Care Health Insurance Benefits, Features and coverages
Updated On Jan 23, 2024
Care Health Insurance is a distinguished name in the healthcare sector. It is a leading health insurance provider founded with the aid of Care Enterprise Ltd., Corporation Bank, and Union Bank of India. Care Health Insurance has a strong presence with 5420+ vast hospital network of cashless claims and is marketed by the leading super-speciality hospital chain, Fortis Healthcare Ltd.
Today, with the rising health care costs and an increase in lifestyle diseases, medical insurance has become a necessity. Of all the health insurers, Care Health Insurance formerly Care Health Insurance has a unique edge in the spectrum of financial services, healthcare delivery and preventive health solutions. With Care health care solutions, one can be rest assured that all their health care needs will be taken care of. Care with their philosophy of “Ab Health Hamesha” offers comprehensive health insurance plans for individuals as well as family members keeping in mind their safety needs. Care health insurance products are available online, and one can choose from a range of options. Under their bouquet of healthcare options, Care Care Policy is a policy that offers comprehensive coverage for medical expenses incurred due to illness, injury or accident. Pocket-Friendly health insurance, ‘Care’ is designed to provide unmatched health protection with individual and floater cover.
Table of Contents
Care Health Insurance Policies Comprehensive Coverage
From diagnosis to recovery, Care Care health insurance offers coverage right from the time of diagnosis and goes on even post-discharge.
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Pre-hospitalisation: The plan offers coverage for medical expenses, including diagnostic tests and routine medication for up to 30 days before hospitalisation.
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Post hospitalisation: Medical expenses including doctor consultations, diagnostic tests and routine medication for up to 60 days after hospitalisation are also covered.
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Ambulance: Depending on the plan variant, the expenses related to a road ambulance and air ambulance are reimbursed.
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In-patient hospitalisation: Expenses related to room charges, nursing expenses, surgeon’s fees, doctor’s fees, ICU charges, anaesthesia, blood, oxygen, etc. are covered if the hospitalisation is for a minimum period of 24 hours.
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Daycare treatment: Over 540+ day care procedures are covered where a person is hospitalised for less than 24 hours.
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Domiciliary treatment: Medical expenses incurred during treatment at home for more than 3 consecutive days are also covered.
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Room Rent/ICU charges: Expenses related to room rent (single or private) and ICU charges are reimbursed.
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Organ donor cover: During organ transplant surgery, the medical expenses incurred by the donor is reimbursed.
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Maternity cover: There is an in-built maternity cover of up to 1 Lakh with sum assured options of Rs 50 Lakh, Rs 60 Lakh and Rs 70 Lakh.
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Second opinion: A second opinion option to consult doctors is available under some plan variant at no extra cost.
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Personal accident cover: There is an add-on cover benefit for personal accident. There is coverage for accidental death and permanent total disability for up to 10 times of the sum assured.
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Alternative treatment: AYUSH (Ayurveda, Yoga, Unani, Siddha, homoeopathy) treatments are covered under specified limits depending on the plan an individual chooses.
