Care Insurance Care

Care Insurance Care is a health insurance policy offered by Care Health Insurance Company. 

The plan is affordable and provides comprehensive coverage. Aside from hospitalisation and related expenses, it covers non-medical expenses like gloves, oxygen masks, etc, and outpatient expenses like medicines, tests, consultations, etc. It also gives you the option to automatically increase your sum insured based on inflation. 

According to our research, the insurer has received a higher number of claim settlement and policy purchase complaints. This implies that the insurer doesn’t possess a good track record in terms of both purchases and claims. And, you don't get a monthly premium payment option under this plan. 

What are the benefits offered by the Care Insurance Care plan? 

• Inpatient hospitalisation coverage: Expenses incurred when you are admitted to a hospital for more than 24 hours are called inpatient hospitalisation expenses. These include fees for accommodation, nursing services, medical consultation, prescribed medication, intensive care unit (ICU) fees, and other relevant charges. Such expenses are covered by the Care Insurance Care plan.
• Pre-hospitalization coverage: The costs incurred before hospitalization, including consultations, tests, checkups, etc., are known as pre-hospitalization expenses.  The insurance company covers these expenses only if they are related to the medical condition that led to the hospitalisation and are approved as part of the inpatient hospitalisation coverage. The Care Insurance Care plan covers pre-hospitalization charges up to 30 days before hospitalisation up to the sum insured.
• Post-hospitalization coverage: Medical expenses incurred after you are discharged from  the hospital are called post-hospitalization expenses. These expenses include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related charges. To be eligible for coverage, the post-hospitalization charges must be related to the medical condition you were hospitalized for and be approved as part of inpatient hospitalization coverage. Care Insurance Care covers post-hospitalization charges up to 60 days after hospitalization up to the sum insured.
• Daycare treatment coverage: A daycare treatment is a medical procedure or surgery that required a prolonged hospital stay, but now, it can be completed within 24 hours, owing to the advancements in medical technology. Care Insurance Care covers 541 daycare treatments up to the sum insured.   
• Domiciliary treatment coverage: Domiciliary treatments include medical treatments that are administered at home if the severity of a medical condition/injury prevents you from being moved to a hospital or there is a lack of availability of hospital beds nearby. Under the Care Insurance Care plan, domiciliary treatment costs are covered up to 10% of the sum insured if the treating doctor certifies it. 12 illnesses are not covered by the plan under this benefit, so if you undergo domiciliary treatments for them, you’ll have to foot the expenses yourself.
• Organ donor coverage: Care Insurance Care plan also provides organ donor coverage. It covers the expenses related to harvesting an organ during organ transplantation, where the insured is the recipient, up to Rs 1 lakh. 
• Modern treatment coverage: The field of healthcare is progressing at an unprecedented pace with advancements in technology, leading to the development of modern treatments that were once believed impossible. These treatments, such as radio surgeries, stem cell therapy, etc. aim to cure ailments that were previously thought to be incurable. Care Insurance Care plan covers the costs of such modern treatments up to the sum insured. 
• Non-medical expenses coverage: Along with the medical costs, the Care Insurance Care plan covers non-medical expenses such as gloves, oxygen masks, nebulization kits, and more. Such items can be expensive, adding an extra cost to the treatment. The Care Insurance Care plan covers these expenses up to the sum insured, alleviating your financial burden.
• No Claim Bonus: A No Claim Bonus (NCB) is a reward offered by the insurer if no claims are filed during a policy year. Care Insurance Care provides an NCB of 10% of the sum insured annually. A maximum bonus of 50% of the sum insured can be accumulated under the policy. And, the accumulated bonus will get reduced if a claim is filed during the policy year.  Important: If you opt for an add-on, the No Claim Bonus will not reduce even in case you make a claim if it is up to 25% of the sum insured.
• Super No Claim Bonus: A Super No Claim Bonus is an advanced form of the No Claim Bonus and works similarly. Care Insurance Care offers a Super Claim Bonus of 50% of the sum insured annually. The policy allows you to accumulate a maximum bonus of 100% of the sum insured. The accumulated bonus gets reduced if a claim is filed during the policy year. Important: The Super NCB results in an increase in the sum insured that is over and above the increase in the sum insured earned through the NCB.
• Restoration Benefit: This feature allows you to restore the sum insured after it gets depleted within a policy year. The Care Insurance Care plan offers the refill benefit for unrelated illnesses. It activates once the sum insured and any No Claim Bonus are fully exhausted and is available for subsequent claims. And you can avail of this feature unlimited times in a policy year if you opt for an add-on. Important: In the case of health insurance portability, the credit for the sum insured will be available up to the amount of the expiring policy's sum insured, including any restored sum insured.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 lakh sum insured. 

