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Claims FAQs
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.
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What I should do in case of claim?
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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.
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What are the documents required
to get claim?
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For ready reference we have listed down basic required documents in each case. Please go through it.
Please refer the
Claims Overview section
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What Whom to contact if I need
further clarification?
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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
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How much I will get in case
of claim?
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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.
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How much time it takes to get
claim?
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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.
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What are the benefits available
under this Plan?
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 Hospital Cash Benefit – HCB.
ICU Benefit.
Recuperation benefit.
Death benefit.
Maturity Benefit.
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What are the Riders Available
under this Plan?
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Major Surgical benefit.
Critical Illness benefit.
Term life Insurance rider benefit.
Term Life Insurance with ADB
cover.
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What is the benefit under HCB?
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Lump Sum payment of 5% of annualized premium subject to a minimum of `500 and
maximum of `2500 per day – waiting period 48 hours - No retroactive payments from
day one are to be made.
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What is the ICU benefit?
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Twice the daily HCB, i.e. minimum of `1000 and maximum of `5000.
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What is the Recuperation benefit?
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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.
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What is the amount payable to
nominee on death?
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Fund Value relating to the base policy and the top ups as on the date of intimation
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What is the amount payable at
Maturity?
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Fund Value relating to the base policy and the top ups as on the date of intimation
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Who can avail the hospital cash
benefit?
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Principal Life Assured (Policy Holder), Spouse (Insured Spouse) and first two eligible
children by seniority in age.
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Can it be taken with other mediclaim
policies?
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Yes, It can be taken.
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Would I get a Health Card?
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Yes, you will receive the same with the Welcome kit.
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What would I receive in the
Welcome Kit?
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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.
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Is there any waiting period
for Hospital cash benefit?
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Yes, 90 days waiting period except for accident related hospitalization.
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Whom should we approach in
case of a claim?
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For Hospital cash Benefit, Surgical Benefit and Critical Illness Benefit, you should
contact your TPA given on the health card.
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What is the claims process?
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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.
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What to do in case of an emergency?
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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.
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What to do if I go to a non
network hospital?
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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.
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Within how many days would
I get the money?
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Within 15 days subject to policy conditions and provided all the required documents
are submitted.
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Is there any waiting period
for surgical benefit rider?
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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.
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Benefit under Surgical benefit?
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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 `15 Lakhs.
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Benefit under Critical Conditions
Rider?
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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.
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Is there any waiting period
for Critical conditions Rider?
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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.
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Admissibility of overseas claim?
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Hospitalization / Surgical procedures should take place with in India.
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What is the Maximum Annual
benefit period?
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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.
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What is the maximum benefit
period during the policy term for hospitalization?
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180 days (in hospital including ICU) for Principal insured, Insured Spouse and Insured
child (90 days until the child completes age 5 years).
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Whether the HCB is payable
during the non premium paying period?
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No.
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Whether dental treatment is
covered?
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No.
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Whether the Death benefit is
payable in case of death of any spouse /children covered under the policy? |
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No, it is paid only in the case of principal Insured.
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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.
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What is Deferment Period? |
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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.
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For any help or information on INDIVIDUAL CLAIMS, please call or write to the
nearest branch |
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Click here to find the nearest Branch Address and Contact
No. |
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Or contact our Claims Department
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THE CLAIMS DEPARTMENT
Reliance Life Insurance Co.
9th Floor - Building No. 2,
R-Tech Park, Nirlon Compound,
Next to Hub Mall, Behind I- Flex building,
Goregaon, (East),
Mumbai-400 063
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