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Care(Religare) Health Insurance

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 (Erstwhile Religare Health Insurance)

About Care Health Insurance Company

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, Microinsurance products for the rural market and other comprehensive wellness services.

Religare health insurance is now Care Health insurance effective from 1st September 2020. The operational philosophy adopted by the Care health insurance companies 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. 

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.
  • Daycare 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 a 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 a 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 an 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 childbirth, 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.
  • Daycare 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 a 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 daycare treatments covered.
  • Automatic Recharge Of Sum insured if exhausted in a policy year
  • Renewability: Life-Long
  • Renewal Premium: Premium payable on a 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 an 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 childbirth, 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.
  • Daycare 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 a 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 a 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 an 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 childbirth, 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.
  • Daycare 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 a 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 a 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 opt
  • 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 an 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 childbirth, 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 a 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 an 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 childbirth, 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 has taken outside the 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.
  • Daycare 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 a 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 a renewal is subject to change with prior approval from IRDA.
  • Co-payment: 20% co-pay per claim for age above 61 years can opt
  • 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 is available for a period of 90 days after which an extra premium is to be paid to add the baby to 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 is available only up to 45 years of age.
  • Tax Benefit: Available
Exclusions:
  • Any diagnosis of diseases/ undergoing of surgery/ occurrence of an 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 childbirth, 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 the cost of routine eye and ear examinations, dentures, artificial teeth, and all other similar external appliances.

Exclusive features of Care Health insurance :

Care Health insurance (formerly known as Religare Health Insurance Company) offers comprehensive health insurance plans which make the best choice for you and your family. Some of the exclusive features offered by Care health insurance companies are:-

  • Care health insurance offers health insurance plans for families up to 6 members (4 Adults and 2 children). This is very convenient for families to include their parents or parents-in-law.
  • The pre and post-hospitalization limits are 30 days and 60 days which are considered best in the health insurance market.
  • Organ donor cover is provided up to Rs.3 L of the sum insured for plans with higher sum insured.
  • Ambulance charges of Rs.3000 per hospitalization which is the highest amount in the insurance industry.
  • Air ambulance is offered to customers availing higher sum insured options.
  • Up to 150% of Sum insured is given as A claim bonus for each claim-free year to the customers.
  • The global treatment option is available in which the customers can get treatment from anywhere in the World with cashless or reimbursement options.
  • Lifelong renewability option to the customers who want to continue their coverage for a long period of time.
  • Under the Room rent category, a Single Private AC room is provided to the patients.
  • 15500+ health care providers serve Cashless Medical Services across the Globe with which the Care Health insurance company has a tie-up.
  • Free health check-up options to customers in a policy year.

What is included in Care Health Insurance?

Different health insurance plans from Care health insurance have different inclusions. Some of the common inclusions are mentioned below:-

