What’s The Product All About?
The Reliance General Health Gain is a robust health insurance policy offered by Reliance General Insurance Company Limited. This policy has three distinct options: Plus, Power, and Prime. What truly sets this plan apart are its captivating features, add-on options, and cost-saving opportunities. With its wide-ranging coverage, you can rest assured that your medical requirements will be met without imposing any financial strain. This policy offers remarkable adaptability, including a variety of enhancing covers that allow you to personalise it according to your specific needs.
Who Is Eligible?
- Dependent children can be covered from 91 days to 25 years for the floater plan.
- If your children are over 5 years old, they can also be covered individually. In such cases, at least one member aged 18 years or older must be the proposer.
- When it comes to adults, the maximum age of entry is 65 years. However, there's no age restriction for individuals seeking a sum insured of Rs. 3 lakhs.
Unlocking the Benefits and Limitations
The Reliance General Health Gain Plan goes beyond just taking care of inpatient expenses like charges for your room, nursing, medical practitioner's fees, prescribed medications, ICU usage, and other connected costs when you're admitted to the hospital for over 24 hours.
Let’s take a quick look at some of the other expenses covered by this plan –
- Pre & Post Hospitalisation Expenses
Your doctor may ask you to undergo several tests before or after you are admitted to the hospital, which entail costs known as pre-hospitalisation and post-hospitalisation expenses. But, don’t worry, the insurer has got your back.
Plus and Power Plans: Will cover expenses up to the sum insured for 60 days before your hospitalisation and 60 days after you get discharged from the hospital.
Prime Plan: Will cover expenses up to the sum insured for 60 days before your hospitalisation and 90 days after hospitalisation.
But you can also extend these limits under all 3 plan options by choosing an add-on. It can increase the pre-hospitalisation limit to 90 days and the post-hospitalisation limit to 180 days. You should keep in mind that the insurer will only cover pre- and post-hospitalisation expenses if they are related to the medical condition that led to your hospitalisation and is approved as part of inpatient hospitalisation.
- Daycare Treatment Coverage
Daycare treatment refers to medical procedures or surgeries that used to demand a long hospital stay but can now be done in just 24 hours thanks to medical advancements. The Reliance General Health Gain Plan includes coverage for all daycare procedures across its 3 variants - up to the sum insured.
- Domiciliary Treatment Coverage
Domiciliary treatments mean medical care for illnesses or injuries that require immediate hospital attention but are administered at home if you cannot move to the hospital due to the severity of your health condition or there is non-availability of hospital beds. With the Reliance General Health Gain Plan, you are covered for domiciliary treatment expenses up to the sum insured, across all 3 variants.
- Organ Donor Coverage
The Reliance General Health Gain Plan (all 3 variants) also provides coverage for organ donor expenses. It handles the costs for inpatient care related to organ transplants (where, you, the insured are the recipient) up to 50% of the base sum insured. However, there is a maximum sub-limit of either Rs. 5 lakhs or Rs. 10 lakhs, depending on the specific plan variant you buy.
- Modern Treatments Coverage
Healthcare is swiftly advancing due to technology, giving rise to innovative treatments that were once thought to be impossible. The Reliance General Health Gain Plan is designed to keep up with these changes and covers the costs related to these advanced treatments.
Plus and Power Plans: Costs are covered up to 50% of the sum insured. However, you have an option to enhance this coverage to 100% of the sum insured by choosing an add-on.
Prime Plan: Costs are covered up to 100% of the sum insured without the need for an add-on.
- Non-Medical Expenses
The Reliance General Health Gain Plan goes beyond medical costs and includes coverage for non-medical expenses too. These expenses refer to the cost of consumables like gloves, nebulization kits, oxygen masks, etc., that are needed for treatment. The plan covers these expenses up to the sum insured across all 3 variants to help ease your financial burden. But you should keep in mind that you can access this benefit only if you pay an extra premium, as it is available as an add-on cover.
- Cumulative Bonus
With the Reliance General Health Gain Plan (all 3 variants), you can earn a bonus of 33.33% for every year you don’t make a claim up to a maximum of 100% of your sum insured. And, by choosing the Guaranteed Cumulative Bonus add-on, which requires an additional payment, your accumulated bonus remains unaffected even if you make a claim in the future. However, certain terms and conditions apply to this coverage.
- Reinstatement of Base Sum Insured
Under the Reliance General Health Gain Plan (all 3 variants), your sum insured gets replenished when it is used up during a policy year.
