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Care Health Insurance – Coverage, Exclusions, Riders, and Claim Settlement, etc.

Care Health Insurance formerly Religare Health insurance is a distribution of a range of health insurance products to individuals, corporates, and families. Care Health Insurance plans offer to include a lot more insurance plans in like Maternity, Senior Citizen, Individual and Family insurance along with Diabetes & Hypertension cover, critical illness covers. These insurance plans are to cover expensive medical treatments, specialized medical procedures, and so on. Check the below procedure for all coverages and plans that cover in PolicyBachat.

Care Health Insurance:

Care Health Insurance Company is one of the stand-alone health insurance companies in India which offers health insurance solutions to customers. It was earlier known as Religare Health Insurance Company and is a part of the Religare group and a direct subsidiary of Religare Enterprises Limited. Care Health Insurance Company offers products such as Health Insurance, Personal accident, Top-up coverage, Maternity, International Travel insurance and Critical illness along with Group health insurance and Group personal accident insurance for Corporate, Micro insurance products for the rural market and other comprehensive wellness services.

The operational philosophy adopted by Care health insurance company is “Customer –centric” and has constantly invested in improving the technology to deliver excellent customer care experience in service, product innovation, and value for money services. In PolicyBachat we provide you with the best customer care support or else feel free to call Our care health insurance customer care number for further assistance. Care Health insurance formerly known as Religare health insurance got its approval from Insurance regulatory and development authority of India (IRDA) in the year 2017 and has been among the five stand-alone health insurance companies to underwrite policies exclusively for Health, Travel and personal accident.

Religare health insurance is now Care Health insurance effective from 1st September, 2020. Care Health Insurance Company offers different health insurance products such as Family floater, Individual health insurance, Critical illness, personal accident, Senior citizen health insurance, and Health insurance for Heart patients, Arogya Sanjeevani, Health insurance policies for Diabetic and Hypertension patients and Super top-up covers.

Care Health insurance plans:

Care Health insurance (Formerly known as Religare Health insurance) offers a comprehensive range of health insurance plans to the customers. Let us understand the features of each health insurance plan offered by Care Health insurance company in detail:-

Care-Family & Individual Health Insurance:

Features:
  • Minimum Entry Age: 91 days
  • Upper age limit for enrolment: No
  • Minimum Sum Insured: Rs.3 L & Max Sum Insured: Rs.75 L.
  • Pre Hospitalization: 30 days & Post Hospitalization: 60 days.
  • Day care treatment is covered
  • Room Rent: From 1% Sum insured per day to Single Private Room upgradable to next level.
  • ICU Charges: Up to 2% of Sum insured to No limit for higher sum insured plans
  • Doctor’s Fee: No Limit
  • Daily Allowance: Rs.500 per day up to 5 days per hospitalization.
  • Ambulance Cover: Up to Rs.3000 per hospitalization
  • Domiciliary Hospitalization: Up to 10% of Sum Insured
  • Organ Donor Cover: Up to Rs.3 L
  • Annual Health Check-up: Yes
  • Second Opinion: Yes
  • No Claim Bonus: Up to 150% of Sum Insured
  • Recharge of Sum Insured: Up to Sum Insured
  • Care Anywhere: Yes (for high Sum Insured Plans)
  • Maternity Cover: Yes (for high Sum Insured Plans)
  • Alternative Treatment: Yes
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • Co-payment: 20% co-pay if your age is more than 61 years.
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 4 years of continuous coverage.
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.

Care Freedom- Health Insurance with Pre policy Check-up:

Features:
  • Minimum Entry Age: Adult – 18 years, Child - 90 days
  • Upper age limit for enrolment: Adult – No, Child – 24 years
  • Age of Proposer- Above 18 years
  • Cover Type: Individual/ Floater (up to 6 members)
  • Minimum Sum Insured: Rs.3 L & Max Sum Insured: Rs.10 L.
  • Pre Hospitalization: 30 days & Post Hospitalization: 30 days.
  • Day care treatment is covered up to Sum Insured
  • Room Rent: From 1% Sum insured per day to Single Private Room.
  • ICU Charges: Up to 2% of Sum insured to No limit for higher sum insured plans
  • Doctor’s Fee: No Limit
  • Consumable Allowance: Up to Rs.1000 per day for a Max of 7 days after 3 days of continuous hospitalization.
  • Ambulance Cover: Up to Rs.1000 per hospitalization
  • Domiciliary Hospitalization: Up to 10% of Sum Insured covered after 3 days of continuous hospitalization.
  • Annual Health Check-up: Yes
  • Dialysis Cover: Up to Rs.1000 per sitting limited to 24 consecutive months.
  • Companion Benefit: Up to Rs.15, 000 if hospitalization exceeds 10 days.
  • Day Care Treatments: Up to 170 day care treatments covered.
  • Automatic Recharge Of Sum insured if exhausted in a policy year
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • Co-payment: 20% co-pay per claim for age up to 70 years, 30% co-pay for age more than 70 years.
  • Treatment for Cataract: Up to Rs.30, 000 per eye.
  • Treatment for Total knee replacement: Up to Rs.1.2 L per knee.
  • Treatment for Hernia, Hysterectomy, BPH, Stones: Up to Rs.80, 000
  • Treatment for Cardiovascular disorders, Cancer Surgeries, Renal Complications, Breakage of Bones: Up to Rs.3 L
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 2 years
  • Named Ailments Waiting period: 2 years
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.
  • Any OPD Treatment