Special Features of Care Health Insurance Policies
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Entry age |
The minimum entry age under the policy is 91 days |
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Upper age limit |
There is no upper age bar for enrollment under ‘Care’ plans |
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Renewal |
Lifelong renewability option is available, provided an individual renews the policy on time every year |
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Co-payment |
There is no co-payment if the policyholder’s age is below 61 years. For an individual who is 61 years or above, there is a co-payment of 20% |
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Sum insured |
The sum insured can be changed at the time of renewal |
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Grace period |
There is a grace period of 30 days from the date of expiry to renew the policy |
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No-claim bonus with NCB super |
For every claim-free year, there is an increase in the sum assured by 10% to a maximum of up to 50% in 5 consecutive years. With NCB super, there is a further increase in the sum assured by 50% for every claim-free year to a maximum of 100%. Hence, in total with both NCB and NCB super, the sum assured can be increased up to 150% in 5 years |
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Unlimited automatic recharge |
There is a restoration or recharge facility available wherein if the sum assured gets exhausted in a single year; there is an automatic recharge of the sum assured. The policyholder can use the additional amount for any other treatment or by any other member covered under the policy for any ailment |
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Annual health checkup |
The plan offers annual health checkup for all the members covered under the policy, including children. |
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Routine Visits |
There is an add-on cover available for everyday care. For all routine visits to the hospital, including diagnostic tests and doctor consultations 1% of the sum assured is given. This can be availed with a cashless health card. |
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Global cover |
With the benefit of ‘Care Anywhere’, global coverage is available for 12 critical illnesses |
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Riders |
Care plans are available with different riders to fit an individual’s health care needs |
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Waiting period |
There is a general waiting period of 30 days for any illness, except in case of an accident |
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Waiting period for a pre-existing illness |
Pre-existing ailments have a waiting period of 4 years |
Care Health Insurance Variants
Care plans offer distinct benefits in the form of thoughtfully designed product and service features. Care is simple, comprehensive, rewarding, flexible and more. It comes with breakthrough advantages to take care of all medical expenses.
Here are some of the plan variants offered by Care Health Insurance:
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Features/Plan |
Care 3 (Rs. 3, 4 Lakh) Super Saver |
Care 4 (Rs. 5, 7, 10 Lakh) Elite |
Care 5 (Rs. 15, 20, 25, 30, 40 Lakh) Elite Plus |
Care 6 (Rs. 50, 60, 75 Lakh) Global |
Care 7 (Rs. 1, 2, 3, 6 Crore) Global Plus |
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Deductible |
Yes, Rs. 10,000* |
No deductible |
No deductible |
No deductible |
No deductible |
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In-patient hospitalisation |
Up to sum assured |
Up to sum assured |
Up to sum assured |
Up to sum assured |
Up to sum assured |
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Pre-hospitalisation |
30 days |
30 days |
30 days |
30 days |
30 days |
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Post-hospitalisation |
60 days |
60 days |
60 days |
60 days |
60 days |
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Daycare treatment |
Yes |
Yes |
Yes |
Yes |
Yes |
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Room rent |
1% of the sum assured |
Single private room |
Single private room (upgradable to next level) |
Single private room (upgradable to next level) |
Single private room (upgradable to next level) |
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ICU charges |
2% of sum assured |
No limit |
No limit |
No limit |
No limit |
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Ambulance cover |
Rs. 1500 per hospitalisation |
Rs. 2000 per hospitalisation |
Rs. 2500 per hospitalisation |
Rs. 3000 per hospitalisation |
Rs. 3000 per hospitalisation |
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Daily allowance |
Rs. 500 per day up to 5 days |
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- |
- |
- |
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Domiciliary hospitalisation |
Up to 10% of sum assured |
Up to 10% of sum assured |
Up to 10% of sum assured |
Up to 10% of sum assured |
Up to 10% of sum assured |
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Health checkup |
Yes, all members |
Yes, all members |
Yes, all members |
Yes, all members |
Yes, all members |
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‘Recharge’ feature |
Yes |
Yes |
Yes |
Yes |
Yes |
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No-claim bonus |
Yes |
Yes |
Yes |
Yes |
Yes |
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Organ donor cover |
Rs. 50,000 |
Rs. 1,00000 |
Rs. 2,00000 |
Rs. 300000 |
Rs. 5,00000 |
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Second opinion |
Yes |
Yes |
Yes |
Yes |
Yes |
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Alternative treatments |
