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Individual Health Insurance Plans
Reliance Health Gain Policy
Health insurance policies are the most common and popular insurance policies in the market due to their protective nature. But often, it has been found that all the benefits of a standard health policy are not applicable and beneficial for all consumers equally. Again, you want a benefit to be covered under your health plan, but your plan does not provide coverage for that. In this way, we often choose a medical policy that is not completely suitable for us and does not cater to the varied needs of the individuals.
To solve this problem, Reliance General Insurance Company has come up with a plan, Reliance Health Gain Insurance, under which you can build your own policy according to your convenience. You have heard it right. You can design your health insurance policy on the basis of your needs and pay for only those covers. This plan has been recently launched that is super flexible, consumer-friendly, and customizable. Therefore, you do not have to make any compromises with your medical plan. to know about this plan in detail, have a look at the following mentions.
Eligibility Criteria
| Parameters | Description |
| Minimum entry age | Child under family floater policy – 91 days Child under individual policy – 5 years Adult – 18 years |
| Maximum entry age | Child – 25 years, Adult – 65 years |
| Exit age | No exist age |
| Renewal | Lifelong renewability |
| Policy type | Individual policy and Family Floater policy |
| Plan variants | Plus, Power, and Prime |
| Individual policy | Maximum 8 members can be covered on an individual sum insured basis (Self, Spouse, Son, Daughter, Father, Mother, Father-in-law, Mother-in-law, Brothers, Sisters, Grand Parents, Grand Children, Daughter-in-law and Son-in-law) |
| Family floater policy | Plus – maximum of 2 Adults (Self + Spouse) and 6 children Power – maximum of 4 Adults (Self+ Spouse + one set of dependent Parents or Parents-in-law) and 6 children Prime – maximum of 6 Adults (Self + Spouse + set of dependent Parents + set of Parents in law) and 6 children |
| Policy tenure | 1, 2, and 3 years |
| Waiting period | The first 30 days – 30-day waiting period is applicable from the start of the policy date towards the treatment of any illness except for claims related to an accident. Pre-existing diseases – 3 years waiting period for expenses related to the treatment of PED. Continuous coverage of 36 months is essential after the date of inception of the first policy. Specific diseases – 2 years waiting period applies to specific diseases. Continuous coverage of 24 months is essential after the date of inception of the first policy. Covid-19 – 15 days |
| Sum insured options | Plus – Rs. 3 lakhs, and Rs. 5 lakhs Power – Rs. 10 lakhs, Rs. 15 lakhs, and Rs. 20 lakhs Prime – Rs. 25 lakhs, Rs. 30 lakhs, Rs. 50 lakhs, and Rs. 100 lakhs |
| Renewal Business/Call Option Base Sum Insured | Plus – Rs. 3 lakhs, Rs. 5 lakhs, Rs. 6 lakhs, and Rs. 9 lakhs Power – Rs. 10 lakhs, Rs. 12 lakhs, Rs. 15 lakhs, Rs. 18 lakhs, Rs. 20 lakhs, and Rs. 24 lakhs. Prime – Rs. 25 lakhs, Rs. 30 lakhs, Rs. 36 lakhs, Rs. 40 lakhs, Rs. 48 lakhs, Rs. 50 lakhs, Rs. 60 lakhs, Rs. 72 lakhs, Rs. 80 lakhs, and Rs. 100 lakhs |
What Will You Get With Reliance Health Gain Policy?
This policy has come up with a sack full of benefits and facilities that promises to protect you and your family from health risks and offer you financial relief. The following table gives you a detailed chart of those benefits. Have a look.