Care Heart- Health insurance covering Pre-existing heart Ailments:

Features:
  • Minimum Entry Age: Adult – 18 years
  • Upper age limit for enrolment: No
  • Age of Proposer- Above 18 years
  • Cover Type: Individual (up to 6 members)/ Floater (2 Adults)
  • Minimum Sum Insured: Rs.3 L & Max Sum Insured: Rs.10 L.
  • Pre Hospitalization: 30 days & Post Hospitalization: 60 days.
  • Day care treatment is covered up to Sum Insured
  • Room Rent: From 1% Sum insured per day to Single Private Room.
  • ICU Charges: Up to 2% of Sum insured to No limit for higher sum insured plans
  • Doctor’s Fee: No Limit
  • Ambulance Cover: Up to Rs.3000 per hospitalization
  • Domiciliary Hospitalization: Up to 100% of Sum Insured covered after 3 days of continuous hospitalization.
  • Cardiac Annual Health Check-up: Yes
  • No Claim Bonus: Up to 50% Sum Insured for each claim free year
  • Day Care Treatments: Covered.
  • Automatic Recharge Of 100% Sum insured if exhausted in a policy year
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • Pre Policy Issuance Medical Check-up: None
  • Co-payment: 20% co-pay per claim for age up to 70 years, 30% co-pay for age more than 70 years.
  • Treatment for Cataract: Up to Rs.30, 000 per eye.
  • Treatment for Total knee replacement: Up to Rs.1.2 L per knee.
  • Treatment for Hernia, Hysterectomy, BPH, Stones: Up to Rs.80, 000
  • Treatment for Cardiovascular disorders, Cancer Surgeries, Renal Complications, Breakage of Bones: Up to Rs.3 L
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 2 years
  • Specific Waiting period: 2 years
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
  • Home Care (Optional Cover): Up to Rs.2000 per day; Max 7 days per occurrence; Max 45 days per policy year per insured person; Deductible of 1 day.
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.

Care Senior - Senior Citizen Health insurance plan above 61 years:

Features:
  • Minimum Entry Age: 61 Years
  • Upper age limit for enrolment: No
  • Cover Type: Individual/ Floater
  • Minimum Sum Insured: Rs.3 L & Max Sum Insured: Rs.10 L.
  • Hospitalization: 30 days & Post Hospitalization: 60 days.
  • Day care treatment is covered up to Sum Insured, 541 procedures
  • Room Rent: From 1% Sum insured per day to Single Private AC Room.
  • ICU Charges: Up to 2% of Sum insured to No limit for higher sum insured plans
  • Organ Donor: Up to Rs. 1 L
  • Second Opinion: Yes
  • Ambulance Cover: Up to Rs.2000 per hospitalization
  • Domiciliary Hospitalization: Up to 10% of Sum Insured covered after 3 days of continuous hospitalization.
  • Annual Health Check-up: Yes, for all members
  • No Claim Bonus: Max up to 50% of Sum Insured for each claim free year
  • Daily Allowance Benefit: Up to Rs.500 per day, max 5 days.
  • Automatic Recharge Of Sum insured if exhausted in a policy year
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • OPD Cover: Yes
  • Co-payment: 20% co-pay per claim for age above 61 years can be opted
  • Treatment for Cataract: Up to Rs.30, 000 per eye.
  • Treatment for Total knee replacement: Up to Rs.1.0 L per knee.
  • Treatment for Hernia, Hysterectomy, BPH, Stones: Up to Rs.65, 000
  • Treatment for Cardiovascular disorders, Cancer Surgeries, Renal Complications, Breakage of Bones: Up to Rs.2.5 L
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 4 years
  • Named Ailments Waiting period: 2 years
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.
  • Any OPD Treatment

Arogya Sanjeevani- Health Insurance Plan with AYUSH coverage:

