Overview
Reliance Health Gain Prime is the most premium variant within the Reliance Health Gain portfolio, offering extensive coverage options compared to other variants. It includes features like unlimited restoration of the sum insured, annual health check-ups, vaccination coverage through add-ons, and modern treatment benefits up to the base SI. The plan allows customization with add-ons such as reduced waiting periods for pre-existing diseases and room rent preferences. Designed for individuals and families, it provides flexibility and robust financial protection against medical expenses.
Experts Review
Written by Nikhil Nair
Senior Writer
Reliance Health Gain Prime sets itself apart from the Plus and Power variants by offering significantly higher sum insured options (up to ₹1 crore) and enhanced benefits tailored for premium healthcare needs. Unlike the Plus variant, which caps coverage at ₹5 lakhs, and the Power variant with a maximum of ₹20 lakhs, Prime caters to those requiring extensive financial protection for major medical emergencies or advanced treatments.
Key upgrades in the Prime variant include increased pre-post hospitalization cover of 60-90 days, respectively, room rent coverage for hospitalization up to the actuals, providing greater comfort compared to the default single-private AC rooms offered in Plus and Power. Additionally, the vaccination coverage add-on is more generous, capped at ₹3,500 annually versus ₹2,000 in the lower variants. The plan also offers a higher convalescence benefit add-on (₹25,000 lump sum) and increased organ donor expense limits (50% of the sum insured up to ₹10 lakhs).
Modern treatments are covered without sub-limits; however, Prime’s higher sum insured ensures more comprehensive financial security during expensive procedures like robotic surgeries or chemotherapy. Add-ons such as reduced waiting periods for pre-existing conditions further enhance its appeal.
While Prime offers robust benefits, its premium pricing may not suit cost-sensitive buyers.
Pros
Feature set is satisfactory.
Great pick if you're looking for something affordable.
Insurer has a solid track record with great claim and service metrics.
Offers Loyalty Cover, which makes this policy stand out.
Cons
Your insurer doesn’t provide free health check-ups, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature.
Reliance
Key Insights
Founded
2000
Reliance was established 25 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
87% claims settled in 30 Days
Reliance settles 87% of all claims it receives. This is reasonable performance, though there is room for improvement compared to top insurers.
Network Hospitals
10,000+
Reliance maintains a moderate network of 10,000 hospitals, offering reasonable coverage across key locations.
Complaints
4 complaints per 10,000 claims registered
Reliance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Loyalty Cover
STANDOUT
Insurance company shall provide a loyalty cover to the insured members up to a specified limit based on the renewal timeline for Accidental Death and Permanent Total Disability, Critical Illness, Hospital Cash, etc.
Co-payment
If you bought this policy after you turned 61, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Customisable
Change Any room to Single Private Room.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 2 or 1 year.
Add-ons
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 2 or 1 year.
Annual Health Checkup
Annual health check-up for specified tests, with a maximum limit of ₹3,000 or as per the sum insured on a cashless or reimbursement basis.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 3 days, with a maximum payout of ₹1000, 1500, 2000 or 2500 per day for up to 30 days.
Room Rent Modifier
Change Any room to Single Private Room.
Aggregate Deductible
Choose deductible between ₹10,000 and ₹1,00,000 and get a discount on premiums.
Enhanced Cover
Keeps the unutilized bonus intact even if a claim has been made, offers unlimited restoration that will restore your cover in full every time a claim is settled for any illness along with extended coverage for generally excluded items like syringes, gloves, PPE kits etc
Family Cover
Covers the cost fo medical expenses related to listed home treatments like Dialysis, Chemotherapy, etc. along with a fixed daily amount payout to the one who accompanies the insured member while getting treated in a hospital. This benefit also covers for children’s expenses in case you are hospitalised and can’t take care of them at home.
Smart Cover
Indemnifies you for the medical expenses incurred towards the correction of eyesight due to refractive error of +-6.0 Dioptres or above and also covers you for the cost incurred towards availing a second opinion from a medical practitioner.
Convenience Cover
Increases your pre & post hospitalisation limit to 90 and 180 days respectively. Provides coverage for air ambulance and Radio Taxi. The insurer will also pay an additional lumpsum amount, on hospitalisation for a minimum period of 7 continuous and consecutive days.
Double Cover
Giives an additional 100% of the sum insured for the same claim.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Hormonal therapies
Peritoneal dialysis
Treatment by a family member
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Sinusitis
Rhinitis
Tonsillitis
Adenoidectomy
Mastoidectomy
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to 2 or 1 year for all diseases.
What's missing in the policy
Your insurer doesn’t provide free health check-ups.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
A
Alok Gupta
Comprehensive coverage with high sum insured. Feel well protected with this plan.
P
Priya Sharma
The unlimited restoration is a great feature, ensures continuous coverage.
N
Neel A.
Modern treatment coverage stood out—it’s reassuring to see things like robotic surgery being included.
P
Pooja Gupta
The co-payment clause applies to senior citizens, wish it was waived off.
R
Rina Sharma
This plan is quite expensive, definitely a premium offering.
S
Shweta Gupta
Claim process was very smooth and fast, excellent service.
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Frequently Asked Questions
Does Health Gain Prime have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Health Gain Prime have room rent restrictions?
Does Health Gain Prime offer a restoration benefit?
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