alcohol or drugs.
  • Diseases existing from the time of birth (Congenital diseases).
  • Cost of spectacles, contact lenses and hearing aids.
  • Dental treatment or surgery of any kind unless requiring hospitalisation with minimum 24 hours stay and treatment.
  • Charges incurred at Hospital or Nursing Home primarily for diagnostic without any treatment.
  • Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the medical practitioner.
  • Cosmetic, aesthetic, treatment unless arising out of accident.
  • Treatment of Obesity, General Debility and congenital external disease.
  • War, riot, strike, terrorism, nuclear weapons induced hospitalisation.
  • Routine medical, eye and ear examinations.
  • Treatment of mental illness.

• Reliance health insurance - Eligibility

  • Anyone between the age of 3 months to 65 years can be covered under the 3 plans as per the eligibilty under each plan.
  • 3 months - 45 years can be covered without Pre-insurance medical tests.
  • 46 years & above Mandatory medical test & necessary approval from the Under Writing team.
  • Renewal is available till 75 years.

  Requirement for different age groups

  3 months to 18 years:
  Covered only along with either of the parents without any medical examination (clear proposals without pre-existing disease/ with nil claims history / with clear medical history)
  18 - 45 years:
  Covered without any medical examination (clear proposals without pre-existing disease/ with nil claims history / with clear medical history)
  46-65 years:
  Covered subject to satisfactory medical examination.
  
  

• Exclusions under the Reliance health plans

  First year exclusions
  There are certain ailments which are not covered for the first year of inception of health insurance cover, but are covered subsequently -
  • Cataract.
  • Benign Prostatic Hypertrophy.
  • Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy.
  • Dilation and curettage.
  • Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis.
  • Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant /adenoids and hemorrhoids.
  • Dialysis required for chronic renal failure.
  • Gastric and Duodenal ulcers.
  Permanent exclusion
  
  • Disease/ Injury existing before inception of health insurance policy being pre-existing disease (however, these will be covered after 2 / 4 year, depending on the choice of plan).
  • Any disease contacted during the first 30 days of inception of policy - accidents excluded and roll over cases excluded.
  • Naturopathy treatment, any other form of nonallopathic treatment on local medication.
  • Treatment arising from or traceable to pregnancy & childbirth complications.
  • Intentional self-injury / injury under influence of alcohol, drugs.
  • Diseases such as HIV or AIDS.
  • Suicide, self inflicted injury or illness, mental disorder, anxiety, stress or depression, use of alcohol or drugs.
  • Diseases existing from the time of birth (Congenital diseases).
  • Cost of spectacles, contact lenses and hearing aids.
  • Dental treatment or surgery of any kind unless requiring hospitalisation with minimum 24 hours stay and treatment.
  • Charges incurred at Hospital or Nursing Home primarily for diagnostic without any treatment.
  • Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the medical practitioner.
  • Cosmetic, aesthetic, treatment unless arising out of accident.
  • Treatment of Obesity, General Debility and congenital external disease.
  • War, riot, strike, terrorism, nuclear weapons induced hospitalisation.
  • Routine medical, eye and ear examinations.
  • Treatment of mental illness.

• Key highlights of Reliance Health Insurance

  Reliance mediclaim insurance caters to the individual and family medical health needs. Reliance health insurance offers a wide range of healthcare plans both for individual and members of the family. Reliance offers healthwise plans ranging us from 2 lakhs to 5 lakhs. A person opting for reliance individual healthwise plan gets medical insurance coverage for himself and a person opting for reliance healthwise family floater plan gets medical insurance coverage for himself and family members mentioned in the policy.

  The newly improved reliance healthcare plan offers health insurance up to the age of 65 years and can be renewed up to the age of 75 years. Some of the key features of the reliance healthwise plans are they offer no caim bonus on every claim free year, no co-payment on claims, no restriction on room rent and any related medical expenses and renewals without claim loading.