The plan restores 100% of your basic sum insured for subsequent claims when it comes to unrelated illnesses. However, there is a sub-limit of 20% for related illnesses. This benefit kicks in when your entire sum insured is utilised and is available for future claims under the in-patient benefit during the policy year. This reinstatement benefit will be available once each policy year, throughout your life, as long as you keep renewing your policy. Moreover, if you choose the Unlimited Reinstatement of the base sum insured (an optional benefit), you'll get unlimited restorations within a policy year.
- Room Rent Limit
The maximum amount your insurer covers for the hospital room you stay in is called the room rent limit. If you choose a room that fits within this limit, you will not be required to pay anything extra. But, if you pick a room that costs more than your eligibility, a proportionate deduction will be applicable. This means you will need to pay a proportionate share of the whole bill, not just the extra room cost. The Reliance General Health Gain Plan (all 3 variants) does not have room rent restrictions if you decide to opt for an add-on.
Additional Features Of The Plan!
- Reduction in PED Waiting Period
With Reliance General Health Gain (all 3 variants), you have the opportunity to decrease the waiting period for pre-existing diseases from 36 months to either 24 months or even just 12 months. It is an optional benefit that you can access by paying an extra premium.
- Extra Sum Insured
This feature helps you expand your coverage beyond the basic sum insured for a policy year - for all 3 plan variants. With this benefit, you receive an extra 20% of the sum insured for the same claim during a single hospitalisation. You can use this once your initial sum insured is entirely used up.
It offers an additional layer of protection, especially for individuals dealing with substantial medical bills. This feature holds particular value in situations involving serious illnesses or accidents, where medical costs can be substantial. It ensures that you have a financial backup if you happen to exhaust your basic sum insured. The coverage is subject to terms and conditions.
- Child Care Cover
This is an important aspect of the Reliance General Health Gain Plan (all 3 variants), particularly helpful for parents with young children. This feature offers a set daily amount of Rs. 1,000 to handle childcare expenses for a single dependent child aged up to 12 years, as long as they are covered by the policy. It helps parents or guardians in managing costs associated with childcare services while they are hospitalised, for a maximum of 30 days. To activate this benefit, you should be hospitalised for a minimum of 72 hours. The coverage is subject to terms and conditions.
Understanding Waiting Periods
When you buy a health insurance policy, it is important to understand the associated waiting periods. A waiting period is a duration during which specific illnesses and medical conditions will not be covered after you purchase the policy. Once this waiting period ends, you can start making claims for these conditions.
Waiting periods are of various types, including –
- Initial Waiting Period
When you purchase a health insurance policy, an initial waiting period applies for all medical conditions except accidents. This means you cannot make a claim for any medical issue during the initial days except in case of an accident. Reliance General Health Gain (all 3 variants) has an initial waiting period of 30 days.
- Pre-Existing Disease Waiting Periods
Pre-existing diseases are those health conditions that you had in the last 48 months prior to issuance of your health insurance plan. With the Reliance General Health Gain Plan (all 3 variants), there is a waiting period of 36 months for these conditions. That means that during this time frame, the policy will not cover expenses linked to your pre-existing diseases. But, if you choose an add-on, you can cut down this waiting period to either 24 or even 12 months.
- Waiting Periods for Specific Diseases
Apart from your pre-existing conditions, there are certain medical issues listed by insurers that have their own waiting periods. This waiting period applies irrespective of whether you have experienced these conditions in the past or not. This period is decided solely by the insurer and does not depend on your current health. In the case of Reliance General Health Gain Plan (all 3 variants), there is a 24-month waiting period for specific diseases.
What is Not Covered Under the Plan?
There are certain situations that your health insurance will not cover and these are called exclusions. Here are some of the types of exclusions -
- Standard Permanent Exclusions
In health insurance, there are specific situations that are excluded from coverage according to the guidelines set by the IRDAI. These ‘standard permanent exclusions’ are consistent across all insurance companies. Here are some of them –
- Investigation and evaluation: Hospital stay purely for observation without active treatment.
- Obesity/weight control: Surgery or treatment for weight control or obesity.
- Plastic/cosmetic surgery: Procedures altering appearance or body characteristics.
- Rest cure, rehabilitation, and respite care: Admission for bed rest without active medical intervention.
- Change of gender treatment: Treatment to change characteristics to the opposite sex.
- Breach of law: Expenses associated with treating someone who has committed or attempted to commit a criminal act.
- Excluded Providers: Treatment from practitioners or hospitals not covered by the insurer.
- Profession in hazardous or adventure sports: Treatment for injuries arising out of engaging in hazardous or professional adventure sports like scuba diving, mountaineering, river rafting, etc.
- Narcotics: Treatment for alcohol, drug addiction, etc.
