If you have any queries about claims, they are answered in this section. The FAQs will give you the information you need to know about claims.
What I should do in case of claim?
Please go through the policy schedule and Policy Document along with the proposal form copy Sent to you. If you are convinced that the present situation is covered by the insurance company, please intimate to Advisor or the nearest branch or the Claims Department at Chennai immediately (at address given below) ' Please refer the suggestions below.
What are the documents required to get claim?
For ready reference we have listed down basic required documents in each case. Please go through it. Please refer the Claims Overview section
Whom to contact if I need further clarification?
We all will be pleased to assist you. You may contact any of our branch or Claims Department. The Claims Department, Reliance Life Insurance Co Ltd, 9th Floor - Building No. 2, R-Tech Park, Nirlon Compound, Next to Hub Mall, Behind I- Flex building, Goregaon, (East), Mumbai-400 063
How much I will get in case of claim?
Claim amount depends upon duration, cause of death and status of Policy. If policy is participating policy then declared bonus will be added to the sum assured and unpaid premium for that policy year will be deducted. Rider benefit, if opted, would be paid as stipulated in the policy schedule.
How much time it takes to get claim?
After receiving all required information it takes 3 days to dispatch cheque to the nearest branch, they would arrange to handover the cheque personally or you may personally collect it from the branch showing your identity.
What are the benefits available under this Plan?
- Hospital Cash Benefit – HCB.
- ICU Benefit.
- Recuperation benefit.
- Death benefit.
- Maturity Benefit.
What are the Riders Available under this Plan?
- Major Surgical benefit.
- Critical Illness benefit.
- Term life Insurance rider benefit.
- Term Life Insurance with ADB cover.
What is the benefit under HCB?
Lump Sum payment of 5% of annualized premium subject to a minimum of Rs. 500 and maximum of Rs. 2500 per day – waiting period 48 hours - No retroactive payments from day one are to be made.
What is the ICU benefit?
Twice the daily HCB, i.e. minimum of Rs. 1000 and maximum of Rs. 5000.
What is the Recuperation benefit?
It is a lump sum benefit equal to 2 days daily amount in a ward other than ICU. The Recuperation benefit is paid only if there is a minimum stay of 5 full days (120 hours) in hospital.
What is the amount payable to nominee on death?
Fund Value relating to the base policy and the top ups as on the date of intimation.
What is the amount payable at Maturity?
Fund Value relating to the base policy and the top ups as on the date of intimation.
Who can avail the hospital cash benefit?
Principal Life Assured (Policy Holder), Spouse (Insured Spouse) and first two eligible children by seniority in age.
Can it be taken with other Mediclaim policies?
Would I get a Health Card?
Yes, you will receive the same with the Welcome kit.
What would I receive in the Welcome Kit?
You would receive the following:
- ID cards/Health Card for all insured person(s) (a card which has your policy number and contact information of TPA).
- Network Hospital List with contact details.
- Claims and Pre-Authorization Forms.
Is there any waiting period for Hospital cash benefit?
Yes, 90 days waiting period except for accident related hospitalization.
Whom should we approach in case of a claim?
For Hospital cash Benefit, Surgical Benefit and Critical Illness Benefit, you should contact your TPA given on the health card.
What is the claims process?
In case of network hospital, Pre authorization is absolutely necessary without which the Network provider will refuse cashless service. Please send the Hospital request note from the attending physician stating the following to TPA via Fax/courier/e-mail/messenger.
- Ailment and its duration
- Known past illness, if any
- Hypertension or diabetes
- The name of the Hospital /Nursing home and consultant's contact no.
- The proposed date of admission
- Class of accommodation
- The approximate duration
- Treatment plan
After due scrutiny, TPA will send an Authorization Letter (AL) for cashless treatment and guarantee of payment. This is subject to the terms, conditions, exclusions and limitations of the Hospitalization cash benefit cover for insured person(s) under the Reliance Wealth + Health plan.
What to do in case of an emergency?
- In the event of emergency, you could first admit the patient in the Hospital and then inform TPA, within 12 hours. You could call up the number provided on the reverse of the ID card
- As it is an emergency, you have the facility of collecting the pre-authorization form from the treating hospital or you could even download the PDF format from the TPA website
- Insured should show the ID/Health card to the network hospital and also submit the pre-authorization form to the treating hospital
- The forms shall be scrutinized and further processed and the cashless facility will be activated
- On discharge, you would need to sign the required documents
- TPA will pay the amount to the hospital
What to do if I go to a non network hospital?
While it is suggested that you choose a network hospital, you are at liberty to choose a Non-network hospital only in the event of an emergency and as advised by your doctor. Prior approval of TPA is a must even in a Non Network Hospital. In this case, you pay the bill first and later get it reimbursed. On completion of treatment, you will have to submit the following documents in original/attested copy to TPA to obtain reimbursement of eligible claim amount.
- Hospital Bill and Receipt for payment
- Claim form duly signed
- Discharge card/discharge summary
- Reports of all investigation
Within how many days would I get the money?
Within 15 days subject to policy conditions and provided all the required documents are submitted.
Is there any waiting period for surgical benefit rider?
Yes, 90 days waiting period. The benefit can only be claimed if the illness is diagnosed at least 90 days after the date of commencement of risk or reinstatement of risk except for accidental injury.
Benefit under Surgical benefit?
Maximum is 100% of SA subject to a maximum of 5 lakhs. Min SA is 10,000 and Maximum - 180 times HCB in a ward other than ICU. Maximum benefit during the entire policy term is 3 times the sum assured under Major Surgical Benefit subject to a maximum of Rs. 15 Lakhs.
Benefit under Critical Conditions Rider?
Min 10,000 and Max -180 times HCB in a ward other than ICU. Maximum limit is 20 lakhs – Across all policies held by the life assured with RLIC. The critical illness cover terminates on payment of the first critical illness benefit.
Is there any waiting period for Critical conditions Rider?
Yes, 180 days waiting period. The benefit can only be claimed if the illness is first diagnosed at least 180 days after the date of commencement or reinstatement of the risk.
Admissibility of overseas claim?
Hospitalization / Surgical procedures should take place with in India.
What is the Maximum Annual benefit period?
18 days in 1st yr, 60 days per year thereafter, inclusive of stay in ICU.
For ICU 7 days 1st year, 30 days per year thereafter - 2nd year onwards.
What is the maximum benefit period during the policy term for hospitalization?
180 days (in hospital including ICU) for Principal insured, Insured Spouse and Insured child (90 days until the child completes age 5 years).
Whether the HCB is payable during the non premium paying period?
Whether dental treatment is covered?
Whether the Death benefit is payable in case of death of any spouse /children covered under the policy?
No, it is paid only in the case of principal Insured.
What are the exclusions under the HCB?
- Hospitalization event within 90 days form the commencement of the policy except for accident
- Pre-existing and related disorders
- Hospitalization for diagnostic reasons
- Dental treatment or surgery of any kind unless necessitated by an accident
- Hospitalization for any condition arising from or traceable to pregnancy or Child birth
- Natural Perils
- Accidents arising from drunken driving
- Participation in any hazardous activity
What is Deferment Period?
First two days (48 hrs) of hospitalization is not covered. The daily HCB benefit will be paid for each complete day of hospitalization (24 hrs) after the first 48 hrs. There will not be any payment for part of the day i.e. before completion of 24 hours