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    Reliance HealthWise Policy - FAQs 
    What are the benefits of taking health insurance?
    Health insurance covers you and your family against expenses that you may incur on hospitalisation (or domiciliary hospitalisation) and/or other related expenses in a hospital or nursing home in India for treatment of a disease.
    With the rising incidence of diseases and cost of treatment, any illness can mean substantial financial outgo for you and your family. Health insurance allows you to plan for such events without feeling the financial burden of treatment. It also allows tax saving since the premium that you pay on your health insurance policy is eligible for tax deduction under Section 80 D of the Income Tax Act. (Up to Rs.15000 for an individual or Rs.20000 for senior citizen of over 65 years of age)

    How much health insurance does one need?
    You can decide on the amount based on the number of family members to be covered under the policy, the age of family members, the expected costs of treatment and the amount of premium you are willing to pay.

    What is the minimum / maximum amount of sum insured?
    The minimum amount of sum insured available under Reliance HealthWise is Rs. 3 lakh. The maximum amount is 5 lakhs.

    What is the eligibility criterion to avail of the Health insurance policy?
    Anyone between the age of 3 months and 65 years can take a health insurance policy (in case of a silver plan till 55 years of age and in case of a standard plan till 60 years of age).

    What are pre and post hospitalisation expenses?
    Pre and post hospitalisation expenses means the medical expenses incurred during a period before and after hospitalisation for any disease / illness / injury sustained which is covered under your Policy. The period before and after hospitalisation that is covered depends on the type of policy opted for. For e.g., in the case of a Silver Plan, the period considered for pre-hospitalisation expenses is 60 days before admission to the hospital / nursing home, while the post-hospitalisation period is 90 days after discharge from the hospital.
    For more details view the table below:

     
    Silver Standard
    Pre Hospitalisation 60 Days 30 Days
    Post Hospitalisation 90 days 60 days


    Can an insurance company decline to give cover under their insurance policy?
    All insurance policies are issued at the discretion of the insurance company and as such an insurance company can decline your policy proposal.

    What is cashless facility?
    Cashless claims facility is available in the network of tied-up hospital where the company settle claims directly with the hospital / nursing home without you having to pay any amount to the hospital directly.
    The way it works is that in the case of pre-planned hospitalisation, if the chosen hospital is included in the network of cashless hospitals, you need to send Reliance General Insurance a claim form along with certification from the doctor about the nature of illness and treatment. Once the Third Party Administrator receives the information, and if the claim is admissible, the TPA sends you a pre-authorisation, in a matter of few hours, for the cashless claim. Then, the company will settle your hospital bills directly. In the unfortunate event of an emergency if the insured person is admitted to a tied-up hospital, you have to inform the hospital of your intention to use the cashless facility. The hospital will then help you with the authorization process.

    Are there any taxation benefits if one takes health insurance policy?
    The premium paid on a health insurance policy is eligible for deduction under section 80D of the Income Tax Act. The amount of deduction available is up to Rs.15000 for individuals or Rs.20000 for senior citizens aged above 65 years and paid the premium from their account. Additionally an amount of 20,000 is also available for exemption towards premium paid for dependant parents.

    How many nominees can one have?
    Each of the insured family members should have a nominee.

    Is the insured value based on my income?
    The insured value for a health insurance policy is the maximum amount that you want to provide towards hospitalisation / treatment. It is an amount decided by you and will depend on the size of your family, ages of the family members, any history of family illness and the amount of premium you would like to set aside for this purpose. So, it is not directly based on your income, though your income will decide the amount of premium you are willing to bear.
     
    What are the various exclusions in your Policy?
    There are certain ailments that are not covered for the First year, but are covered subsequently such as
    • 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
    Disease/ Injury existing before inception of health insurance policy, also called pre-existing disease, is only covered from the 3rd year of the policy in case of a silver plan (after 2 continuous renewals) and from the 5th year onwards (after 4 continuous renewals)

    Apart from these there is a list of permanent exclusions mentioned in your policy document. It includes any disease contracted during the first 30 days of inception of policy, non-allopathic treatment, pregnancy & childbirth related diseases, Intentional self-injury, injury under influence of alcohol, drugs; diseases such as HIV or AIDS, etc.

    Other permanent exclusions

    Does Reliance General Insurance provide for health insurance policy - sickness only?
    Only comprehensive health policies are issued which cover sickness and injury. You can choose not to cover other benefits such as Recovery, critical illnesses, donor expenses and daily hospital allowance by choosing between a Silver Plan and a Standard Plan.

    What is a health card?
    A health card is an identity card that is sent to you when the policy is issued. A Health Card that can be produced at the time of admission into a hospital for using the cashless facility.

