Reliance HealthGain Health Insurance Plan

HealthGain is a comprehensive health insurance cover offered by the general insurance wing of Reliance. The company offers a range of health insurance plans for its customers and ensures that adequate coverage is provided for everyone. This policy comes with multiple options, and it can be taken either as an individual cover or a family floater cover.

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

Eligibility for Reliance HealthGain

The eligibility criteria outlined by the company for enrolling in Reliance HealthGain can be listed as follows:

• Anyone over the age of 5 years can be enrolled in the individual or family floater plan.
• Children between the age of 91 days and 5 years can be enrolled in the policy provided at least one adult over the age of 21 is covered simultaneously.
• There is no maximum entry age for the sum insured option Rs.3 lakh (lowest). For all other sum insured options, the entry age is capped at 65.
• Once entered, lifetime renewability option is available for this policy cover.
• A maximum of 6 family members can be enrolled in this policy cover.

Features of Reliance HealthGain

The key features of Reliance HealthGain can be listed as follows:

• This policy is available in 6 different sum insured options - Rs.3 lakh, Rs.6 lakh, Rs.9 lakh, Rs.12 lakh, Rs.15 lakh, and Rs.18 lakh.
• All pre-existing conditions can be covered after 3 years of continuous policy coverage.
• For plan A (Rs. 3 lakh, Rs.6 lakh and Rs.9 lakh), pre-insurance medical checkup is required for people above 46 years of age.
• For Plan B (Rs.12 lakh, Rs.15 lakh, and Rs.18 lakh), pre-insurance medical checkup is required for people above 18 years of age.
• There is an initial waiting period of 30 days for all illnesses. For accidental hospitalisation, this waiting period does not apply.
• Pre and post hospitalisation expenses are covered for up to a period of 60 days.
• For certain conditions like arthritis, cataract, hernia, kidney stone, etc., there is a waiting period of 2 years.
• There is a mandatory copayment requirement of 20% for people entering this policy cover after 61 years of age.
• There are various policy discounts available with this cover: 5% for girl child or single woman, 5% discount for existing Reliance car insurance customers, and 5% or 10% discount depending upon family size.
• Free auto extension of the policy is available if the insured is diagnosed with any of the named critical illness.
• The sum insured amount for the policy will be doubled after 4 continuous claim-free years.
• This policy can be ported to other insurance service providers in the market. The company must be notified at least 45 years before the date of renewability.
• Tax benefit is available as per Section 80D of the Income Tax Act for people enrolling in this policy.

Benefits of Reliance HealthGain

Exclusions of Reliance HealthGain

Some of the permanent exclusions applicable to Reliance HealthGain policyholders can be listed as follows:

• Intentional self-injuries or suicide attempt
• Injuries or illnesses that can be related to drug use or alcohol
• Injuries or illnesses attributable to war, nuclear weapons, chemical weapons, biological weapons, etc.
• Any kinds of stem cell treatment
• Any kinds of congenital diseases
• Expenses related to the treatment of HIV, AIDS, and sexually transmitted diseases
• Expenses related to the treatment of mental disorders
• Any kinds of dental treatment unless arising out of accident
• All kinds of non-allopathic treatments including unproven or experimental treatments
• Cosmetic or aesthetic treatments of all kinds
• Maternity expenses except for ectopic pregnancy
• Cost of accessories such as hearing aids, spectacles, contact lenses, etc.

Claim Procedure

The claim process for Reliance HealthGain begins with intimation to the company about the hospitalisation. For cashless claims, the authorisation form and other relevant documents must be submitted immediately following hospitalisation. For reimbursement claims, all necessary documents must be submitted after discharge from the hospital.

For cashless claims, the company promises approval within 6 hours. Beyond the 6-hour limit, the company offers 1% of the claim amount extra for every delay of 6 hours. The same is applicable for reimbursement claims too. For every delay of 21 days after the initial 21 days, the company offers 1% of the claim claim subject to a maximum of 6%.