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Parent's health insurance Religare vs Care

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29 Aug, 2023 by  Ramakrishna MV

I have purchased a policy in Religare (now care) for my mother before she turned 61 in 2019. The Policy is in force from last 3 years. The policy underwent name change in 2020s

I was looking for cataract surgery related information in T&C and surprisingly the document though covers the surgery did not mention the amount that can be claimed

When I browsed through the care website, I couldn't find the same product in the latest offerings. But onething I noticed is for the latest products in their website the T&C includes cataract limits

Customer care people told me that since policy doesn't mention the amount, "reasonable charges" can be claimed. They are not clearly quoting the "reasonable" amount when I questioned them.

What are the options available to me - Kindly suggest

Product purchased in Religare: CARE (along with shield cover): SI: 20L


2 Answer

03 Sep, 2023

Hello Ramakrishna,

If the policy doesn't mention any limits for cataract surgery, it means that the expenses would be covered up to the sum insured. However, it's important to note that only reasonable and customary charges will be covered. This means that if the hospital you choose charges significantly more than other hospitals in the same geographical area for cataract surgery, the insurer may refuse to pay the excess amount and will cover only the standard rates charged by similar hospitals in your area. You can read in detail about the Reasonable & Customary Clause in Health Insurance in our article here:

Thank you!

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05 Sep, 2023
Udit Jain

You can also initiate a cashless pre approval process with the amount which hospital/eye centre is charging you, based on that you will come to know beforehand how much amount company is approving and declining on which you can take a call whether you want to go ahead with this policy or the other option you would have.

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