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Reliance HealthWise Policy - Claims Procedure

We, at Reliance General Insurance, constantly work towards enhancing your experience with us. In the same context, to provide prompt claims servicing to you we have appointed Third Party Administrator (TPA) duly licensed by IRDA. We also directly serve our health insurance customers through Reliance Health Claims Management Team (HCMT) in certain areas. In case of health insurance claims, contact numbers are available on the HealthWise Card/Policy Schedule.

We will be glad to provide you with services in a hassle free manner within the terms and conditions of your health insurance policy. We will provide you the following claims services:

  • "Cashless Facility" at all our Network Hospitals.
  • Processing and settlement of claims under the health insurance policy with a time bound approach.
  • 24 hours Customer Helpline Service.

Health Insurance Claim Procedure:

Claims are broadly of two types: a. Reimbursement Claims b. Cashless Claims

General Claim Procedure

As soon as there is a need for hospitalisation, please intimate the HCMT/TPA on 24x7 Customer Helpline number as mentioned in your Health Card/Policy Schedule.

You are required to furnish the following information while intimating a claim:

  • Contact Numbers
  • Policy Number (as on the Health Card//Policy Schedule)
  • Name of Insured person who is hospitalised
  • Nature of sickness/accident
  • Date & Time in case of accident, commencement date of
  • symptom of disease in case of sickness
  • Location of accident

As Reliance HealthWise Policy holder you have the option of either choosing our network hospital or a hospital outside the network.

The benefit of choosing our network hospital is that you can avail of "Cashless Facility" while you are hospitalised whereas you will have to settle your hospital bills in the hospital which is outside our network.

You have to follow the procedures listed below to get the services in different situations.

Procedures for "Cashless Facility"

"Cashless Facility" is the service wherein you need not pay your hospitalisation bills to the hospital either at the time of admission or at the time of discharge from the hospital. This facility is available only at our Network Hospitals. To avail the "Cashless Facility" you need to fill "Cashless request form" available in all the network hospitals. The hospitals will co-ordinate to get the authorisation from the HCMT/TPA for such "Cashless Facility". This authorisation along with a copy of the card issued by us needs to be given to the Hospital at the time of admission. You are also required to carry a Photo ID Card. Please Note: HCMT/TPA shall authorise "Cashless Facility" at the Network Hospitals in respect of treatments which are covered under the policy.

"Cashless Facility" may be denied by the HCMT/TPA in some of the situations as listed below.

  • In case of any doubt on coverage of the present ailment/ treatment under the policy
  • If the information sent by you /hospital is insufficient
  • The ailment/condition etc. not being covered under the policy
  • If the request for preauthorization is not sent in time

Denial of "Cashless Facility" is not denial of treatment. You may continue with the treatment, pay for the services to the hospital, and later submit the claim for processing and reimbursement.

Emergency hospitalisation

Step 1. Take admission into the hospital.

Step 2. As soon as possible, Intimate the claim at the call centre, obtain the pre-authorisation form from hospital and get the same filled in and signed by the attending doctor.

Step 3. Fax the pre-authorisation form to the HCMT/TPA along with necessary medical details like investigation report etc at the number mentioned in your Health Card/Policy Schedule. The hospital will co-ordinate for the same.

Step 4. (Option I)

A. If an authorisation for "Cashless Facility" from HCMT/TPA has been received

  • At the time of discharge
    • You will be required to pay for all such expenses that are not payable as per the terms of the policy.
    • Verify the bills and sign on all the bills
    • Leave the original discharge summary and other investigation reports with the hospital. Retain a Xerox copy for your records

Step 4. (Option II)

B. In case "Cashless Facility" has been denied by HCMT/TPA

  • At the time of discharge settle the hospital bills in full and collect all the original bill documents and reports
  • Lodge your claim with HCMT/TPA for processing and reimbursement

Planned hospitalisation

Step 1. Please co-ordinate with your doctor and the hospital and send all the details about the planned hospitalisation including the plan of treatment, cost estimates etc. to HCMT/TPA.

This may be sent at least 2 days prior to the planned admission.