Care Insurance Care: Financial Limits

• Room rent Limit: The room rent limit is the maximum amount your insurer will pay for the room you stay in during your hospitalization. If you opt for a room within the specified limit, you won’t have to pay anything from your pocket. However, if you choose a room that goes beyond your eligibility, a proportionate deduction will apply. It means that you will be responsible for paying a proportionate share of the entire bill, not just the difference in the room rent. Under Care Insurance Care, you are eligible to opt for a single private AC room at the most. You can go for lower-category rooms too, but cannot select a room category that is higher than a single private AC room.
• ICU rent limit: The ICU rent limit is the maximum amount that a health insurance policy covers for your stay in the intensive care unit (ICU) during hospitalization. Care Insurance Care has no limit on the ICU expenses, meaning the plan will cover the entire cost without any restrictions - up to the sum insured.
• Co-payment: Copayment is a part of the approved claim amount that you are supposed to pay from your end before the insurer pays the rest. The Care Insurance Care plan has a mandatory co-payment of 20% for individuals with an entry age of 61 years and above.
• Deductible: A deductible is an amount you need to pay from your end before your health insurance steps in to cover your medical expenses.  Care Insurance Care has no deductible limit.
• Limits on surgeries/treatments: It is the maximum amount a health insurance policy provides for certain medical procedures or treatments. While some policies may restrict the amount they will cover for specific procedures, others may not. The Care Insurance Care plan covers important surgeries like joint replacement surgery and cataract treatment - without placing any cap - up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 lakhs. 

Care Insurance Care: Waiting Period & Exclusions

👉Waiting period

Some illnesses and diseases will not be covered for a certain period after you purchase a health insurance policy. This period is called the waiting period. Once this period ends, you can claim for these conditions. Here are some types of waiting periods -

• Initial waiting period: There is an initial waiting period of 30 days that applies to all health conditions except accidents. It means that you won’t be able to make claims for hospitalisation expenses during the first 30 days of policy purchase, except in case of accidents.
• Waiting period for pre-existing diseases: A pre-existing disease is a medical condition you had in the 36 months before purchasing the policy. The Care Insurance Care plan has a waiting period of 36 months for pre-existing diseases. During this period, the medical expenses that you incur for a pre-existing disease will not be covered by your health insurance policy. However, by opting for an add-on, you can reduce this waiting period to 24 months.
• Waiting period for specific diseases: Insurance companies have a predefined list of medical conditions that entail a waiting period, regardless of whether you have previously experienced those conditions or not. This waiting period is not influenced by your present health condition and is decided by the insurer. Care Insurance Care plan has a waiting period of 24 months for specific diseases.

👉Exclusions

Health insurance policies will not cover certain circumstances at any cost. These are known as exclusions. Here are some types of exclusions -

• Standard Permanent Exclusions: IRDAI has established a list of standard permanent exclusions which are required to be enforced by all insurance companies. Some of them are:

1. Investigation and evaluation: Hospital admission for the purpose of monitoring or observation.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without any active treatment provided. 
3. Obesity/weight control: Treatments or surgeries related to weight control or obesity.
4. Gender reassignment: Treatments that are aimed at altering the body’s characteristics to match those of the opposite sex. 
5. Plastic/Cosmetic surgery: Treatments or surgeries intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses incurred while participating as a professional in adventurous activities such as river rafting, mountaineering, scuba diving, etc. 
7. Breach of law: Expenses that are related to the treatment of a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatments from medical practitioners or hospitals that the insurance company excludes.
9. Narcotics: Treatments for the addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Treatments that are undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses incurred in correcting refractive errors of up to 7.5 diopters for improved eyesight
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.