| Plan variants | Plus | Power | Prime |
| Basic Features | |||
| Hospitalization expenses including in-patient hospitalization, daycare, and accommodation bonus | Covered up to the sum insured Accommodation Bonus: Additional fixed daily amount of Rs. 1,000 on opting lower category room | ||
| Domestic road ambulance cover | Covered up to Rs. 1500 per hospitalization Intercity Ambulance cost (beyond 100km): Rs. 20,000 per hospitalization | Covered up to Rs. 3000 per hospitalization Intercity Ambulance cost (beyond 100km): Rs. 20,000 per hospitalization | Covered as per Actuals (Including Intercity ambulance, beyond 100km) |
| Domiciliary hospitalization | Within the sum insured | ||
| Modern treatment cover | Covered up to 50% of the base sum insured | Covered up to 100% of the base sum insured | |
| Pre-hospitalization expenses | Up to 60 days within the sum insured | ||
| Post-hospitalization expenses | Up to 60 days within the sum insured | Up to 90 days within the sum insured | |
| Organ donor expenses | Covered up to 50% of the base sum-insured, Maximum up to Rs. 5 lakhs | Covered up to 50% of the base sum insured, Maximum up to Rs. 10 lakhs | |
| Accidental death cover | Not applicable | 5% of base sum insured that is subject to a minimum of Rs. 1 lakh | |
| Waiver of premium | Not applicable | This benefit waives the renewal policy premium for one year, in case of the first diagnosis of a certain listed Critical Illness. For long-term policies, the company will waive a one-year proportionate renewal policy premium. | |
| Cumulative bonus | An increase in base sum insured by 33.33% for every claim-free policy year is allowed, which is subject to a maximum of 100% of the base sum insured and a decrease of 33.33 % of the base sum-insured for every claim year. | ||
| Loyalty cover | At the end of each completed and continuous Policy Year, the company will provide Loyalty Cover to the policyholder (who is also an Insured Person) under the policy. | ||
| Policy service guarantee | Rs. 10000 | Rs. 20000 | Rs. 20000 |
Add-on Features (You can avail of the benefits by paying a little extra premium amount) | |||
| Guaranteed cumulative bonus | This benefit waives off the condition of a decrease in Cumulative Bonus in case of a claim in an immediate policy year. | ||
| Unlimited reinstatement of based sum insured | On a subsequent claim, unlimited reinstatement of base sum insured on unrelated illness or injury, sub-limit of 100% of base sum insured for related illness/injury | ||
| Consumable cover | Within sum insured (reasonable and customary expenses incurred by the policyholder/insured person, during the policy year, for items which are listed in the annexure of the policy wordings) | ||
| Double cover | Choosing this cover will provide an additional 100% of the base sum insured on the same claim, in single hospitalization after exhaustion of the base sum insured under the policy. This benefit supersedes the base feature of ‘Extra Sum insured’. | ||
| Change in room rent limit | Category of Room capped to Twin sharing | Category of Room upgrade to Actuals Or Category of Room capped to Twin sharing | Category of room capped to Single private AC room. |
| Reduction in pre-existing disease waiting period | Choose this benefit to reduce the Pre-Existing Waiting Period to 24 months or 12 months | ||
| Removal of co-payment | This benefit waives off the Co-Payment condition of 20% on the Assessed Claim Amount, applicable on Policies where the Insured age, first time entering the Policy is >=61 years | ||
| Hospital cash | Daily Cash options: Rs. 1,000, Rs. 1,500, Rs. 2,000, and Rs. 2500, maximum of up to 30 days for In-Patient Hospitalisation and 15 days for ICU Hospitalisation. Minimum Hospitalisation of 72 hours is required. | ||
| Change in pre and post-hospitalization limit | The benefit enhances the pre-hospitalization limit to 90 days and the post-hospitalization limit to 180 days | ||
| Air ambulance cover | Covers cost up to 7.5% of the base sum insured or Rs. 5 Lakhs whichever is higher | ||
| Radio taxi | Over expenses up to Rs. 1000 per hospitalization | ||
| Convalescence cover | Rs. 10,000 lumpsum is provided if the Insured Person is hospitalized for a minimum period of 7 continuous and consecutive days | Rs. 25,000 lumpsum is provided if the insured person is hospitalized for a minimum period of 7 continuous and consecutive days | |
| Health check-up | End of every policy year preventive health check-ups up to Rs. 3,000 can be availed of. | ||
| Vaccination cover | Annual expenses for vaccination (as listed in the policy wording) covered up to Rs. 2,000 | Annual expenses for vaccination (as listed in the policy wording) covered up to Rs. 3,500 | |
| Vision correction | Medical expenses covered up to Rs. 50,000 for correction of eyesight due to refractive error | Medical expenses covered up to Rs. 1,00,000 for correction of eyesight due to refractive error | |
| Second opinion | Expenses up to Rs. 3000 are covered by a second opinion from a medical practitioner in India | Expenses up to Rs. 5,000 is covered towards the second opinion from a medical practitioner in India | |
| Homecare treatment | Covered up to 100% of the sum insured | ||
| Companion cover | A fixed daily amount of Rs. 1,000 is offered towards expenses incurred by the Companion towards accommodation, transportation, food, or any other miscellaneous expenses, maximum of up to30 days. A minimum of 72 hours of hospitalization is required for this benefit to trigger. | ||
| Child care cover | A fixed daily amount of Rs. 1,000 is offered towards childcare expenses for any one dependent child covered under the policy up to 12 years of age, for a maximum of up to 30 days. A minimum of 72 hours of hospitalization is required for this benefit to trigger. | ||
Key Highlights of Reliance Health Gain Policy
Apart from the above benefits, this policy offers a bundle of extraordinary advantages that have made the policy unique and popular among consumers. Those mentions are as follows.