Step 2. (Option I)

A. If authorisation for "Cashless Facility" from TPA has been received

  • At the time of admission, present the authorisation letter and photo ID card to the hospital
  • At the time of discharge
    • Pay for those expenses that are not reimbursable under the policy
    • Verify the bills and sign on all the bills.
    • Leave the original discharge summary and other investigations reports with the hospital. Retain a Xerox copy for your records

Step 2. (Option II)

B. In case "Cashless Facility" has been denied by HCMT/TPA

  • Get admitted and take treatment
  • At the time of discharge settle the hospital bills in full and collect all the original bill documents and reports
  • Lodge your claim with HCMT/TPA for processing and reimbursement

"Please note that failure to intimate HCMT/TPA as soon as the hospitalisation takes place can invalidate your claim."

Procedures for Reimbursement Claims Emergency hospitalisation

Step 1. Take admission into the hospital.

Step 2. As soon as possible, intimate the HCMT/TPA about the hospitalisation.

Step 3. At the time of discharge, settle the hospital bills in full and collect all the original bills, documents and reports.

Step 4. Lodge your claim with HCMT/TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form.

Planned hospitalisation

Step 1. Intimate HCMT/TPA of the planned hospitalisation.

Step 2. Get admitted into the hospital.

Step 3. At the time of discharge, settle the hospital bills in full and collect all the original bills, documents and reports.

Step 4. Lodge your claim with HCMT/TPA for processing and reimbursement.

How to lodge your claim with HCMT/TPA for processing and reimbursement

Within 7 days after discharge, please lodge your claim for processing. While submittiing your claim, please make sure that all the documents listed under the document check list are attached.

Document Check list for Hospitalisation, Domiciliary Hospitalisation & Critical illness claims

Hospitalisation / Day Care Treatment

  • 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, in original
  • Copy of FIR (if any in case of accident)

Critical Illness Claims

  • Claim form duly completed
  • Original Specialist Doctor's certificate confirming the diagnosis and when the symptoms first occurred
  • Relevant Investigation reports (Radiology, Pathology etc) confirming the diagnosis
  • Hospital admission & discharge card / certificate

Domiciliary Hospitalisation

  • 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 doctors, medical shops, diagnostic centre etc supported by Doctor's advice
  • Copy of FIR (if any in case of accident)
  • Certificate from attending Doctor/Physician stating the condition of the patient is not permissible for him/her to be removed to Hospital/Nursing Home or documentary proof of lack of accommodation in Hospital/Nursing Home

Please note the above list is only indicative. We may call for additional documents/information if required.

Reliance General Insurance

Testimonials for Claims

Here's what our customers have to say about their health claim experience with us.


4.5 out of 5
based on 42 ratings.
16 user reviews
I have had a Reliance General Insurance policy for 10 years.

We sent a mail to reliance general insurance claiming for a cashless hospitalization in non-cashless clinic... Dr.Mishraji and Dr. Sakshi Chavan instantly replied our mail and gave us a ray of hope... It is very kind and generous of RGI that people like Dr.sakshi chavan and Dr. Mishraji came in our lives as angels to help us and arrange for the cashless facility and other important procedure in no time. They both came personally to meet us in the hospital and ask about our health. Their personal attention and presence gave a healing touch.

Today my mother who was totally bed ridden and couldn't walk a step, is now able to walk with the help of a walker independently. The day is not far when she will walk without any support. This is all because of the dedicated staff like Dr.Sakshi and Dr.Mishraji present in Reliance General Insurance Company�. Their support and blessings have given my mother a new life which is unforgettable and priceless.

I've already recommended this Reliance General Insurance to more than 20 of my friends and relatives because I find that---"GO EAST OR WEST RELIANCE IS THE BEST".