• Additional permanent exclusions: Insurance companies may impose additional exclusions for specific medical conditions or situations in addition to standard permanent exclusions. If you suffer from certain diseases or severe medical conditions considered risky by the insurer, they may permanently exclude them from the policy. It is important to note that IRDAI has specified a list of illnesses for which insurance companies can apply a permanent exclusion. Apart from those illnesses, no illness or disease can be categorised under permanent exclusions.
• Non-standard exclusions (Specific exclusions): These are the specific exclusions in addition to the standard permanent exclusions listed by the IRDAI. These exclusions vary depending on the insurance companies and the policy’s terms and conditions. The specific exclusions under the Care Insurance Care plan include - 

1. Prostheses or external equipment such as wheelchairs, walkers, glucometers, crutches, etc.
2. Treatment expenses for external birth defects.
3. Circumcision, unless it is medically necessary for treating a disease or injury.
4. Preventive care, vaccination, inoculation, and immunisation costs, except for post-animal bite treatment.
5. Use of a ventilator for a patient in a vegetative state (brain dead) with no chance of recovery.
6. Expenses related to donor treatment, including organ removal surgery in the case of transplant procedures.
7. Any non-allopathic treatments associated with unrecognised systems of medicine.
8. Injuries or illnesses directly or indirectly caused by terrorism, nuclear emissions, war, civil war, etc.
9. Treatments that are related to intentionally self-inflicted injuries or attempted suicide by any means.
10. Injuries or illnesses resulting from nuclear, chemical, or biological attacks or weapons.
11. Impairment of intellectual faculties due to the abuse of stimulants or depressants, unless prescribed by a medical practitioner.
12. Expenses related to hair loss treatments and products.
13. Treatment received in a clinic, rest home, sanatorium, nursing home, or similar institution. 
14. Injuries or illnesses arising from participation or involvement in naval, military, or air force operations.

What to expect in terms of claims experience if you buy from Care Health Insurance Company?

• Speed of Claims: Care Health Insurance Company has a stellar track record of settling 100% of claims in less than 30 days. This means you can receive your claim amount promptly.
• Claim-related Complaints: In terms of claim-related complaints, Care Health Insurance Company has received higher complaints than other companies at 0.39%. This indicates that their claim settlement process is not efficient and you may not experience a satisfactory outcome. 
• Claims Incurred Ratio: The claims incurred ratio of Care Health Insurance Company is 57.69%. This ratio reflects the proportion of claims incurred by the company relative to the total premiums collected. 
• Claim Settlement Ratio: Care Health Insurance Company has a claim settlement ratio of 90.50%. This ratio signifies the percentage of claims settled by the insurer compared to the total number of claims received by them in a financial year. 
• Network Hospitals: With a network of 24,800+ hospitals, Care Health Insurance Company offers a wide range of healthcare providers across multiple locations. This extensive network enables you to access cashless treatment conveniently, without worrying about your finances.

How is the customer service of Care Health Insurance Company?

• Policy Purchase-Related Complaints: Care Health Insurance Company has received a higher percentage of complaints related to its after-sales service at 0.01%. This suggests that customers may not have a positive experience in this aspect.
• Response on Toll-free: Our research indicates that Care Health Insurance Company provides an average response on their toll-free helpline. Thus, you can expect efficient resolution of your issues.
• Response on Twitter: As compared to other companies, Care Health Insurance Company’s response on Twitter has also been found to be average, according to our research. 

About Care Health Insurance Company

Care Health Insurance (previously known as Religare Health Insurance Company Limited) is a dedicated health insurance provider operating in India. Their offerings encompass a range of products in the retail sector, including health insurance, top-up coverage, personal accident cover, maternity cover, international travel insurance, and critical illness coverage. Additionally, they offer group health insurance and group personal accident insurance for corporate entities and more. Established in 2012, the company is based in Gurugram, Haryana, and Mr. Anuj Gulati holds the position of CEO and MD.