Reinstatement of Base Sum Insured:
On the subsequent claim, one reinstatement of up to 100% of the base sum insured is allowed for unrelated illness/injury. Sub-limit of 20% of the base sum insured for related illness/injury is applicable.
Extra Sum Insured:
The policy allows you to avail of an additional 20% of the Base sum insured on the same claim in a single hospitalization.
Call Option For Enhancement of Base Sum Insured:
After 4 continuous and consecutive claim-free Policy Years, if the policyholder avails of this benefit, then the enhanced Sum Insured is the sum of the expiring Policy’s Base sum insured and accumulated Cumulative Bonus.
Wellness Services:
This is a service in which an insured person can seek medical advice by telephonic or online mode.
Claim Service Guarantee:
This unique feature works as per the following:
- Cashless Claim – 1% of the delayed claim amount (for delays beyond 6 hours to 12 hours), an additional 1% for every additional delay of 6 business hours.
- Reimbursement Claim – 1% of the delayed claim amount (for delays beyond 21 days to up to 42 days), an additional 1% for every additional delay of 6 business hours Maximum limit – 6% of the delayed claim amount.
Available Discounts:
This policy offers several discounts as per the followings:
- Cross-sell Discount – If you are an existing Reliance customer (e.g.: Private Car Package Policy Insurance), you get to zoom off with a special 7.5% discount on your Health Gain premium or if you already have another health policy, you can extend this discount to 10%.
- Girl Child and/or Female Proposer Discount – You are eligible to get an exclusive 5% discount on the premium if you are a woman and/or if you have a girl child.
- Family Discount – Depending on your family’s size, when you insure more than one family member individually in the same policy you can get up to a 10% discount on the policy premium.
- Long-Term Discount – You are eligible to get a 7% discount for 2 years policy and 12% for 3 Years Policy.
- Long-Term Fresh Healthy Life Discount – There is an option to get a 15% discount if you are <50 years of age, buying a long-term 2/3-year health policy for the first time.
- Online discount – You can avail of up to a 10% discount if you purchase this policy online.
Tax Exemption Benefits:
This policy also gives you the scope to get tax exemption benefits under Section 80D of the Income Tax Act of India.
What are the general exclusions of the Reliance Health Gain Policy?
Understanding a policy is not completed if you do not go through its exclusions of it thoroughly. Therefore, to offer you a better idea of the plan, and to avoid future complications, here are the general exclusions of the Reliance Health Gain Policy for which it does not provide any coverage.
- Investigation & Evaluation
- Rest Cure, rehabilitation, and respite care
- Obesity, Weight Control unless life-threatening
- Change-of-Gender treatments
- Cosmetic or Plastic Surgery unless for the accident, cancer, or burns
- Hazardous or Adventure sports
- Breach of law
- Excluded Providers
- Substance Abuse and Alcohol
- Wellness and Rejuvenation
- Dietary Supplements & Substances
- Refractive Error
- Sterility and Infertility
- External Congenital Anomaly
- Medically Not Necessary Treatment
- Outpatient treatment
- Overseas treatment
- Charges other than Reasonable and Customary
- Self-injury, suicide attempt, or suicide
- Treatment outside discipline
- War or similar situations
- Unproven Treatments
Premium Calculation of Reliance Health Gain Policy
After knowing the inclusions and exclusions of the policy, the next important thing to know is the premium amount that you need to pay to purchase this policy. Therefore, to offer you a clearer view of the policy here is an example.
