Reliance HealthGain Insurance

Reliance HealthGain insurance coverage is an exclusive policy designed to cover medical expenses. There are plans available both for individual and family with 3 to 18 lakh sum insured.

  • Sum insured ranging from 3 lacs to 18 lacs with wide range of coverage
  • Renewal option for life long.
  • There is no loading even if you claim.
1. Coverage type:
2. Coverage amount:
3. Age of senior:
     years OR age
 
 
*Optional
  • Advantages
  • Benefit table
  • Medical Test
  • Exclusions


  • As low as 91 days of entry age and There is NO maximum entry age for sum insured of Rs, 300,000
  • After 36 months of continuous coverage you can get coverage for pre –existing diseases.
  • “Claim & Policy Service Guarantee” available.
  • Special benefits like “Call Option” & “Re-instatement of Base Sum Insured”.
  • Wellness Services.
  • Entire family coverage along with Spouse, Children , Parents, Parent in law, Brothers, Sisters, Grand Parents, Grand Children, Daughter-in-law and Son-in-Law.


Benefits Plan A Plan B
Sum Insured - on annual basis 3Lacs, 6Lacs , 9Lacs 12Lacs, 15Lacs & 18Lacs
In-Patient Treatment Yes Yes
Day Care Treatments Yes Yes
Pre-hospitalisation 60 days 60 days
Post hospitalisation 60 days 60 days
Domestic Road Ambulance Upto 1500 Upto 3000
Domiciliary Hospitalization Up to 10% of SI, subject to a maximum of Rs 50,000 Up to 10% of SI, subject to a maximum of Rs 50,000
Donor Expenses 50% of SI upto max 5 lacs 50% of SI upto max 5 lacs
Initial Wait Period 30 Days 30 Days
Named ailments 24 months 24 months
Pre-existing Diseases 36 months 36 months
Room Eligibility Single Private Single Private
Co-payment @ 20% per claim
In Floater policy : for all insured if the age of eldest member at entry is 61 years or above
In Individual policy : for those insured whose age at entry is 61 years or above
@ 20% per claim
In Floater policy : for all insured if the age of eldest member at entry is 61 years or above
In Individual policy : for those insured whose age at entry is 61 years or above
Tenure 1 Year 1 Year
Cumulative Bonus 33 1/3 % increase in Base SI for every claim free year ; Max up to 100%
33 1/3 % decrease in Base SI for every claim year ; Max up to Cumulative Bonus earned
33 1/3 % increase in Base SI for every claim free year ; Max up to 100%
33 1/3 % decrease in Base SI for every claim year ; Max up to Cumulative Bonus earned
Call option After every 4 claim free years. Upto maximum 4 times Base Sum Insured provided the enhanced Sum Insured <=50lacs . Can be exercised upto the age of 60 years (under floater policy as per the age of senior most member and under individual policy as per the age of respective member) After every 4 claim free years. Upto maximum 4 times Base Sum Insured provided the enhanced Sum Insured <=50lacs . Can be exercised upto the age of 60 years (under floater policy as per the age of senior most member and under individual policy as per the age of respective member)
Reinstatement of Base Sum Insured One re-instatement upto 100% of Base Sum Insured, subject to sublimit of 20% for related illness/ injury One re-instatement upto 100% of Base Sum Insured, subject to sublimit of 20% for related illness/ injury
Claim Service Guarantee Cashless Claims 1% for every delay of 6 hours beyond 6 hours of receipt of all information/documents
Re-imbursement Claims - 1% for every delay of 21 days beyond 21 days of receipt of all information/documents Maximum - 6% for a claim
Cashless Claims 1% for every delay of 6 hours beyond 6 hours of receipt of all information/documents
Re-imbursement Claims - 1% for every delay of 21 days beyond 21 days of receipt of all information/documents Maximum - 6% for a claim
Policy Service Guarantee SI of Rs 10000 SI of Rs 20000
Accidental Death Cover for No Claim Renewal No 1 Lac PA-Death cover for Policyholder-Insured
Insurance Renewal No One time Renewal premium waiver if the Policyholder- Insured suffers from named Critical Illness



Medical test require for above 45 years of age

  • MER ( Medical Examination Report) MER ( Medical Examination Report)
  • CBC with ESR CBC with ESR
  • Urine Routine Urine Routine
  • Fast Blood Sugar HBA1C
  • Sr.Cholesterol Total Lipid Profile
  • SGPT LFT with GGT
  • Sr.Creatinine Sr.Creatinine
  • ECG HBsAG
  • TMT
  • X ray Knee Joint AP & Lateral -Both Knees


Waiting Period

30-Day waiting period: Claim for any Medical Expenses incurred for treatment of any Illness which began within 30 days of Policy Period Start Date shall not be admissible, except those incurred as a result of an Injury.

2 year waiting period: In case of Pre-existing disease at the time of commencement of first policy with the Company, these shall not be covered until 36 months of continuous coverage has elapsed, since the first Policy Period Start Date with the Company.

  • 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.
  • Treatment of mental illness.
  • 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.
  • Routine medical, eye and ear examinations.

 

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