    Does Reliance General Insurance have hospital tie - ups that provide cashless checkouts as part of your health insurance policy?
    Reliance General Insurance provides cashless claims facilities at a network of over 3500 hospitals. The list of hospitals will be sent to you along with your policy pack and includes most major hospitals and nursing homes across over 300 cities.

    In case you are admitted to any hospital not covered in our network, you need to inform the TPA of the admission within 7 days of hospitalisation.

    You will have to pay the bill to the hospital, and the claim will be settled in your name after discharge from the Hospital. You will need to submit all original bills, discharge card, prescriptions, medical reports etc. along with your claim form.

    What are emergency medical expenses?
    Your hospitalisation expenses due to an emergency illness/injury are covered under your Reliance Health Care insurance policy. You can avail of the cashless facility in times when there is emergency hospitalisation. It is part of your health insurance policy and you need not pay an extra premium for it.

    Why does one need an individual health insurance policy though his company covers him under a group plan?
    Corporate Health cover will be available to you only till you are part of the company. Also, it might be available only to a specific amount. It might not be sufficient when a medical contingency occurs. Hence it would be advisable to go for an individual health insurance policy.
    Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Family Floater Health Insurance policy will come to your rescue.
    Reliance Health Care Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.

    Will the health insurance policy provide cover in case of any hospitalisation abroad?
    The health insurance policy is meant to cover hospitalisation only in India. To cover hospitalisation abroad, you need to take a travel insurance policy.
    A health insurance policy is not transferable. That is because; the premium for the policy is based on your age, medical history, family medical history etc. which will be different for different people.

    Can one cover a family staying in different parts of the country under a single policy?
    Yes, you can cover them under one policy. The cashless facility is available at over 3000 leading hospitals and nursing homes spread across India. You can avail of the facility at any of these locations in any unfortunate event.

    In case of health policies from two insurance companies, how ill the claim be made?
    The claim will usually settled by both the companies in a rateable proportion depending on the coverage amount under each health insurance policy
    For example a person has a policy with Sum Insured of Rs.3 lacs and takes another policy from another insurance company for Rs.3 lacs.
    In the event of claim:
    • If claim amount is Rs.1 lac, both the Policies will contribute. i.e claim will be settled on rateable proportion.
    • If the claim amount is 7 lac. Both the Policy will pay upto the respective sum insured.

     

    What is a floater policy? How is it beneficial to take it?
    In case of a floater policy, all members of the family are covered under one single policy. A single premium is payable for the entire family and the amount of cover (Limit) "floats" over the entire family. This means that it offers you the flexibility in terms of the cover available for each member of the family during hospitalisation. The limit can be used by any member of the family, and for any number of times.
    For eg. If you take a floater policy of 5 lakhs for your family, there is no fixed limit of how much of this amount is used for a single-family member. The claim amount during the year is restricted to Rs. 5 lakhs for all family members put together.
    If you take a normal group insurance policy in place of a floater, you have to define fixed amounts towards each family member and any unused amounts from one family member cannot be transferred to another member. Hence it is restrictive.

     
    If I am only admitted in a hospital for less than a day, is the expense still covered?
    The hospitalisation expenses are covered only if you have been hospitalised for a minimum period of 24 hours. However, certain day care treatments, which do not require 24 hour hospitalisation, are also covered under our Health Insurance policy. The treatments included are
    • Dialysis
    • Chemotherapy
    • Radiotherapy
    • Eye surgery
    • Dental surgery
    • Lithotripsy (kidney stone removal)
    • Tonsillectomy
    • Dilatation & Curettage
    • Cardiac Catherization
    • Hydrocele surgery
    • Hernia repair surgery
    • Surgeries/procedures that require less than 24 hours hospitalisation due to advancement in technology.
    Can the nominee be changed mid-term of the policy?
    You can change the nominee for your health insurance policy at any time during the policy term. To change the nominee, all you need to do is write and give your changed nominee details to the company.

    Can the sum insured be changed during the year?
    It may not be advisable to change plan mid term since you will have to cancel your existing policy and take a new policy. This will mean that all your coverage and exclusions will be applicable all over again as on day one. This will impact you especially with regard to first year exclusions and pre-existing illness covers.

    What is domiciliary hospitalisation? What is covered under it?
    Domiciliary hospitalisation means treatment done at home in India for a period exceeding three days for disease, illness or injury, which in the normal course, would require hospitalisation. This could happen if either the condition of the patient is such that he/she cannot be moved to Hospital/Nursing Home, or the patient cannot be admitted to Hospital/Nursing Home for lack of accommodation.
    In such cases, the cost of the treatment as well as expenses, if any, on employment of qualified nurses, employed on the recommendation of the attending Medical Practitioner is covered. The cover is limited to a maximum of 10% of the sum insured and will be payable once the treatment exceeds 3 days and it has to be applied for at the time of taking the policy.

