What is restoration benefit in health insurance?
Restoration benefit in health insurance - Importance, types and points to note before claim.
By Pazcare
July 11, 2022
Claim settlement ratio (2019-20)
98.12%
Network hospitals
8014+
Total GHI lives insured (2020-21)
25.8 Lakhs
Total GHI claims incurred (2020-21)
Rs 443 Crores
TPA
External TPA
One of the leading general insurance companies in India is the Reliance General Insurance Company Limited. Established in the year 2000, the Reliance General Insurance Company is promoted by the Indian financial services holding company Reliance Capital. The Reliance General Insurance Company is a part of Reliance Anil Dhirubhai Ambani Group. Ensuring to provide complete convenience and satisfaction to the customers of the firm, Reliance General Insurance has successfully been a pioneer in the healthcare industry.
The Reliance Group Health Insurance gets even better with Pazcare. We make sure that you get the best group health insurance quotes for your employees without spending unnecessarily on high premium rates. Our tech-enabled Pazcare dashboard helps manage the group health insurance by the HR/Admin. You can also integrate the employer dashboard with the HRMS tools.
These simple steps allow you to purchase Reliance group health insurance online at Pazcare.
Connect with us for further information,
Email: support@getpaz.com.
Customer care number: +91 78291 11300.
Whatsapp number: +91 81973 79596.
Group Mediclaim Insurance Policy
This policy is suited for an employee-employer group and non-employer employee group. It is also best suited for institutions, associations and society. The Reliance ProHealth Group Insurance Policy provides a sum insured up to Rs 1 Crore. There is no such extry age for this policy and the minimum size of the group has to be seven members to avail it.
Here are some factors why you have to choose the Reliance group health insurance from Pazcare.
Fast product delivery
The company has set its standards in quick product delivery just after the purchase of the product. Asserting to deliver the product within 10 seconds, the policyholders receive the product in their email inbox.
Wide network
The Reliance Health Insurance Company has a wide and robust list of 8014+ network hospitals. This allows policyholders to find and reach any network hospital for cashless claims easily and in no time.
Fast online renewal
Skipping the tedious and endless paperwork, Reliance Health Insurance Company has made sure that renewals are easier than ever! Just by entering your registered mobile number and policy number, now you can renew your policy in no time.
An Innovative claim process
Now, download the Reliance Self-i App and intimate the insurance company about your claim request instantly. This has made tracking claims seamless and you can undergo this process at your fingertips.
A Happy workplace environment
Employees tend to work better when they feel that their employer values them. As a result, it creates a sense of inclusion and consideration. It also results in a happy workplace atmosphere leading to lower employee turnover.
Lower premium
With more people being covered under a single policy, the premiums get lower with comprehensive benefits.
Tax benefits
A group health insurance comes with great tax benefits. Businesses get a credit back on their taxes that partly or wholly take care of the premiums as compensation.
Tailor-made policies
The policies provided by Reliance group health insurance can be customized according to the workforce type. One can also opt for add-ons and many more benefits according to the employee base.
Daycare procedures included
With Reliance group health insurance, daycare procedures are also covered. You get coverage for treatment that does not need hospitalization for 24 hours or more. Moreover, pre and post-hospitalization and medical expenses are covered for the specified number of days.
A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled by the health insurance company to the number of claims made or requested in a financial year.
Hence, a CSR ratio can be calculated as
All health insurance companies have a list of network hospitals or cashless hospitals. One can claim cashless treatment from these network hospitals. With a larger list of network hospitals, the chances of finding a cashless network hospital near your location get higher. Reliance group health insurance has around 7607+ network hospitals located in pan India.
Reliance group health insurance cashless claim
With Reliance group health insurance you can make a cashless claim following the steps below-
Step 1: Find a Reliance Health network hospital
To get your treatment, find a Reliance Health network hospital near you.
Step 2: Intimate the insurer
You need to inform the insurer before 48 hours of admission in case of planned hospitalization. For emergency hospitalization, the insurer has to be informed within 24 hours of admission.
Step 3: Fill out the pre-authorization form
Fill out the form of the pre-authorization request. It will be available at the hospital and has to be submitted to the hospital once filled.
Step 4: Claim process is taken forward by the hospital
After your identity is verified as per the policy terms and conditions,
the hospital sends your pre-authorization request form to Reliance health insurance company.
Note: Expenses incurred by the excluded treatment or procedures will be necessary to be paid by the policyholder If the claim is rejected.
Reliance group health insurance reimbursement claim
In case you get hospitalised at a non-network hospital, the reimbursement claim from Reliance group health insurance can be carried out by the following steps.
Step 1: Intimate the insurer
You need to inform about your hospitalization at the toll-free helpline within 3 days in advance for a planned hospitalisation. For emergency cases, intimation has to be done within 48 hours of hospitalization.
Step 2: Collect all the documents
All the necessary documents like original medical bills, pharmacy store bills, receipts, examination reports, etc, are to be collected at the time of discharge from the hospital.
Step 3: Fill out and submit the reimbursement claim form
Go to the closest Reliance branch and submit the claim reports within 15 days from the discharge. Reliance will verify your claim reports.