Features:
  • Minimum Entry Age: 91 days
  • Upper age limit for enrolment: 65
  • Cover Type: Individual/ Floater
  • Sum Insured: Minimum Rs.50k to Maximum Rs.10L
  • Pre Hospitalization: 30 days & Post Hospitalization: 60 days.
  • Room Rent: Up to 2% of S.I subject to a maximum of Rs.5000 per day
  • ICU Charges: Up to 5% of Sum insured subject to a maximum of Rs.10,000 per day
  • AYUSH Treatment: Up to Sum Insured
  • Listed Modern Treatment Methods: Up to 50% Sum Insured
  • Ambulance Cover: Up to Rs.2000 per hospitalization
  • Cumulative Bonus: 5% increase in SI each claim free year; Max up to 50% of Sum Insured
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • Co-payment: 5% co-pay per claim for each claim
  • Treatment for Cataract: Up to 25% of S.I or Rs.40, 000 per eye whichever is lower.
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 4 years
  • Named Ailments Waiting period: 2 years to 4 years
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.
  • Any OPD Treatment/ Domiciliary treatment
  • Gender change treatment
  • Obesity/Weight control
  • Cosmetic or Plastic surgery
  • Hazardous or Adventurous sports
  • Maternity
  • Treatment taken outside geographical area of India.

JOY- Maternity Plan with Baby Cover:

Features:
  • Minimum Entry Age: 18 Years
  • Upper age limit for enrolment: 65
  • Cover Type: Individual/ Floater
  • Minimum Sum Insured: Rs.3 L & Max Sum Insured: Rs.5 L.
  • Pre Hospitalization: 30 days & Post Hospitalization: 60 days.
  • Day care treatment is covered up to Sum Insured.
  • Room Rent: Single Private AC Room.
  • ICU Charges: Up to 2% of Sum insured to No limit for higher sum insured plans
  • Ambulance Cover: Up to Rs.1000 per claim.
  • No Claim Bonus: Max up to 100% of Sum Insured if there are no claims during the policy tenure of 3 years.
  • Renewal Premium: Premium payable on renewal is subject to change with prior approval from IRDA.
  • Co-payment: 20% co-pay per claim for age above 61 years can be opted
  • Maternity Cover: Rs.35, 000 to Rs.50, 000 depending on the sum insured.
  • Policy Period: 3 years
  • New Born Baby Cover: Rs.30k to Rs.50k.
  • New Born baby cover available for a period of 90 days after which extra premium is to be paid to add the baby in the policy.
  • Initial Waiting Period: 30 days for any illness except injury
  • Pre-existing waiting period: 4 years
  • Named Ailments Waiting period: 2 years
  • Maternity waiting period: 9 months
  • Change in Sum Insured: At the time of renewal
  • Grace Period: 30 days from the date of policy expiry
  • Maternity cover available only up to 45 years of age.
  • Tax Benefit: Available
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of event, whose signs or symptoms first occur within 30 days of policy start date.
  • Expenses incurred due to Self-inflicted injury resulting from suicide or attempted suicide.
  • Expenses arising out of or attributable to alcohol or drug misuse/ abuse.
  • Expenses incurred on treatment for pregnancy or child birth, miscarriage, abortion etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.
  • Non Allopathic treatment
  • Charges incurred in connection with cost of routine eye and ear examinations, dentures, artificial teeth, and all other similar external appliances.

Add-ons in Care Health insurance:

Add-ons or Riders are a form of extra coverage available to the insured customer on payment of additional premium which are to be opted at the time of policy purchase. There are different add-ons with Care Health insurance company to cover your specify needs at different points of time.

There are certain add-ons which are available in the Care health insurance policies on payment of extra premium. They are:-

