Claims Process – Reliance Wealth + Health Plan.
As a part of the Welcome Kit, you will receive the following:
 Health Card.
 Network Hospital List with contact details.
 Claims and Pre-Authorization Forms
Your Health Identity Card:
Your health card which will be provided will identify you as a beneficiary of Reliance Wealth + Health plan will give you access to our network Hospitals. Secure your Health ID card and carry it with you all the times, Quote your TPA ID card no. when you call TPA helpline.
The cashless access in TPA network of hospitals is merely a facility extended to you by TPA under the contract with RLIC.
TPA does not guarantee the availability, quality and outcome of the treatment. Selection of a network to a non-network hospital is a prerogative of the beneficiary.
Please note you are not entitled to any benefit on the first 48 hours of stay in the hospital. The hospital expenses in excess of the policy benefit amount would be paid by you directly to the hospital of admission.
How to get admitted in a Network Hospital /Nursing Home :
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.
1)  Ailment and its duration.
2)  Known past illness, if any.
3)  Hypertension or diabetes.
4)  The name of the Hospital /Nursing home and consultant’s contact no.
5)  The proposed date of admission
6)  Class of accommodation.
7)  The approximate duration.
8)  Treatment plan.
After due scrutiny, TPA will send an Authorisation Letter (AL) for cashless treatment and guarantee of payment. This is subject to the terms, conditions, exclusions and limitations of the Hospitalisation cash benefit cover for insured person(s) under the Reliance Wealth + Health plan
Admission Procedure :
In order to secure admission on the appointed day, you are advised to register your name with the hospital well in advance.
Approach the admission / Reception counter of the hospital on the day of admission with the Authority Letter and your ID card.
The Hospital/nursing home will admit you and extend the credit facility up to the amount guaranteed by RLIC subject to availability of bed.
When Cashless Access to Hospital Can be Denied :
A)  In the event sufficient information in the prescribed format is not given by the insured person(s)
B)  In the event of ineligible disease or vague symptoms as per the medical practitioner (pre-authorization for cashless can be denied). About 95% of admission in the hospitals is planned, therefore it is necessary to obtain Authority Letter in advance.

The denial of Authorization for cashless access does not mean denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization. In such cases you are advised to file your claim for reimbursement and TPA will settle the claim as per policy eligibility and policy coverage under Reliance Wealth + Health plan.
What to do After Discharge From Hospital :
You have to send the following document s in original to TPA office within 7 days after the discharge.
1)  Hospitalization claim form duly signed by the insured person(s)/policy holder.
2)  Discharge card/discharge summary.
3)  Reports of all investigations.

You are advised to keep photocopy of discharge card and reports. The above list is not exhaustive; TPA/RLIC may request additional documents / information, if any, for processing the claim.
Emergency Hospitalization:
 In the event of emergency, you could first admit the patient in the Hospital and then inform TPA, within 12 hours of admission and for this purpose you would need to provide “ADMIT IMMEDIATELY” advice from a qualified doctor/medical practitioner. 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.
 Please note that as per policy terms and condition the hospital needs to be equipped with a minimum of ten beds.
Payment of Hospitalisation benefits for treatment in 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 respect of admission to a Non Network Hospital.
In the event you choose to get treated in a Non-Network, you will have to submit the following documents in original to TPA to obtain reimbursement of eligible claim amount.
1)  Hospital Bill and Receipt for payment.
2)  Claim form duly signed.
3)  Discharge card/discharge summary..
4)  Reports of all investigation.

The above list is not exhaustive;

TPA may request additional documents / information, if any, for processing the claim.

TPA reserves the right to change the claim process with 15 days prior notice.

Enclosed is an indicative claim process flow chart.
Reliance Wealth + Health Plan – Claims Process Indicative Flow Chart