All documents to be submitted in original.
Reimbursement Claims can be lodged by visiting nearest RNLIC branch office.
The Insurer / TPA may call for additional documents, on a case to case basis, to evaluate the merit of a claim
Additional documents in case of claim under Critical Conditions (25) Rider / Major Surgical Benefit in Wealth + Health Plans
Photocopies of all documents should be attested by a Reliance Nippon Life Insurance Official.
The Insurer / TPA may call for additional documents, on a case to case basis, to evaluate the merit of a claim.
In the event of death of the Life Insured prior to claim intimation, the relevant forms/documents are to be filled/provided by Nominee/ Claimant under the policy
Photocopies of documents should be attested by a Reliance Nippon Life Insurance Official.
The Insurance Company reserves the right to ask for additional documents/information
In the event that the policyholder is hospitalized /planning a hospitalization in a network hospital / nursing home, he / she need not pay the medical expenses (as per coverage) up to the sum insured specified under the policy. This is subject to claim intimation to the TPAs appointed by Reliance Nippon Life Insurance Company Limited (RNLIC) and approval of the request as per terms of the policy.
The insured has to approach the TPA desk of the hospital along with the RNLIC Health Card, KYC (a Photo ID card such as Pan Card, Voter ID card, Driving Licence etc.) and all the medical reports including diagnosis report. The hospital will then send the request for authorization of treatment to RNLIC through TPA. TPAs appointed by RNLIC will coordinate with the hospital/nursing home directly for approval and/ or pre-authorization, if required and also for settlement of the bills to the extent of authorization only to the hospital directly by the insurance company after the insured patient is discharged. If the request is denied as per the policy’s terms and conditions, the insured himself/ herself has to pay the bills and submit the claim documents for a reimbursement to the insurance company through the TPA.
Note: In cashless hospitalization, RNLIC will pay 95% of total admissible expenses while the balance 5% and inadmissible expenses (if any) will be borne by the Policyholder at the time of discharge from the hospital.
In the event that an insured is hospitalized in any hospital / nursing home (within India) and pays the treatment expenses at the time of discharge, he / she needs to file a claim with RNLIC for the amount due under the policy. RNLIC will process the claim as per the terms of the policy and reimburse the medical expenses covered to the insured if the claim is admissible.
Ideally within 15 days from the date of discharge from the hospital, the insured has to ship / courier mandatory documents to the TPAs addresses mentioned below:
Alternatively, claim can also be intimated at nearest RNLIC branch office.
This happens due to various reasons. The most common are:
Yes, the claim would be payable subject to the payment of renewal premium before date of discharge from the Hospital or within the grace period, whichever is earlier.
There is no limit on the number of claims during the policy period; however the settlement amount of all claims should not exceed the Sum Insured under the policy.
When members of the same family are covered under a single plan and the Sum Insured is utilized by any one member or all the members collectively during the policy year, the plan is called Family floater.