Care Insurance Care Advantage

Care Insurance Care Advantage Plan is a health insurance policy crafted by Care Health Insurance Company. 

The plan strikes a smart balance, giving you good value for your money. It is affordable and comes with many handy features like global coverage and flexibility to reduce the waiting period for pre-existing conditions. Plus, it covers outpatient expenses and provides consumables like masks and gloves. However, there are a couple of drawbacks – firstly, it does not cover the expenses incurred for domiciliary treatments. And secondly, you do not have the option to pay your premium on a monthly basis.

Our research shows that the insurer has faced more complaints about settling claims and purchasing policies. This suggests they have a poor track record in both areas.

What Are The Benefits Offered By the Care Insurance Care Advantage Plan?

• Inpatient hospitalisation coverage: The Care Insurance Care Advantage Plan provides coverage for all expenses related to inpatient stays lasting more than 24 hours. This comprehensive coverage includes nursing care, medical consultations, prescription medications, intensive care unit (ICU) charges, and any other associated costs.
• Pre-hospitalisation coverage: The pre-hospitalization coverage provided by the Care Insurance Care Advantage Plan includes expenses incurred before admission to the hospital, such as consultations, tests, check-ups, and related costs. These charges must be linked to the medical condition that leads to hospitalisation and approved as part of the inpatient hospitalisation coverage to be eligible. Under this plan, pre-hospitalization expenses accrued within the 30 days preceding hospitalisation are covered up to the cover amount.
• Post-hospitalisation coverage: Post-hospitalization expenses include medical costs occurring after a hospital stay, such as follow-up consultations, check-ups, rehabilitation sessions, physiotherapy, and related expenditures. To be eligible for this coverage, the expenses must be linked to the medical condition requiring hospitalisation and approved under the inpatient hospitalisation coverage. The Care Insurance Care Advantage Plan provides coverage for post-hospitalization expenses for 60 days after hospitalisation, up to the cover amount.
• Daycare treatment coverage: Daycare treatment encompasses medical procedures or surgeries that previously required extended hospital stays but can now be finished within 24 hours with the advancements in medical technology. Under the Care Insurance Care Advantage Plan, there is no limit to coverage for 541 daycare procedures, meaning all expenses related to these treatments are covered up to the chosen sum insured.
• Domiciliary treatment coverage: Domiciliary treatments involve urgent medical interventions for illnesses or injuries that would typically necessitate hospital care but are instead administered at home due to the severity of the medical condition or a lack of available hospital beds. Unfortunately, the Care Insurance Care Advantage Plan does not provide coverage for expenses related to domiciliary treatments.
• Organ donor coverage: The Care Insurance Care Advantage Plan offers coverage for harvesting expenses, with you as the recipient, up to the cover amount.
• Modern treatment coverage: As healthcare progresses through technological advancements, innovative treatments such as stem cell therapy and robotic surgery are now handling diseases that were once considered incurable. The Care Insurance Care Advantage Plan is tailored to keep up with these advancements by offering coverage for costs associated with modern treatments, up to the selected sum insured.
• Non-medical expenses coverage: The Care Insurance Care Advantage Plan extends its coverage beyond medical expenses to include essential non-medical items such as gloves, nebulization kits, oxygen masks, and other necessary treatment supplies, up to the sum insured. This coverage is applicable if you choose it as an add-on.
• No Claim Bonus: This No Claim Bonus is offered by an insurer as an incentive for refraining from filing claims during a policy year. Under the Care Insurance Care Advantage Plan, you can earn a No Claim Bonus equivalent to 10% of the sum insured. This bonus has the potential to accumulate, reaching a maximum limit of up to 50% of the sum insured. It is important to recognize that the bonus may decrease if claims are made, at the same rate at which it was accumulated. When Super NCB is applied, the resulting increase in the sum insured goes beyond what is earned through the regular No Claim Bonus (NCB) for insurance.
• Super No Claim Bonus: The Super No Claim Bonus functions similarly to the standard No Claim Bonus but offers enhanced benefits. With the Care Insurance Care Advantage Plan, the annual bonus that can be accrued if you do not make a claim in the previous year is 50% as an add-on. It is important to note that any claims made in the previous year will result in a reduction of the accumulated bonus. The maximum Super No Claim Bonus that you can accumulate is 100%. 
• Restoration Benefit: Within the Care Insurance Care Advantage Plan, there is a valuable feature known as the restoration benefit. This feature kicks in to replenish your sum insured in the event it is depleted during a policy year, particularly for unrelated illnesses. For related illnesses, you can utilise the restoration benefit, but only if you have been admitted to the hospital for that illness at least 45 days after discharge from your previous claim. To activate this benefit, both the sum insured and the No Claim Bonus must be fully utilised. It is crucial to understand that you can utilise this restoration benefit only once per policy year for subsequent claims.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

