Reliance Life Insurance Life Care for You: Details on How plan works, Covers included in this plan, eligibility Tax Benefits, Claim Process and Grace period.
How does the plan work?
This is regular premium, non-participating, non unit linked, hospitalization benefit plan based on Individual and Family Floater* basis. The plan will be offered to individuals or a family which includes the primary insured, spouse, eldest four eligible children, dependent parents and parents in law. The premiums are paid on annual basis or monthly (only if premiums are paid electronically) basis only.
Member with the highest age among husband and wife will be referred as Primary Insured and all the other members of the family covered under the plan will be referred as Secondary Insured. On death of the Primary Insured during the policy term, the insured spouse becomes the Primary Insured. If both Primary Insured and Insured Spouse die, the policy will be terminated from the policy anniversary following the death of the second life.
* Family Floater means the Sum Insured for a particular Insured and the members of his/her family as covered under the policy and is available for any or all the members of his /her family for one or more claims during the tenure of the policy.
Children are covered, provided the children are economically dependent on parent(s) and having marital status single at the time of commencement of policy or on any subsequent renewal date.
What does your plan cover?
The plan covers reasonable and customary medical expenses incurred towards hospitalisation during the policy term for the disease, illness, medical condition or injury contracted or sustained by the member(s) subject to terms, conditions, limitations, waiting period and exclusions .
In a policy year, the total liability of the company under this policy is limited to the sum insured, without making any reference to what the company has reimbursed or are liable to reimburse for the claims made in the previous policy year. Where sum insured means the sum shown in the your policy document which represents our maximum liability in relation to all claims made by You and all of Your Dependents, if any, during the Policy Year.
Reliance Life Care for You Advantage Plan will reimburse all admissible medical expenses in case of an unfortunate event of Hospitalisation:
- Room, boarding and nursing expenses.
- Surgeon, Anaesthetists, Medical Practitioner, Consultants, Specialists fee
- Operation theatre charges
- Anaesthesia, blood, oxygen, medicines and drugs etc.
- Diagnostics and laboratory tests.
Day Care Treatment
We cover 150 listed day care treatment and procedure as given in Annexure A, wherein even 24 continuous hours of hospitalisation is not required.
Pre & Post hospitalisation Benefit A flat benefit of 5% of the admissible hospitalisation expenses, subject to a maximum of Rs.5000 will be paid on each hospitalisation claim towards Pre and Post hospitalisation expenses.
Ambulance charges will be reimbursed by us subject to a maximum of Rs. 1,000 in a policy year provided the member is hospitalised for more than 24 continuous hours.
What are the Eligibility Criteria?
|Age at Entry||Primary Insured and Spouse – 18 years last birthday
Dependent parents and parent in- law – 40 years last birthday
Children- 3 months
|Primary Insured and Spouse – 60 years last birthday for new policy and 72 years last birthday for renewed policy
Dependent parents and parent in-law – 66 years last birthday for a new policy and 72 years last birthday for a renewed policy.
Children – 18 years last birthday
|Maturity age||Adults – 75 years last birthday
Children – 21 years last birthday
|Policy term||Fixed term of 3 years||Fixed term of 3 years|
|Sum Insured (Sum insured should be in multiples of Rs.1,00,000 between minimum and maximum sum insured)||Rs.2,00,000||Rs.10,00,000|
The benefits and premiums payable under the policy are subject to tax laws and other financial enactments as they may exist from time to time.
You can avail tax benefit under section 80-D on premium paid under the Income Tax Act, 1961. Service tax and education cess will be charged as per applicable rates.You are recommended to consult your tax advisor.
30 days waiting Period:
Hospitalisation or Medical Expenses incurred for any illness/diseases diagnosed during first 30 days of the Policy commencement date or date of revival, whichever is later will not be reimbursed except accidental injuries.
90 days waiting period:
This is applicable if any of the secondary insured members is not included on commencement of the policy but added from a subsequent policy anniversary. Hospitalisation due to illness/treatment within 90 days from the date of inclusion of member will be excluded.
One year waiting Period:
The following ailments/procedures are not covered during the first year of the policy from commencement date or revival date: Tonsillectomy, Cancer of any kind.
Two years waiting Period
The following ailments/procedures are not covered during the first two years of the policy from commencement date or revival date. Kidney Stone/ Ureteric Stone / Lithotripsy, Cataract, Hysterectomy, Cholelithiasis, Choledocholithiasis, surgery of Gall bladder and Bile ducts excluding Malignancy, surgery of Benign Prostatic Hypertrophy, Hernia (Inguinal), Hemorrhoids, Anal Fissure, Fistula-in-anus, Exploratory Laparotomy, Lapchole, diagnostic Laparoscopy, any gynaecological disease, Hydrocoele, Fibroids.
Three years waiting Period
The following ailments/procedures are not covered during the first three years of the policy from commencement date or revival date.
Tympanoplasty, Valve Replacement, Valvotomy, Cerebral Haemorrhage; Angiographies, Angioplasty (with or without stent), Coronary Artery Bypass Graft, unless post Accident.
Cost of treatment payable after completion of 1 year from the 1st term renewal
On completion of one year after the first term renewal of the policy from commencement date or revival date if the following diseases are diagnosed or Hospitalisation or Medical Expenses incurred are not payable:
Total Knee Replacement, Total Hip Replacement, Diskectomy, Arthroscopy, unless post Accident for each of these treatments/surgeries/procedures, Pelvic Inflammatory Disease, Varicose Veins; Diabetes with or without high blood pressure and its complications, direct results of or accompanied by it; Chronic Renal Failure, no matter when detected.
Claim information & role of the TPA
You have the option to avail of cash less service facility at network hospitals as identified and empanelled by the company / Third Party Administrator (TPA).
In case of a planned hospitalisation, you have to take pre-authorization from the Third Party Administrator (TPA) prior to taking admission at any network hospital. In case of emergency hospitalisation, you have to notify the TPA in writing within 24 hours of the hospitalisation on medical emergency.
You will be provided with a photo identity card with a unique membership number by the TPA which will entitle you and your enrolled family members to avail of cash less hospitalisation services.
However if the policyholder does not wish to avail cash less facility or the member is hospitalised in any hospital other than the specified network hospitals or cash less facility has been disapproved by the company/TPA, the policyholder has to notify the company in writing, within 7 days of the hospitalisation of the member. The company will reimburse the medical expenses as per the policy terms and condition.
Grace period, Lapse & Revival (Reinstatement)
The grace period will be 30 days from the due date for payment of regular premiums under annual modes and 15 days from the due date for payment of regular premiums under monthly mode. If premium is not received within the grace period then the policy will lapse.
The policy can be revived within 90 days from the due date of first unpaid premium, This will be subject to satisfactory medical and financial underwriting.
If the lapsed policy is not revived within 90 days of the due date of the first unpaid premium then the policy will be terminated
The company will not be liable to make any payments if claims are made due to any treatment of illness/ailment/disease diagnosed or hospitalization taking place during the period when the policy lapsed.