  • In-patient hospitalization: Care health insurance covers the hospitalization expenses of the insured including Room rent, boarding charges, ICU charges, Doctor Charges, etc., up to the sum insured mentioned under the policy. The in-patient hospitalization requires the insured to get admitted to the hospital for treatment for more than 24 hours. The in-patient hospitalization charges cover a big chunk of the treatment cost of the insured customer.
  • Pre-hospitalization expenses: The cost of treatment incurred by the customer before getting admitted to a hospital as in-patient treatment for treatment is known as a pre-hospitalization expense. Pre-hospitalization expenses for up to 30 days would be paid by the Care health insurance company to the customers in case there is an inpatient claim admissible under the policy.
  • Post hospitalization expenses: The cost of treatment incurred by the customer after getting treatment as an inpatient is known as a post-hospitalization expense. The cost of treatment including medicines, diagnostic tests, etc. after getting discharged from the hospital is paid up for a certain number of days. The post-hospitalization expenses are paid up to 60 days from the date of discharge from the hospital.
  • Room rent & ICU Charges: Care health insurance plans cover the room rent and ICU charges as a part of inpatient hospitalization cover. There are certain sub-limits for which these charges are provided by the insurance company.
  • Day Care Treatments: Daycare treatments are those treatments that can require less than 24 hours. Due to the advancement of technology, there are many diseases or illnesses which are treated within a few hours and these are covered under the daycare treatment section. The maximum coverage under the daycare treatment section would be the sum insured or actual whichever is less.
  • Daily Allowance: Daily allowance is an amount given to the customer if the hospitalization exceeds a certain number of days. The daily allowance is given up to 5 days per hospitalization. The daily hospitalization amount is different from that of the inpatient charges paid to the customer.
  • Health check-up facility: Care health insurance provides health check-up facilities to the members covered in the health insurance policy. The number of health check-ups and the sub-limits are specified in the policy terms and conditions.
  • Domiciliary hospitalization: Domiciliary hospitalization is the expenses incurred by the customer for getting the treatment at home on the advice of a doctor. The cost of treatment incurred for treatment at home is covered by Care Health Insurance Company under their health insurance plans.
  • Alternative Treatments: Alternative treatments are medical treatments such as Ayurvedic, Siddha, Homeopathy, Unani, and Yoga which are recognized by the Government of India as alternative treatments for diseases. The sum insured covered under this section is mentioned in the policy terms and conditions.
  • Organ Donor Cover: Organ donor cover includes the cost of operating expenses to carry out organ replacement activity. The cost of harvesting and transplanting the organ to the insured customer is covered by Care Health Insurance Company in their health insurance plans. It also pays the organ donor costs as well in addition to the cost of insured.
  • No Claim Bonus: No claim bonus of up to 150% on the sum insured is provided to the customer for each claim-free year which is one of the highest percentages in the insurance industry. The no-claim bonus super provides up to 100% No claim bonus for each claim-free year in addition to the base NCB cover.
  • Recharge of Sum Insured: Sum insured would be recharged or reinstated if the base sum insured is exhausted in a policy year. This option can be availed once in a policy year and the recharged sum insured can be utilized to treat different diseases or illnesses. With the Unlimited recharge option, you can get your sum insured recharged an unlimited number of times as there would be no limit on the number of times the sum insured can be reinstated.
  • Maternity & Baby Cover: Maternity and Newborn baby covers are available under the Care health insurance plans which cover the cost of delivery and other costs related to a newborn baby. These are available as base covers as well as add-ons depending on the health insurance plan selected by the customer.
  • Second Opinion: The insured customer can go for a second option from any doctor in the World related to the treatment and the cost of that would be borne by the insurance company.
  • Sum Insured Range: There are different sum insured options available to the customers. The sum insured ranges from Rs.50K to Rs.1 Cr depending on the type of health insurance plan. The higher the sum insured, the higher would be the premium to be paid by the customer.

What is Excluded in Care Health insurance?

Exclusions in a health insurance policy mean the charges for diseases or illnesses which are not covered even after satisfying the waiting period mentioned in the policy. There are certain exclusions in Care health insurance plans which are mentioned below common to all the types of plans:-

  • Any diagnosis or disease-related treatment within the first 30 days of the policy inception date is not covered.
  • 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 childbirth, miscarriage, abortion, etc.
  • Diseases present from birth- Congenital diseases.
  • Expenses incurred on treatment of infertility.
  • War, Riot, Strike, Nuclear weapons induced hospitalization.
  • Charges incurred in connection with the cost of routine eye and ear examinations, dentures, artificial teeth, and all other similar external appliances in certain types of health insurance plans.

