Care Health Care Insurance Plan

When dealing with healthcare uncertainties, securing your well-being and that of your family is paramount. This is where you can benefit from Care Health Care Insurance Plan (formerly known as Religare Care Health Insurance Plan). You can consider it as a robust shield against the financial burdens that accompany medical emergencies. This comprehensive insurance policy has been crafted with precision and offers a safety net during critical times. It ensures you and your loved ones receive unparalleled medical care within the borders of India and overseas.

If you are worried about health issues, this policy can help you deal with the complexities of health crises. It allows you to direct your energy towards recovery, unburdened by financial concerns.  In this guide, you will discover the extensive coverage, flexibility, and peace of mind Care Health Care Insurance Plan instills. 

Key Features of Care Health Care Insurance Plan

• High Claim Settlement Ratio

With an impressive 92% claim settlement ratio, as per the insurer’s official website, Care Health Care Insurance plan comes with a reliable and efficient process for settling claims.

• Extensive Network of Hospitals

You can access quality healthcare with cashless treatment available in more than 16,500 network hospitals. This widespread network ensures you can avail of medical services without worrying about upfront payments.

• Annual Medical Check-up

This policy can help you prioritize preventive healthcare with the annual medical check-up facility provided for all insured members. Regular health check-ups can contribute to early detection and timely intervention.

• Hassle-Free Claim Settlement

You can also benefit from an in-house claim settlement team, ensuring a quick and hassle-free process. Experience cashless claim approval within a limited timeframe, allowing you to focus on recovery rather than paperwork.

• Sum Insured Enhancement

You can also benefit from the flexibility of increasing the sum insured by up to 150% through the No Claim Bonus (NCB) discount and NCB Super. This feature rewards policyholders for maintaining a healthy lifestyle.

• Automatic Recharge

The policy offers automatic recharge of the sum insured, ensuring uninterrupted coverage during medical emergencies.

• Care Anywhere Cover

You can avail of comprehensive coverage including 12 critical illnesses under the Care Anywhere cover.

• Tailored Coverage Options

You can customize financial protection under this plan with specialized riders like Covid Care and Global Coverage. These additional choices enhance the adaptability of your policy to address specific healthcare concerns.

Read More: Group Health Insurance: Advantages, Features, and More

Care Health Care Insurance Plan: Key Highlights

1. Coverage Options: Individual and Floater
2. Sum Insured: Ranging from Rs 5 lakh to Rs 6 crore
3. Policy Tenure: 1 year, 2 years, or 3 years. 
4. Pre-existing Diseases Waiting Period: 48-month 
5. Co-payment: 20% co-payment for individuals above 60 years 
6. Tax Benefits: under section 80D of the Income Tax Act

Add-on Covers in Care Health Care Insurance

No Claim Bonus Super	– An optional cover amplifies the sum assured for each claim-free year, increasing the No Claim Bonus (NCB) by 50%, up to a remarkable 100% –  Can elevate the sum insured by up to 150% over five years cumulatively, with NCB and NCB Super
Global Coverage – Total	An extension of Global Cover, providing unlimited coverage for medical treatments overseas, eliminating geographical limitations
Unlimited Automatic Recharge	A rider ensuring uninterrupted coverage with this feature reinstating the sum insured upon exhaustion, available an unlimited number of times throughout the policy period
Everyday Care	Offering coverage for all OPD consultations, including diagnostic procedures and doctor consultations, up to 1% of the sum insured
Air Ambulance Cover	Vital in emergencies requiring treatment far from the city of residence, this add-on covers the costs associated with air ambulance services
Reduction in PED Wait Period	Help reduce the waiting period for pre-existing diseases from 48 months to 24 months, ensuring coverage for existing health conditions
Covid Care with OPD	Covers hospitalization and quarantine expenses, along with outpatient costs up to 1% of the sum insured for government-authorized diagnostic center tests
Co-payment Waiver	Eliminates the mandatory 20% co-payment for insured individuals above the age of 60 years
OPD Care	Covers outpatient medical expenses, including doctor’s consultations, investigative tests, and pharmacy costs
Smart Select	Offers a 15% premium discount with a 20% co-payment commitment if admitted to a non-listed hospital.