- Treatments in establishments arranged for domestic purposes: Expenses from treatments in spas, nursing homes, etc., arranged for domestic reasons.
- Refractive Errors: Treating refractive errors of up to 7.5 diopters.
- Expenses related to birth control, sterility infertility: Contraception, artificial insemination, sterilisation, and infertility treatments like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Dietary supplements, substances purchased without prescription: Expenses of vitamins, and minerals, etc. not prescribed by a doctor.
- Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisations, etc.
- Unproven Treatments: Medical procedures not proven to be effective.
- Additional Permanent Exclusions
Apart from the standard exclusions mentioned earlier, insurance companies might also exclude specific situations or medical conditions. If you have certain diseases or severe health conditions that insurers deem too risky to cover, they might not provide coverage for them as well. It is important to note that insurance companies can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
- Non-Standard Exclusions (Specific Exclusions)
In addition to the usual permanent exclusions outlined by the IRDAI, there are specific exclusions as well. These exclusions can differ across insurers and may depend on the policy's terms and conditions.
Here are some of the specific exclusions of the plan (all 3 variants) –
- Dental treatments or surgeries, unless they result from an injury and necessitate hospitalisation.
- Costs of hearing aids, eyeglasses, contact lenses, routine eye and ear examinations.
- Circumcision unless medically required for illness or due to an accident.
- All preventive care, vaccination, including inoculation and immunisations (except in the event of post-bite treatment).
- Artificial life maintenance, such as the use of life support machines in case of no possibility of recovery or restoration of previous health.
- Expenses associated with donor screening, treatment, like donor organ removal surgery in transplant cases.
- Costs of non-allopathic treatments, except for AYUSH treatment.
- Domiciliary hospitalisation or home-based treatment.
- Self-inflicted injuries.
- Expenses related to organ transplant surgeries involving organs not harvested from a human body.
- Injuries or medical conditions arising out of events of war foreign enemy actions, hostilities, military or usurped power, etc.
Here's a quick overview of the product’s benefits and their coverage limits -
Pre & Post Hospitalisation
Plus & Power Plans: Expenses covered 60 days before hospitalisation and 60 days after hospitalisation up to the sum insured.
Prime Plan: Expenses covered for 60 days before your hospitalisation and 90 days after your hospitalisation up to the sum insured.
This can be extended to 90 days and 180 days (as an add-on) under all 3 variants.
Daycare Treatment Coverage
Up to the sum insured under all 3 variants.
Domiciliary Treatment Coverage
Up to the sum insured under all 3 variants.
Organ Donor Coverage
Inpatient expenses up to 50% of base sum insured for all 3 variants.
Subject to a sub-limit of Rs 5/10 Lakhs, depending on the variant.
Modern Treatment Coverage
Plus and Power Plans: Expenses up to 50% of the sum insured. You can extend coverage to 100% with an add-on.
Prime Plan: Expenses up to 100% of the sum insured.
Non-Medical Expenses Coverage
Up to the sum insured (with add-on) for all 3 variants.
33.33% bonus up to 100% of the sum insured for all 3 variants. With an add-on, you can keep the bonus intact even after claims.
Reinstatement of Base Sum Insured
Up to 100% of the sum insured for unrelated illnesses and 20% of sum insured sub limit for related illness - for all 3 variants.
It triggers on full exhaustion of the base sum insured.
Room Rent Limit
No limit for all 3 variants with an add-on.
Covered after a waiting period of 36 months under all 3 variants. You can reduce it to 24 or 12 months with an add-on.
Covered after a waiting period of 24 months under all 3 variants.
Here’s Your Reading Material!
- What is the waiting period for pre-existing diseases (PED) with Reliance General Health Gain?
Under this plan (all 3 variants), there is a waiting period of 36 months for pre-existing diseases. But if you choose to get an add-on, you have the option to shorten this waiting period to either 24 months or even just 12 months.
- Is AYUSH treatment covered by Reliance General Health Gain?
No, unfortunately, any variant of the plan does not cover Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy treatments, collectively known as AYUSH treatments.
- Will I receive a discount with Reliance General Health Gain for choosing a longer policy duration?
Yes. Opting for a 2-year policy will give you a 7% discount while a 3-year policy will provide an even bigger discount of 12% - across all 3 variants.
- Is maternity coverage included in Reliance General Health Gain?
Unfortunately, any variant of the plan does not cover maternity expenses.
- Is coverage provided for consumables under the Reliance General Health Gain Plan?
Yes, all variants of the plan offer an optional cover that includes all costs related to consumables and or single-use medical supplies like gloves, syringes, masks, cotton, etc.