Claim Process of Care Health Insurance:

Care Health Insurance Cashless Claim Process:

Care Health Insurance Company (Formerly known as Religare Health Insurance Company) provides cashless treatment to its customers in more than 15,500 network hospitals all over the World. These hospitals are tied-up to offer comprehensive cashless services to the Care health insurance company customers. The procedure to claim cashless treatment from the network hospitals is listed below:-

Step 1: In case of planned cashless treatment intimate the insurance company on their toll-free number 1800-102-4488 and register the treatment for which the cashless service would be availed. In case of emergency hospitalization, it is required to intimate the insurance company before the treatment starts. The insurance company would provide the go-ahead to the hospital and the claim would be settled on a cashless basis.
Step 2: The second step is to fill and submit the Claim intimation form / pre-authorization form available with the hospital. The E-card or the insurance policy copy should also be submitted along with the pre-authorization form to enable the insurance company to process the claim.
Step 3: The next step is to submit the cashless claim form along with all the other documents as required to process the claim.
Step 4: The form and the other documents submitted would be verified by the insurance company and if found satisfactory, a go-ahead will be given by the insurance company for a cashless claim.
Step 5: Once the treatment is done and the cashless request is accepted by the insurance company, Care Health Insurance Company would transfer the claim amount directly to the hospital without any involvement of the insured customer.

Care Health Insurance Reimbursement Claim Process:

There are certain documents required by the Care health insurance company to process the claims other than cashless. Any treatment taken in the non-network hospital would be settled on a reimbursement basis as the process involves the customer paying the bill and then claiming for the reimbursement after submitting all the necessary documents. The process of claim settlement under reimbursement basis would be as below:

Step 1: The first step under the reimbursement claim process is to intimate the insurance company within 24 hours of admission to the hospital. For pre-planned treatment, intimation can be given even 48 hours prior to admission to the hospital.
Step 2: The next step is to duly fill the claim intimation form and sign it. There are certain documents that are to be submitted to the insurance company along with the claim intimation form which is mentioned below:-
  • Details of the hospital in which the insured has undergone treatment which includes the details of the patient, the treatment underwent, etc.
  • Policy copy of the Health card of the insurance company to prove the validity and the coverage.
  • Date of admission and date of discharge.
  • Discharge Summary.
  • Estimated claim amount for the treatment undergone at the hospital.
  • Authorization from doctor advising hospitalization/ diagnostic tests/ consultation.
  • Original hospital bills and the discharge summary.
  • Pathological reports and any other reports were taken as a part of the treatment.
  • Police FIR and Post mortem report (for death claims)
  • Any other documents as requested by the insurance company.
  • Canceled cheque leaf of the insured customer.
Step 3:The last step is where the insurance company would settle the bill after thorough inquiry and the quantum of claim would be decided by the insurance company subject to the terms and conditions mentioned under the policy. The insurance company would transfer the claim amount to the bank details submitted by the customer and any other bank details other than that of the customer would not be accepted by the insurance for claim settlement.

Care Health insurance Riders:

Add-ons or Riders are a form of extra coverage available to the insured customer on payment of additional premium which is to opt at the time of policy purchase. There are different add-ons with Care Health insurance companies to cover your specific needs at different points in time. There are certain add-ons that 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. Global coverage is available in most of the countries around the World. There is a 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 surgery, in this case, you have the option to take a second opinion from an internationally recognized doctor and go ahead with the treatment. This international second opinion can be utilized to take the opinions 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 a positive confirmative diagnosis from Government Authorized Centre.
  • COVID Care with OPD: In addition to the above coverage OPD cover is also provided in this add-on. Up to 1% of the 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 are so incurred are after positive confirmative diagnosis of Coronavirus disease (COVID-19).
  • No Claim Bonus Super: A regular No claims bonus feature offers the customers a 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 a 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 the 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 the 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 a cumulative basis at each renewal on the basis of the inflation rate in the 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 an amount equivalent to the bills provided at the time of reimbursement. Coverage amounts ranging from INR 5,000 to INR 50,000 can opt.
  • Unlimited Automatic Recharge: In a base health insurance policy the sum insured is reinstated once 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 diseases 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 the 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 the insured person on recommendation of a doctor. The company will pay Rs.1000 for a maximum of 7 days per hospitalization. Under this add-on, a maximum of 45 days of 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 a Diabetes health check-up or Cardiac health check-up. This add-on provides an 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 a 15% discount on 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 a 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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