    What is the difference between a Standard and Silver Policy?
    The main difference between a Standard Policy and a Silver Policy is that coverage of Donor Expenses is available in the Silver Policy and not in a Standard Policy. Also, pre-existing illnesses in the case of a Silver Policy are covered from the 3rd year onwards, while in the case of a Standard Policy, they are covered only from the 5th year.
    The limits for pre and post hospitalisation are also different for the two policies. While in the case of Silver Policy, we cover 60 and 90 days for pre and post hospitalisation, in case of a Standard Policy, the limits are 30 and 60 days respectively.
    Nursing Allowance is also not available in a Standard Policy while it is available in case of a Silver policy.
    The maximum age limit for taking a Silver Policy is 60 years whereas for a Standard Policy, it is 65 years.
    Ambulance charge limit for a Silver Policy is Rs. 750/-, whereas for a Standard Policy, it is Rs. 500/-. In the case of a Silver Policy, expenses on an accompanying person are reimbursed at Rs. 250 per day for 5 days, while in the case of a Standard Policy, they are reimbursed at Rs. 200 per day.

    Reliance HealthWise Policy
    Coverage Silver Standard
    Basic Features Hospitalisation √ √
    Domiciliary Hospitalisation √ √
    Pre and Post Hospitalisation √ √
    Pre-Existing √ √
    Critical illness x x
    Donor Expenses √ x
    Day Care √ √
    Value Add Features Expenses on accompanying person at the Hospital √ √
    Local Road Ambulance Services √ √
    Convalescence Benefit x x
    Cost of Health Check up √ √
    Nursing Allowance √             x
    Hospital Daily Allowance x x
    Policy Features Family floater √ √
    Income tax benefit √ √
    Sum Insured √ √
    Medical Health Check up √ √
    Option in duration of the plan √ √
    Renewal Discounts √ √
    Cashless Facility (Through Third Party Administrators - TPA) √ √
    Age Slabs √ √
    Exclusions Exclusion for 1st year √ √
    Permanent Exclusion √ √

    What happens to the premium if no claims are made against the policy?
    If you have made no claims against your policy during the year, we give you a 5% discount on the premium at the time of renewal.
    Also, we pay for the cost of a full medical check-up upto a maximum of 1.25% of average Sum Insured, every four years if there are no claims on the policy during the period of four years.

    What kind of medical tests need to be done, if required?
    Three tests need to be done - an ECG, Blood Sugar Test - both fasting and Post partum (post meal) and a routine urine test.

    How long does the company take to issue a policy once the documents are submitted?
    If age below 45 years - The health kit will be given to you on the spot.
    If age above 45 years - The Health kit will be given as soon as the medical reports are approved.

    How often or how frequently do I have to pay my premium? Can I pay premium in instalments?
    You have to pay the premium at the inception of the policy and at each renewal of the policy. You cannot pay the premium in instalments.
    In case you opt for the two-year policy, you have to pay the premium for two years at one time.

    How does one make changes in the policy details?
    To make any changes to your policy, you will need to write a letter to Reliance General Insurance detailing the change required and submit the same at any of the branch offices, with all the required documentation.

     
    Can a misplaced policy be replaced?
    In case you lose or misplace your policy, Reliance General insurance can issue you a policy. All you need to do is submit a request letter at any of the branch offices, narrating the circumstances in which the original policy was lost at the branch. On the receipt of this letter, the company will issue a policy for you, for a charge of Rs.100.

    While renewing the policy, does the customer have to submit fresh documents?
    You do not need to submit any documents at the time of renewal. If there is no break in insurance, you also do not need to undergo medical tests.

    What happens if hospitalised is needed in the course of time when the policy has gone for renewal?
    So long as your old policy is valid, there is no problem even if you need to be hospitalised during renewal. Also, once we receive your renewal cheque, your renewed policy becomes effective, whether or not you receive the renewed policy pack.
    So you do not have to worry so long as you ensure that the policy does not lapse.

    How does one make the get a cashless authorisation in an emergency?
    In case of cashless claims for an emergency, please intimate the TPA using their toll free number specified in your health card. You would need to submit to the TPA all the necessary information of the emergency along with a certificate from the Medical Practitioner and/or Hospital.
    The TPA will then issue a pre-authorisation, in a matter of few hours, to the Hospital concerned for cashless hospitalisation for the treatment upto the limit of the Sum Insured specified in the policy.
    Once the hospital is in the network, in case of an emergency just get admitted and contact the TPA about the emergency nature of hospital admission and furnish the required details as stated above.