  • Global Coverage:Hospitalization expenses can be availed outside India with the Global coverage options available under the Care health insurance policy. The global coverage is available in most of the countries around the World. There are certain number of hospitals in each country where the customers can avail Cashless facility and reimbursement facility from the other hospitals where there is no tie-up.
  • International Second Opinion: There might be situations where you have not been satisfied with the opinion of your treating doctor to go for an operation or a surgery, in this case you have the option to take second opinion from an internationally recognised doctor and go ahead with the treatment. This international second opinion can be utilised to take opinion of doctors from anywhere around the World. This add-on covers the expenses for consultation from International Medical experts.
  • Covid Care: This add-on covers medical expenses incurred for treatment and/ or quarantine for (Covid-19) with positive confirmative diagnosis from Government Authorized Centre. Benefits of Covid care are as below:-
    • In-patient Care: If you are admitted to a hospital for in-patient care due to Illness related to Corona virus disease which should be Medically Necessary, for a minimum period of 24 consecutive hours.
    • Day Care Treatment: we will indemnify you for Medical Expenses incurred on Day Care Treatment maximum up to the Sum Insured, provided that period of treatment for you in the Hospital/Day Care Centre does not exceed 24 hours.
    • Sub-limits on Coverage for Quarantine: we will indemnify you for Medical Expenses incurred maximum up to 1% S.I. per day maximum up to 30 days in a Policy
    • Pre-Hospitalization Medical Expenses: Under Pre-hospitalization Medical Expenses, for a period of 30 days immediately prior to your date of admission to the Hospital
    • Post-Hospitalization Medical Expenses: Under Post-hospitalization Medical Expenses, for a period of 60 days immediately after your date of discharge from the Hospital.
  • COVID Care with OPD: In addition to the above coverage OPD cover is also provided in this add-on. Up to 1% of sum insured can be availed as an OPD benefit. Care health insurance company will indemnify the customer through Reimbursement for availing Out-Patient consultations, Diagnostic Examinations and Pharmacy expenses, up to the specified amount, during the Policy Year provided that the Medical Expenses so incurred are after positive confirmative diagnosis of Corona virus disease (COVID-19).
  • No Claim Bonus Super: A regular No claim bonus feature offers the customers 10% increase in the sum insured each claim free year subject to a maximum of 50% for consecutive 5 claim free years. With No claim bonus super cover customers can receive 50% increase in the sum insured each claim free year up to 100% sum insured. The no claim bonus super cover will be in addition to the basic no claim bonus feature mentioned in the policy terms and conditions.
  • Care Shield: An add-on cover that offers 3 benefits in a single shot; Claim Shield, No claim bonus shield and Inflation shield.
    • Claim Shield- List of Non-payable expenses like attendant charges, gloves, mask etc, now payable under this benefit in the policy. Basically the consumables which are not paid in the base policy would be payable under this add-on.
    • No Claim bonus Shield- If total payable claim amount in a Policy Year is < 25% Sum Insured, then No Claim Bonus (No Claim Bonus Super, if opted) as applicable in base product shall not be reduced. For example, if your Sum insured is Rs.10 L and the claim made in that particular year is Rs.2 L (which is < 25% S.I), then in this case the no claim bonus will remain intact.
    • Inflation Shield- The base policy Sum Insured will be increased on cumulative basis at each renewal on the basis of inflation rate in previous year.
  • Reduction in Pre existing waiting period: This add-on cover reduces the pre existing waiting period from 48 months to 24 months. The claims will be admissible for any Medical Expenses incurred for Hospitalization in respect of diagnosis/treatment of any Pre-existing Disease after just 24 months of continuous coverage has elapsed, since the inception of the first Policy with Care Health insurance company. This add-on would be beneficial to those people who are already suffering from some kind of disease or illness prior to the inception of the policy. The waiting period would be reduced to half with the help of this add-on.
  • OPD- Care: This add-on cover takes care of the expenses incurred on Doctor Consultations, Pharmacy & Investigative tests. Through this optional cover, one can claim amount equivalent to their bills provided at the time of reimbursement. Coverage amount ranging from INR 5,000 to INR 50,000 can be opted.
  • Unlimited Automatic Recharge: In a base health insurance policy the sum insured is reinstated once in a year in case the entire sum insured is exhausted due to one or more claims. The reinstated sum insured can be used for the treatment of different disease and this is done for free. With the unlimited automatic recharge option the sum insured can be reinstated in the policy “any number of times” in a particular policy period. The recharge of sum insured is done more than 2 times under this add-on which is available on payment of additional premium.
  • Home Care: This add-on covers the expenses incurred towards hiring a qualified nurse for providing care to insured person on recommendation of doctor. Company will pay Rs.1000 for a maximum of 7 days per hospitalization. Under this add-on, a maximum of 45 days coverage will be available in a policy year. 1 day deductible in each hospitalization is applicable under this add-on.
  • Health Check Plus: Under this add-on the basic annual health check-up can be upgraded to Diabetes health check up or Cardiac health check up. This add-on provides with extra number of check-up options to the insured customers which can be availed yearly.
  • Co-payment Waiver: In the base health insurance policy for customers aged 61 years or above, there is a co-payment for each and every claim. With this add-on the co-payment can be waived off and there would be no need to bear a part of a claim whenever you go for a claim. The 20% co-payment is waived off under this add-on on payment of additional premium.
  • Smart Select: Under this add-on you can get up to 15% discount in the premium by restricting the treatment on a specially created smart select network of hospitals. This add-on helps in reducing the premium up to certain extent thereby restricting the cashless options available for the customer.
  • Room Rent Modification: By choosing this add-on the room rent/ category shall be restricted/ limited to Single Private Room under Hospitalization expenses.

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