Step 4: Settlement of claim
Once the insurer approves the request, the reimbursement claim amount will be paid to the policyholder. It will be done either through net banking or cheque/DD.
Connect with us at support@pazcare.com, to guide you through the whole process.
The Reliance group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Reliance group health insurance plan.
Step 1: Connect with Pazcare. Submit a form containing details like your name, name of the company, number of employees you wish to insure, work email address and phone number.
Step 2: Once the form is submitted, our consultants will get in touch with you. Since this is not a fresh policy, you will have to submit the following documents.
Step 3: You can choose additional add-ons to your existing policy like dental insurance riders, maternity insurance riders to your existing policy cover. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Reliance group health insurance. These add-ons include wellness and therapy sessions, unlimited doctor consultations, comprehensive check-ups, and many more.
Step 4: Our consultants will get back to you with the competitive quotes for your Reliance group health insurance. Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.
Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Reliance group health insurance policy. The policy will be usually valid for a year after the renewal.
Step 6: In case, you are purchasing your Reliance group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this period, our associate will get in touch with you and provide you with all the essential information to get started with your group health insurance.
We make sure that your Reliance group health insurance experience will be seamless using our Pazcare dashboard. Your employees can access their policy using Pazcare’s employee app which is available on both the app store and the play store.
The Reliance group health insurance premium aligns with the risks involved. There are certain factors which affect the premium of your group health insurance policy. Following are some of the important categories that are used to calculate the premium -
Age
The average age of the people insured determines the calculated premium. The premium is directly proportional to the age. The younger the age, the health risks get lower.
Job nature
Nature of the job is another important factor that determines the premium. For eg, certain jobs have higher risks like factory workers.
Total Sum insured
The maximum amount that an insurance company will pay you in case of any hospitalisation in a particular year is known as the sum insured. The policyholder pays any expenses that exceed the sum insured.
Add-ons
The add-ons opted for eg, dental insurance riders, and maternity insurance riders, along with the existing group health insurance policy increase the premium of your group health insurance.
History of claims
The claim history is considered to calculate the premium for that particular financial year. If the number of claims raised in a previous financial year is higher, in the case of a group health insurance policy renewal, the premium towards the policy increases during the policy renewal.
For instance, a company wants to renew their Reliance group health insurance policy for 2022. The premiums paid by them for 2021 were ₹45,000. If the number of claims raised during 2021 is higher than that of 2020, then the premiums for 2022 will be greater than ₹45,000.
Medicine, consumables etc
Medicines, drugs, anaesthesia, blood, oxygen, surgical appliances, pacemaker and radiotherapy, diagnostic material and X-rays, dialysis and chemotherapy, artificial limbs and organs, etc, are covered under this policy.
Expenses due to hospitalisation
With Reliance group health insurance cover, hospitalisation expenses including doctor’s fees, nursing expenses, OT charges, fees for anaesthetists, and pre and post hospitalization charges are covered.
Daycare expenses
Daycare expenses are covered by the Reliance group health insurance policy. Daycare expenses include treatments that require less than 24 hours of hospitalisation.
Domiciliary treatment
Domiciliary hospitalisation that is subject to no room in hospitals or inability to shift to a hospital is covered under the policy.
Cosmetic treatments
Dental treatments, cosmetic or aesthetic surgeries, re-shaping treatments, etc. are excluded from the Reliance group health insurance policy.
Hearing aids, spectacles, or contact lenses
Hearing aids, spectacles, or contact lenses and optometric therapy are not included in the Reliance group health insurance policy.
Treatments for substance abuse
Treatment expenses due to substance abuse of any substance like drugs or alcohol are exempt from coverage in your Reliance group health insurance.
Sexually transmitted diseases
Sexually transmitted diseases like HIV or AIDS are excluded from the Reliance group health insurance policy.
Treatments due to wars
Any treatments due to wars or nuclear perils are not covered under the group health insurance cover.
A Happy workplace environment
Employees tend to work better when they feel that their employer values them. As a result, it creates a sense of inclusion and consideration. It also results in a happy workplace atmosphere leading to lower employee turnover.
Lower premium
With more people being covered under a single policy, the premiums get lower with comprehensive benefits.
Tax benefits
A group health insurance comes with great tax benefits. Businesses get a credit back on their taxes that partly or wholly take care of the premiums as compensation.
Tailor-made policies
The policies provided by Reliance group health insurance can be customized according to the workforce type. One can also opt for add-ons and many more benefits according to the employee base.
Daycare procedures included
With Reliance group health insurance, daycare procedures are also covered. You get coverage for treatment that does not need hospitalization for 24 hours or more. Moreover, pre and post-hospitalization and medical expenses are covered for the specified number of days.
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OkayWhy buy a group health insurance
policy online from Pazcare?
For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.
TPA for Reliance is Paramount Health Services & Insurance TPA Pvt.
The owner of Reliance Anil Dhirubhai Ambani Group.
Visit the official website or app of Reliance. Then fill out the name and date of birth, and download the receipt.