    When I need hospitalisation, do I have to inform Reliance General Insurance Company before hospitalisation-
    • In case of tied - up hospitals
    • In case of other hospitals
    You can inform TPA or Reliance General Insurance. If the insurance company is informed, they will note down and advice you to contact the TPA giving details of contact. If the hospitalisation is pre-planned and you have adequate time to inform us, it is always better to take a pre-approval for hospitalisation whether you are being admitted in a tied-up hospital or any other hospital. Even otherwise, you must try and inform us of hospitalisation as soon as the person is hospitalised.
    Even in case of non-network hospitalisation, you need to inform either TPA or Reliance General Insurance.
    The pre-approval ensures that there are no disputes with regard to claims at a later stage.

    Are expenses for diagnostic procedures such as an angiography / endoscopy etc. covered under the policy?
    Yes, the expenses incurred on such diagnostic procedures are covered provided that such diagnostic tests / procedures are not taken without any relevance to the illness or taken just like that. However, any expenses on other tests such as x-rays or lab examinations which are not directly related to the main diagnosis and treatment are not covered.
    Your policy also covers any pre and post hospital medical expenses relevant to the treatment (which is covered under the Policy )which you may incur.
    To claim such expenses you have to submit the relevant medical bills, prescription, reports directly to our TPA. The claim for such expenses is settled on a reimbursement basis.

    Can a claim be lodged in parts or does it have it be post treatment?
    You may claim for hospitalisation expenses immediately after discharge whilst under going post hospitalisation treatment. Once your treatment is over you can claim the post hospital medical expenses on a reimbursement basis.

    Is FIR required on account of admission to the hospital or for filing a claim due to an occurrence of any accident?
    The requirement of FIR to get admission in the hospital following an accident depends upon the hospital internal rules. As far as possible, our TPA will facilitate such admission.
    However, for processing of an accidental claim, we would insist on an FIR. We would therefore advise you to please lodge an FIR for any accident.

    Does a claim have to be lodged or made in a specific time frame from the time of the accident?
    It is recommend that you intimate your claim to the TPA as soon as you can. You also need to submit written proof of claim along with the signed claim form to the TPA within a maximum of 30 days from the date of discharge.

    Is there a limit on the number of claims that can make in the year on the policy?
    No there is no limit on the number of times you can claim in the year on your policy. As soon as you incur a claim, you need to submit the claim documents. All claims will be processed then and there subject to the availability of the sum insured under the Policy.

     
    If I avail of cashless facility, will the insurer pay the complete amount?
    The insurance company will make payments towards all admissible charges. All inadmissible charges have to borne by you. The cashless will be only for those admissible charges.

    Under what circumstances can Reliance General Insurance Company reject my claim?
    Claim can be rejected, if it is not within the terms and conditions of the Policy or if it is falling within any of the exclusions.

    What is the procedure and time schedule for filing claims?
    Claims are settled in two ways - either through the cashless facility or on a reimbursement basis. The cashless facility is only available in the network of hospitals and it works on the basis of a pre-approval which means that you have to send your documents such as the doctor's prescription, provisional estimate and any reports / diagnosis to the TPA who will then send a pre-approval to the hospital concerned mentioning the amount upto which allowable expenses would be payable. On discharge from the hospital, you need to send to the TPA the bills and discharge card received. All admissible claim amounts are settled by the company directly with the hospital.
    In case of a reimbursement claim, you have to submit all your bills along with doctor's prescription and reports to our TPA in original along with a filled in claim form. The TPA will process your claim and send you the claim cheque in 7 working days.

    What documents are to be submitted along with the claim form?
    You need to submit:
    • The first prescription of doctor with commencement date of the symptom of disease.
    • Treatment papers along with doctors prescriptions
    • Investigation reports (X-ray/Scan/ECG, Laboratory etc)
    • Original medical bills and receipt of Hospital, doctors, medical shops, Diagnostic centre etc supported by Doctor's advice.
    • Hospital discharge card
    • Copy of FIR (if any in case of accident).

     

    What happens to the any policy already taken by individual employees?
    Their health insurance benefit would be beneficial to them as supplementary health insurance coverage apart from the coverage offered by the corporate policy. Plus, if they have taken an individual health insurance policy, it helps them to get some income tax rebates. So it is not necessary for them to cancel their existing policy. Also such a policy will also pay for a claim on a rateable proportion.

     
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