Inclusions of Care Health Care Insurance Plan 

• 30-day coverage for medical expenses incurred before hospitalization
• All expenses related to ambulance services 
• Inclusive coverage for in-patient hospitalization, encompassing room rent charges, intensive care unit charges, nursing expenses, and more
• 540+ daycare treatments that necessitate hospitalization for less than 24 hours
• Assurance of coverage for medical expenses incurred up to 60 days after hospitalization
• Access to an annual medical check-up
• Reassurance with coverage for obtaining a second medical opinion
• Coverage for medical treatments conducted at home
• Expenses related to organ donation procedures 
• Coverage for alternative medical treatments
• Inclusive coverage for advanced and specialized treatment methods
• Daily allowance for up to 5 days per hospitalization as per policy terms
• Coverage for hospitalization expenses globally, excluding the USA
• Specific coverage for vaccinations for children
• Maternity cover available for sum insured between Rs 50 to Rs 75 lakh, ensuring comprehensive care during the maternity period

Exclusions of Care Health Care Insurance

• Expenses related to the treatment of congenital diseases
• Hospitalization required due to self-inflicted injuries or suicidal attempts 
• Medical treatment or hospitalization resulting from the overdose of drugs, alcohol, or intoxications 
• Any disease, illness, or surgery diagnosed or exhibiting symptoms within 30 days of the policy commencement date 
• Medical tests and hospitalization related to infertility and in vitro fertilization 
• Hospitalization arising from war, strike, nuclear weapons, or riots

For a comprehensive understanding of inclusions and exclusions, refer to the policy wordings or check this comprehensive Care Health Insurance guide.

Care Health Care Insurance Eligibility Criteria

• Minimum Entry Age: 5 years (for a floater cover, it starts at 91 days, provided at least one insured member is above 18 years)
• No Maximum Entry Age Limit
• Lifetime Renewability
• Waiting Period for Illness: 30 days for illnesses, excluding injuries

Understanding these eligibility criteria ensures you can assess their eligibility and make informed decisions regarding enrollment. 

Care Health Care Insurance Claim Process

Here is a detailed guide to the claim process related to this Care Health Insurance plan:

Cashless Claims:

• Inform the insurance company within 24 hours of emergency hospitalization.
• Notify the insurer at least 48 hours before planned hospitalization.
• Get admitted to a network hospital affiliated with Care Health Insurance Limited.
• Submit the pre-authorization form to the hospital’s Third-Party Administrator (TPA) desk.
• Receive the approval letter from the claim management team.
• Undergo treatment, and the insurance company settles the claim post-discharge.
• Respond to any queries raised by the claim management team, either by the insured or the hospital.
• If a cashless claim is rejected, the insured can commence treatment, settle bills, and file a fresh reimbursement claim upon discharge.

Reimbursement Claims:

• Receive treatment at a hospital and pay all bills at discharge.
• Submit the claim form and necessary documents to the insurance company according to the terms and conditions.
• Care Health Insurance Limited’s claim management team verifies the documents and coverage details.
• The insurance company will inform you about claim approval and disburses the claim amount.
• In case of rejection, the insurance company notifies the policyholder, providing reasons for the denial.

Everyday Care Claim Procedure:

• Check the list of Everyday Care network centers conveniently available on the insurance company’s official website.
• Ensure the chosen service provider falls within the network for seamless claim processing.
• Visit the chosen OPD service provider armed with your Everyday Care Card. This card serves as your access pass for availing services.
• Carry an original copy of a government-issued photo ID as an essential document during your visit.
• The service provider will deduct 80% of the total bill directly from the Everyday Care Card. The insured is then required to cover the remaining 20% as a co-payment. 

OPD Care Claim Procedure:

• Download the OPD Care claim form directly from the insurer’s official website. Ensure you have the latest version of the form for accurate processing.
• Collect all original bills and invoices related to the OPD treatment. Ensure each document is clear, complete, and includes relevant details for comprehensive claim assessment.
• Attach the downloaded claim form along with the original bills and invoices. 
• Submit the complete claim application to the insurer through the specified channels. 
• Expedite the settlement process by including NEFT details in the claim application.
• Experience prompt resolution, as most OPD Care claims are settled within 15 days from the date of receiving all the necessary documents. 

FAQs

What is the minimum entry age for individual and floater coverage under Care Health Care Insurance?

The minimum entry age is 5 years for individual coverage and 91 days for floater cover, with at least one insured member above 18 years.

Are pre-existing illnesses covered, and if so, what is the waiting period?

Pre-existing illnesses are covered, with a waiting period of 4 years from the policy commencement date.

How is the claim process for hospitalization handled?

For cashless claims, get admitted to a network hospital, submit the pre-authorization form, and receive approval. For reimbursement claims, pay bills at discharge and submit the claim form and documents.

What does the Everyday Care claim procedure entail?

Check the online list of Everyday Care network centers, visit with the Everyday Care Card and a government photo ID, and pay the 20% co-payment.

How can I claim OPD Care benefits?

Download the claim form from the insurer’s website, attach original bills, and submit the application. Include NEFT details for seamless settlement.

What is the waiting period for illnesses, excluding injuries?

There is a 30-day waiting period for illnesses, not applicable to injuries, from the policy commencement date.

Is there a maximum entry age limit for Care Health Care Insurance?

No, there is no maximum entry age limit, ensuring accessibility for individuals across all age groups.

What add-on covers are available, and how do they enhance coverage?

Add-ons like No Claim Bonus Super, Global Coverage, and Care Anywhere Cover enhance coverage by offering increased sum assured, global medical treatment, and coverage for 12 critical diseases globally.

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