Reliance Health Wise Gold Insurance

Eligibility for Individual HealthWise Gold

• Any individual buying an healthwise policy should have completed 18 years of age
• No fresh policy to be issued after 55 yrs incase of Silver Plan
• 3 months - 45 yrs can be covered without Pre-insurance medical tests
• 46 yrs & above Mandatory medical test & necessary approval from the Under Writing
• Individuals below 18 years can be covered under the family floater as dependents

Eligibility for Family Floater HealthWise Gold

• Anyone between the age of 3 months to 75 yrs can be covered under the Standard Plan
• No fresh policy to be issued after 55 yrs incase of Silver Plan
• 3 months - 45 yrs can be covered without Pre-insurance medical tests
• 46 yrs & above Mandatory medical test & necessary approval from the Under Writing

Age Slabs
Age band	Coverage
3 months to 18 yrs	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 yrs	Covered without any medical examination (clear proposals without pre-existing disease/ with nil claims history / with clear medical history)
46-55 yrs	Covered subject to satisfactory medical examination

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 4000 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
• Coverage of pre-existing conditions after 2 years for gold plan.

Reliance Health insurance 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
  
  
• Critical Illness Cover
  
  "Critical Illness" means disease/illness/surgery limited to the following:
  1. Cancer
  2. Coronary artery bypass surgery
  3. First Heart attack
  4. Kidney Failure
  5. Multiple Sclerosis
  6. Major organ transplant
  7. Stroke
  8. Aorta graft surgery
  9. Paralysis
  10. Primary Pulmonary Arterial Hypertension

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)

	Reliance Healthwise - Gold Plan
Pre Hospitalisation	60 Days
Post Hospitalisation	90 Days

Coverage of Pre-Existing Diseases

Hospitalisation expenses incurred on treatment towards Pre-existing diseases / condition can be covered after completion of 2 consecutive years of the policy period

Donor Expenses

Covers Hospitalisation expenses incurred towards the donor is covered in case of major organ transplant within the overall limit of Sum Insured.

Reliance Health Insurance - Value Added Features

• Expenses on Accompanying Person
  
  Subject to the Insured/Insured Person(s) being hospitalised for a period of 5 days at a given time, an allowance towards expenses of accompanying person at the hospital is payable at Rs.300 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 Rs.1000/- for gold plan.
  
  
• Cost of Health Check up
  
  The Insured/Insured Person (s) is entitled to reimbursement of the cost of medical check-up at the end of a block of 4 consecutive years provided there were no claims reported under the Policies by any member, during this block. The cost so reimbursable shall not exceed an amount equal to 1% of the average Sum Insured during the block of 4 Underwriting years. In case of Family Floater the above limit is 1.25% of the average Sum Insured for all the Insured Person covered in the policy put together.
  
  
• 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 for Gold plan is Rs. 300/- 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

Exclusions

Reliance Health Insurance - Exclusions

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