Mr. Bose, a 36-year-old, Kolkata-based businessman, bought Reliance Health Gain Policy for himself. Let us find out how much premium value he has to pay to avail of the benefits of this policy for the given details.
| Parameters | Data |
| Age | 36 years |
| Sum insured | Rs. 15 lakhs |
| Policy for | Self |
| Policy type | Individual policy |
| Policy tenure | 2 years |
| Total premium | Rs. 27,434 |
| Premium break-up |
|
Now, the same Mr. Bose wants to include his wife under the same policy. Certainly, the credentials will change. So, now we will find out the newly formed premium amount that he has to pay for the policy for the given credentials.
| Parameters | Data |
| Age | Self – 36 years, Spouse – 34 years |
| Policy for | Self and spouse |
| Sum insured | Rs. 20 lakhs |
| Policy tenure | 3 years |
| Policy type | Family floater policy |
| Total premium | Rs. 59,253 |
| Premium break-up |
|
Frequently Asked Questions
20% of the claim amount in Floater Policy is applicable, for all insured, if the age of the eldest member at entry is 61 years or above. In the case of an Individual Policy, for those insured whose age at entry is 61 years or above, the co-payment is applicable.
The minimum age of the proposer should be 18 years.
Year-wise availability of Sum Insured for Loyalty Cover (‘Earned’ Loyalty Cover Sum Insured) is as per the following table.
| Policy year | Coverage |
| Year 2 | 10% of Base Sum Insured Accidental Death & Permanent Total Disability |
| Year 3 | 20% of Base Sum Insured Accidental Death & Permanent Total Disability + 10% of Base Sum Insured Critical Illness |
| Year 4 | 30% of Base Sum Insured Accidental Death & Permanent Total Disability + 20% of Base Sum Insured Critical Illness + Hospital Cash {Daily Cash amount (Plan accordingly) of: Plus: Rs. 1000, Power: Rs. 2000, Prime: Rs. 3000} |
| Year 5 | 40% of Base Sum Insured Accidental Death & Permanent Total Disability + 30% of Base Sum Insured Critical Illness + Hospital Cash {Daily Cash amount (Plan accordingly) of Plus: Rs. 1000, Power: Rs. 2000, Prime: Rs. 3000 + Leave Compensation Benefit (Rs. 1000 per day) |
| Year 6 | 50% of Base Sum Insured Accidental Death & Permanent Total Disability + 40% of Base Sum Insured Critical Illness + Hospital Cash {Daily Cash amount (Plan accordingly) of Plus: Rs. 1000, Power: Rs. 2000, Prime: Rs. 3000} + Leave Compensation Benefit (Rs. 1000 per day) |
| Year 7 | 50% of Base Sum Insured Accidental Death & Permanent Total Disability + 50% of Base Sum Insured Critical Illness + Hospital Cash {Daily Cash amount (Plan accordingly) of Plus: Rs. 1000, Power: Rs. 2000, Prime: Rs. 3000} + Leave Compensation Benefit (Rs. 1000 per day) |
| Maximum limit | 50% of Base Sum Insured or 25 lakhs (whichever is lower ) Accidental Death & Permanent Total Disability + 50% of Base Sum Insured or 25 lakhs (whichever is lower) Critical Illness + Hospital Cash {30 days of payment} + Leave Compensation Benefit (30 days of payment) |
The followings are the conditions:
- The total of all discounts should not exceed 40% (Excluding Long Term discounts) in aggregate.
- Long Term Fresh Healthy Life Discount will be applicable subject to no Pre-Existing Disease.
Yes, with this policy, you will get the facility to avail of both cashless and reimbursement benefits. More than 8600 network hospitals of the company are spread all over the country.
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