Group Insurance 440 views June 4, 2021

Reliance Group Mediclaim Insurance Plan offers coverage against medical expenses to the employees of an organization or company. The insurer shall cover all the medical expenses incurred during the policy period up to the sum insured as specified in the policy schedule. Read this page below and learn about the coverage of the Reliance Group Mediclaim Insurance Plan in detail.

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Reliance Group Mediclaim Insurance Plan Base Cover

The insurer will cover the following medical expenses incurred during the policy term

  1. In-patient Treatment: If the insured person undergoes hospitalization on the written advice of a medical practitioner, then the insurer will cover the following – room rent, nursing and ICU charges, medical practitioner’s fees, cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and other consumables, diagnostic procedures such as cost of prosthetic and other devices or equipment implanted internally during a surgical procedure.
  2. Pre-hospitalization Expenses: Up to 30 days before the date of admission, provided the claim is accepted under in-patient treatment.
  3. Post-hospitalization Expenses: Up to 60 days post-discharge from the hospital, provided the claim is accepted under in-patient treatment.
  4. Day Care Treatment 
  5. Domiciliary Hospitalization
  6. Ayush Treatment
  7. Modern Treatment: This includes – Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Immunotherapy-Monoclonal Antibody to be given as an injection, Oral Chemotherapy, Deep Brain Stimulation, Intra Vitreal injections, Robot surgeries, Stereotactic radio surgeries, Bronchial Thermoplasty, Vaporization of the prostate (Green laser treatment or holmium laser treatment), IONM- (Intra Operative Neuromonitoring) • Stem Cell therapy: Including Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.

Waiting Period Applicable to Reliance Group Mediclaim Insurance Plan

The below-mentioned waiting period shall apply to this group insurance

  1. Pre-Existing Diseases: 48 months
  2. Specified disease/procedure: 12 months
  3. Initial Waiting Period: 30 days

List of specific diseases/procedures where a 12-month waiting period applies:

  1. Cataract
  2. Benign prostatic hypertrophy
  3. Hysterectomy
  4. Menorrhagia
  5. Fibromyoma
  6. Hernia
  7. Hydrocele
  8. Internal congenital diseases/anomalies
  9. Fistula in anus
  10. Piles
  11. Sinusitis

Note: The initial waiting period shall not apply to the claims arising due to an accident.

Exclusions from Reliance Group Mediclaim Insurance Plan

The insurer shall not pay for the following:

  1. Investigation & Evaluation
  2. Rest Cure, rehabilitation and respite care
  3. Obesity/Weight Control Programs
  4. Change-of-Gender treatments
  5. Cosmetic or Plastic Surgery
  6. Claim arising out of participation in hazardous or adventure sports
  7. Breach of law
  8. Treatments received by excluded providers
  9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and its consequences
  10. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  11. Unprescribed dietary supplements and substances
  12. Treatment for correction of eyesight due to refractive error < 7.5 diopters
  13. Unproven treatments
  14. Sterility and infertility treatment
  15. Medical treatment expenses traceable to childbirth, miscarriage and lawful medical termination of pregnancy
  16. Circumcision unless necessary for the treatment of a disease or injury
  17. Cost of spectacles, contact lenses and hearing aids
  18. Dental treatment or surgery unless requiring hospitalization
  19. Convalescence, general debility, ‘run-down’ condition venereal disease
  20. Medical expenses arising out of Human T-Cell Lymphotropic Virus Type III (HTLV III), Lymphadenopathy Associated Virus (LAV), the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind
  21. Disease or injury caused by nuclear weapons/materials.
  22. Any non-medical expenses as specified in the policy schedule
  23. War and warlike occurrence or invasion
  24. Any pre-existing disease/condition that is specifically excluded

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