Up to Rs. 15000 |
Up to Rs. 20,000 |
Up to Rs. 30,000 |
Up to Rs. 40,000 |
Up to Rs. 50,000 |
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Care Anywhere |
- |
- |
- |
Yes |
Yes |
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Maternity Cover |
- |
- |
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Up to Rs. 1,00000 |
Up to Rs. 2,00000 |
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Vaccination cover |
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- |
- |
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Yes, up to Rs. 10,000 |
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Global Coverage (excluding USA) Coverage outside India & USA - 45 continuous days in a single trip; Max 90 days on a cumulative basis, in a policy year |
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Up to sum assured for hospitalisation expenses & up to limit specified under ‘Maternity Cover’ towards maternity expenses; with a 10% co-payment per claim |
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Global coverage - Total Geographical scope of Benefit ‘Global Coverage (excluding USA)’ is extended to USA also |
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Up to sum assured for hospitalisation expenses & up to limit specified under ‘Maternity Cover’ towards maternity expenses; with a 10% co-payment per claim |
*if the plan is brought online with Insurancedekho there is no deductible
Plan Exclusions Under Care Health Insurance
Some standard exclusions not covered under Care Care Health Insurance:
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Any diagnosis of disease/illness contracted within 30 days of the policy start date, except those arising out of accidents
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Expenses arising out of self-inflicted injury
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Expenses arising out of drug or alcohol abuse/use
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Costs incurred for treatment of AIDS
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Congenital disease
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Expenses related to infertility and in vitro fertilization
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Expenses arising out of pregnancy and childbirth, miscarriage, abortion, and its consequences
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Expenses arising out of the war, riot, strike, nuclear weapons induced hospitalisation
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Cost of spectacles, contact lenses, dental treatment
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Some treatments such as non-infective arthritis, joint replacement, cataract, etc. are covered after the waiting period of 2 years
Pre-Policy Care Health Medical Checkup
On purchasing the policy, a pre-policy medical checkup is required to get a better understanding of an individual’s current and future health needs. If the policy is opted for 2 or 3 years, then 100% of the cost of medical checkup is borne by the insurer. However, if the policy is purchased for 1 year and the proposal is accepted, then 50% of the cost of medical checkup is paid by the insurer. If the proposal is rejected or policy is cancelled during the free-look period, then the cost of medical checkup borne by the insurer is deducted from the refundable premium.
Care Health Insurance Claim Process
In the case of hospitalisation, there can be a cashless claim or an individual can file for reimbursement.
Cashless claim processing:
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In case of a cashless claim, the hospitalisation can be planned or unplanned. For planned hospitalisation, intimation is required 48 hours prior to admission. In case of emergency, intimation should be provided within 24 hours of hospitalisation.
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The pre-authorization form available at the TPA/hospital insurance desk needs to be filled in and sent to the TPA/insurer.
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In case of approval, the authorization letter is sent to the hospital. In case of query, the hospital/insured needs to respond. In case of rejection, the insured may initiate the treatment and file for reimbursement.
Reimbursement claim processing:
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In case of reimbursement, an individual gets treated at the hospital and pays for all the medical expenses out of pocket and on discharge collects all the original bills, doctor reports, medical documents, and diagnostic tests.
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The duly filled claim form needs to be submitted along with all the original documents to the TPA/insurer, as per the policy terms and conditions
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Upon approval, the approval letter is sent by the claim management team. In the case of query/doubt, the insured is required to respond to the raised query. In case of rejection, the reason for rejection is communicated by the claim management team.
Care Health InsuranceTax Benefits
One can also avail a tax benefit under section 80D of Income Tax on the premium paid of up to Rs. 25,000 in case of individuals and Rs. 30,000 in case of senior citizens.
Care Policy is genuinely a comprehensive health insurance cover with enhanced benefits and features. With ‘Care’ one can stay worry free and focus only on recovery, as all the hassles related to treatment are surely taken care of. So, next time you are looking for a plan that offers worry-free today and tomorrow go for Care ‘Care’. If you have any questions regarding the plan, don’t hesitate to contact our agents at insurancedekho.com and help us serve you better.
Also Read:
Types of Health Insurance Plans Offered by Care Health Insurance
