1.                     The brief history of the case of the complainant is that the complainant had obtained a health insurance policy No.18889425 on 12.4.2011 from the Ops with plan name “Reliance Life Care For You Plan” for premium paying term 3 years and the policy continued for 3 years with regular premium valid up to 12.4.2014 which covers reasonable and customary medical expenses incurred towards hospitalization during policy term with pre and post hospitalization benefits.  It is submitted that as per persuasion of the Ops, the complainant again obtained for “Reliance Cash Flow Plan” and after submission of all documents, the Ops issued Policy No.51064966 with DOC 28.6.2013 and the said policy lapsed on 28.6.2014 due to nonpayment of premium.  In order to continue with the 1^st policy No.18889425 the Ops suggested that, if the complainant goes for a 2^nd policy for the above plan, then the policy benefit will continue as that of 1^st one and no gap will be treated in the policy further and that will be treated as linked policy of No.1.  The complainant has taken again the Reliance Care for You Plan and the Ops issued Policy No.57158792 with DOC 14.6.2014 for payment payin 2.                     The Ops 1 & 2 filed counter in joint denying the allegations of the complainant but admitted about the “Reliance Care for You Advantage Plan” vide Policy No. 18889425 dt.12.4.2011 taken by the complainant from them.  It is an admitted fact that the complainant has taken Reliance Cash Flow Plan vides Policy No.51064966 with DOC 28.6.2013 which was lapsed on 28.6.2014 due to nonpayment of premium.  Again the complainant has taken Reliance Care for You Plan Vide No.51758792 with DOC 14.8.2014.  It is contended that the complainant was admitted in the hospital on 05.6.2014 and was discharged on 12.6.2014 and the reason for hospitalization was to be Obesity and the Ops have received claim Vide Membership No.RLC4U014101A for a claim amount of Rs.1, 65,000/- through Medicare TPA Services (I) Pvt. Ltd(OP.3).  It is further submitted that vide their letter dt.12.5.2015 the Ops denied the claim with reason that the operation for Laparoscopic Gastric Bypass is excluded from the scope of the policy issued by the Company and the disease process is pre existing and hence the claim is not payable.  With these and other contentions, denying any deficiency in service on their part, the Ops prayed to dismiss the case of the complainant.  The OP No.3 in spite of valid notice did not prefer to participate in this proceeding in any manner.

3.                     Parties have filed certain documents along with affidavits in support of their cases.  Heard from the parties through their respective A/Rs and perused the materials available on record.  Both the Ops also filed written arguments.

4.                     In this case, “Reliance Care for You Advantage Plan” vides Policy No.18889425 on 12.4.2011 which was valid till 12.4.2014 taken by the complainant from the Ops is an admitted fact.  It is seen that during subsistence of that policy, the complainant has taken another plan namely, “Reliance Cash Flow Plan” vides Policy No.51064966 with DOC 28.6.2013 and the said policy lapsed on 28.6.2014 due to nonpayment of further premium.  During the subsistence of Cash Flow policy, the complainant has undergone medical treatment i.e. from 05.6.2014 to 12.6.2014.  According to the Ops, “Reliance Care for You Advantage Plan” was a health insurance policy whereas the “Reliance Cash Flow Plan” is a double benefit for life insurance money back policy on specified intervals.

5.                     The complainant stated that due to nonpayment of premium, the Cash Flow Plan lapsed on 28.6.2014.  The OP.1 as well as the Agent persuaded the complainant to opt for “Reliance Care for You Advantage Plan” again for the second time, so that the policy benefit will continue as that of 1^st one and no gap will be treated between two policies and the claim will be settled due to continuance of the policy.  It is seen that the complainant has obtained the said plan and policy w.e.f. 14.8.2014.

6.                     From the above facts it was ascertained that during treatment period i.e. from 05.6.2014 to 12.6.2014, the Cash Flow Plan was in existence and incidentally that plan was not a health insurance plan but a plan of double benefit of life insurance money back policy at specified intervals which covers specific diseases.  We are also fully convinced with the arguments by the A/R for the Ops in that line.  It was further revealed that due to non existence of Reliance Care for You Advantage Plan, during the treatment period which is a health insurance plan, the complainant later on has taken the said policy again in order to cover up the benefits.  This attempt of the complainant in no way would be benefited to him on the principle of no insurance no claim during the relevant period.  As the complainant had no health insurance during the material time, he has no cause of action to maintain this case.

7.                     In the above facts and circumstances, we do not find any merit in the case of the complainant which needs to be dismissed.  In the result, we dismiss the case of the complainant and the parties are to bear their own costs.

(to dict.)