Bhushan Punamiya, 18 January 2014
Thank you all for the timely help and service provided for my mother's hospitalization.
Shabbir Ashraf, 14 January 2014
Deepthi thanks a lot for immediate positive answer, what a marvelous system adopted by your company and followed by you, tu jio hajaro sal ...
Nainesh Mashruwala, 18 April 2013
NAME :- Manohar S. Varma CLAIM NO. :- 20130024475I Manohar Varma is very much thankful to you because you helped me a lot in passing out my health claim. You all properly communicated with me and gave me the best service you all could have given me. I am heartily thankful to you'll because of your great service. Thank you for your great co operation ...
Manohar Varma, 17 April 2013
Thank you Ms Amina, This is first service experience after In House TPA formed. The highlight of the service was on every occasion I was getting the feedback from your team on my mobile. such as request received , request under process, approval given. I hardly make one or two calls to Rajani. This kind of communication will get the business to RGI. Well done Thank you once again.
Chunnilal Kadel, 25 March 2013
Today I received Rs. 72,800/- (Seventy Two Thousand Eight hundred Only) against Claim No. 20130024591. I really thankful to you in my heart that you are with me in my bad time. You give me a financial support which I always remember. Your early response and support is really appreciated. Once again I give thank you very much for settle the medical insurance claim.
Vinod Navandhar, 22 March 2013
Thanks a lot madam for the prompt reply. WE heartily appreciate the quick responses from your end and this has really motivated us to work harder for selling more health-wise policy, rather than any schemes raised from the Branch level end ...
Ajay Sidana, 5 March 2013
Trust all is well with you. This is to inform you that I received the claim cheque today 4/03/2013 at 21:15hrs, to be precise. At last I can heave a sigh of relief that my health claim has been settled after 7 months. Just wanted to write you a note to thank you very much for your assistance in looking into the Re-issue of my claim cheque. It certainly was a pleasure to have someone respond so quickly and in a professional manner. I do appreciate your hard work. Please forward this mail to all concerned.
Belinda Alphonso, 5 March 2013
I really appreciate your efforts in solving my complain, it was harassment for me by the call centre, even though i was in continuously touch with them. Words cannot express my gratitude for all your efforts creating something very special and unique ... without you, this would not have been possible. Thank you for your patience, understanding and sensitivity. Thank you once again Good night.
Narendra Jadeja, 7 January 2013
I have recd the courier at 4pm. At the time of courier reached my home I went out just now came back and opened. I have recd both the cheques as you told. Thank you very much for your great help and following up of the payment. You have done a great job in helping us. After having so many bad experiences with reliance from the beginning really it is a very nice ending. Thank u so much once again Mr. Vijay. satisfied with your service. I believe, if we help one person in need, god will help us surely when in need. GOD BLESS YOU!!!
KMN Mohhan Raw, 2 January 2013
You are the person it was so kind and helpful at our time of grief. We had a lot of questions, and they were all answered to our satisfaction. Thank you very much for your help. I already collected the cheque amounting INR 14239 from Reliance General Insurance office. I appreciate your efforts in whole process and looking forward for the same kind of response in future. Thank you again to all ... I would recommend this company to anyone.
Amol Waman, 2 January 2013
At the outset I wish to thank you for your prompt attention and help in settlement of my above health insurance Claim. While the same was pending for more than one and half month; thanks for your timely help!
Kanna Iyer, 26 December 2012
I would like to take an opportunity to Thank both of you for all your help and support for the settlement of the claim. Today on 21st Dec'2012 finally our Aunt Smt Prem Lata Agrawal W/O Late Gopal Ji Agrawal received the cheque. Attached is the photograph where Joint Commissioner- Sales Tax Basti-UP (Mr R K Singh Extreme Left) along with the President and Secretary of Chamber of Commerce presented the cheque. Thank you once Again!!!!!!!Wish You both great success in future.
Neel Shukla, 21 December 2012
First of all I would like to thanks a lot for helping me in respect of my Health Claim No. 20120014334. This claim is approved and passed only because of your kind support. Again thank you very much.Pl. keep in touch.
Samiullah Inamdar, 1 November 2012
NAME :- Manohar S. Varma CLAIM NO. :- 20130024475I Manohar Varma is very much thankful to you because you helped me a lot in passing out my claim. You all properly communicated with me and gave me the best service you all could have given me. I am heartily thankful to you'll because of your great service. Thank you for your great co operation ...
Manohar Varma
Thank you Ms Amina, This is first service experience after In House TPA formed. The highlight of the service was on every occasion I was getting the feedback from your team on my mobile. such as request received , request under process, approval given. I hardly make one or two calls to Rajani. This kind of communication will get the business to RGI. Well done Thank you once again.
Chunnilal Kadel
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