Reliance Mediclaim 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.

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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.

Plan offers four health policy plans

Very affordable - Rs. 2 lakh cover for a family of two at Rs. 3698 per annum

No co-payment on claims

No sublimities in room rent & all medical expenses

24 x 7 cashless facility and TPA support

No medical check-up to age of 45 years

Cashless claim settlement available across 4000 network hospitals through our well know TPA MEDI ASSIST

No claim bonus on every claim free year

Subsequent renewals without claim loading

Policies available up to the age of 65 years.

Renewal age up to 75 years

Portability benefit will be available

Pre-existing illnesses coverage after two years or four years (depending on the plan you choose) of continuous cover

Income Tax benefit under Section 80 D

Healthwise coverage options available only for individuals are standard, silver and gold.

Individual Healthwise policy coverage available in the options of 2 lakhs, 3 lakh, 4 lakh and 5 lakh

Available for the individuals 22 years to 45 years(for 46 years - 65 years, medical examination is compulsary)

Key Advantages

Individual HealthWise

24 hours cashless facility at more than 3000 network hospitals.

Income Tax benefits under section 80 D.

Duration of coverage - 1 year

Discounts on renewal premium for claim free policy

Coverage of pre-existing conditions after 2 years / 4 years as per plan opted.

Healthwise Policy (Family Floater)

Sum Insured for Gold Plan is 2 lakhs, 3 lakhs , 4 lakhs and 5 lakhs (Available for couple and 2 dependent kids(3 months - 21 years) and for 46-55 age group, medical examination is compulsary)

Sum Insured for Silver Plan is 2 lakhs, 3 lakhs , 4 lakhs and 5 lakhs (Available for couple and 2 dependent kids(3 months - 21 years) and for 46-60 age group, medical examination is compulsary)

Sum Insured for Standard Plan is 2 lakhs, 3 lakhs , 4 lakhs and 5 lakhs (Available for couple and 2 dependent kids(3 months - 21 years) and for 46-65 age group, medical examination is compulsary)

Family HealthWise Key Advantages

For the first time in India, Critical Illness are also covered as part of your health insurance policy.

24 hours cashless facility at more than 3000 network hospitals.

Income Tax benefits under section 80 D.

Duration of coverage - 1 year.

Family Floater benefit giving comprehensive protection to your family memebers under one single policy.

Discounts on renewal premium for claim free policy from 5% accumulated to 20% for every claim free year

Coverage of pre-existing conditions after 2 years / 4 years as per plan opted.

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
Age band Coverage
3 months to 21 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)
22 - 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

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 hospital izations

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

Cardiac Catheterization
Cataract
Chemotherapy
Coronary Angiography
Coronary Angioplasty
Dialysis
Dilation & Curettage
Eye Surgery
Hernia Repair Surgery
Hydrocele Surgery
Lithotripsy (Kidney stone removal)
Radiotherapy
Tonsillectomy

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:

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 6th day to the 10th day of hospitalisation)
Silver Plan : Rs. 250/- per day for a maximum of 5 days (i.e. from the 6th day to the 10th day of hospitalisation)
Standard Plan : Rs. 200/- per day for a maximum of 5 days (i.e. from the 6th day to the 10th 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:

Gold Plan - Rs. 1000/-
Silver Plan - Rs. 750/-
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 hositalized 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.

Rs. 10,000/- for self, spouse, kids and parents
Rs. 15,000/- if the policy includes senior citizens whose ages is above 65 years

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

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 2nd 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 or other forms of local medication

Pregnancy & childbirth related diseases

Intentional self-injury / injury under influence of alcohol, drugs

Diseases such as HIV or AIDS

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 hospitalization

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 related to obesity

War, riot, strike, terrorism, nuclear weapons induced hospitalisation

Routine medical, eye and ear examinations

Treatment of mental illness