Care Insurance Care Advantage Plan: Financial Limits

• Room rent limit: Your health insurance features a room rent limit designed to cover your hospital stay expenses. When you stay within this limit, it ensures that you will not incur additional charges. However, if the room you choose exceeds the specified limit, a proportional deduction applies. In such instances, you will be responsible for a share of the total bill proportionate to the excess room rent, not just the portion exceeding the limit. One advantage of the Care Insurance Care Advantage Plan is its flexibility in allowing you to select any room type without restrictions.
• ICU rent limit: This feature specifies the maximum coverage your health insurance offers for your ICU stay. What distinguishes the Care Insurance Care Advantage Plan is its exceptional provision of unlimited coverage for ICU stays, guaranteeing that the entire cost is covered up to the specified sum insured.
• Copayment: A copayment requires you to pay a certain percentage of the claim amount out of pocket before your insurance provider provides coverage for the remaining expenses. With the Care Insurance Care Advantage Plan, there is an optional 20% copayment for hospitalizations at non-network hospitals.
• Deductible: A deductible is the money you must pay out of pocket before your insurance begins to cover your expenses. The Care Insurance Care Advantage Plan does not include a deductible.
• Limits on surgeries/treatments: It represents the highest payout your health insurance will provide for specific medical treatments or procedures. Some insurers set limits on coverage for certain procedures, but not all. The Care Insurance Care Advantage Plan covers cataract treatment and joint replacement surgery up to the sum insured, ensuring comprehensive coverage for these procedures.

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 Advantage: Waiting Periods & Exclusions

👉Waiting period

When you acquire a health insurance policy, there is a specific period during which certain illnesses and conditions are not covered, known as the waiting period. After this waiting period ends, you become eligible to claim coverage for these conditions. Here are some types of waiting periods –

• Initial waiting period: It is important to note that there is an initial waiting period of 30 days for all medical conditions, except for accidents. This means that during this period, you cannot make a claim for hospitalisation unless it is due to an accident.
• Waiting period for pre-existing diseases: Any listed illness or medical condition you had in the past 36 months before purchasing a health insurance policy is called a pre-existing disease. Under the Care Insurance Care Advantage Plan, you can add an optional add-on with an applicable 24-month waiting period for pre-existing diseases. During this period, you cannot make claims for expenses related to these pre-existing conditions.
• Waiting period for specific diseases: It is important to note that, besides pre-existing diseases, insurers often have a specified list of medical conditions or illnesses that come with a waiting period. This waiting period is set by the insurer and is not affected by your current health status. The Care Insurance Care Advantage Plan imposes a 24-month waiting period for certain diseases, regardless of whether you have previously had them or not.

👉Exclusions

Health insurance policies typically exclude coverage for specific medical conditions, known as exclusions. Here are some types of exclusions –

• Standard permanent exclusions: All insurance providers must follow the 'standard permanent exclusions' outlined by IRDAI. These include –

1. Investigation and evaluation: Hospital admission for observation or monitoring without active treatment.
2. Rest, rehabilitation, and respite care: Admission for bed rest without active treatment.
3. Obesity/Control of weight: Treatment or surgery for weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite gender.
5. Plastic/Cosmetic surgery: Medical treatments or surgeries intended to modify body characteristics or appearance.
6. Professional hazardous or adventurous sports: Medical expenses resulting from participation in adventurous activities such as mountaineering, river rafting, scuba diving, etc., as a professional.
7. Breach of law: Expenses incurred in treating a person who commits or attempts to commit a criminal act.
8. Excluded providers: Treatments received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Medical expenses incurred for treatments in health spas, nursing homes, or similar establishments intended for domestic reasons.
11. Dietary supplements and substances purchased without prescription: Vitamins, minerals, and other supplements not prescribed by a medical practitioner.
12. Refractive error: Costs for correcting refractive errors up to a maximum of 7.5 diopters to improve vision.
13. Unproven treatments: Surgeries, medical procedures, or treatments not proven to be effective.
14. Expenses related to birth control, sterility, and infertility: Costs for artificial insemination, contraception, sterilisation, advanced reproductive technologies including IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Costs related to pre/post-natal care and other childbirth-related hospitalisation.

• Additional permanent exclusions: Insurance companies have the discretion to add additional exclusions for certain medical conditions or situations beyond the standard permanent exclusions. If you have a severe medical condition or a particular disease considered risky by the insurer, they may choose to permanently exclude it from the policy. The IRDAI has outlined a list of illnesses for which insurers can implement permanent exclusions. However, it is important to emphasise that insurers cannot impose permanent exclusions on illnesses or diseases not included in this list.
• Non-standard exclusions (Specific exclusions): Specific exclusions denote medical conditions not covered by a health insurance policy, apart from the standard permanent exclusions mandated by the IRDAI. These exclusions may differ among insurance providers and are subject to the policy's terms and conditions. Here are some notable specific exclusions under the Care Insurance Care Advantage Plan–

1. Injury or illness resulting from participation in naval, military, or air force operations.
2. Prostheses or external equipment such as wheelchairs, walkers, crutches, cochlear implants, etc.
3. Expenses related to hair loss treatments and products.
4. Costs for screening, counselling, or treatment of external birth defects or anomalies.
5. Circumcision unless deemed necessary due to accident or for treating a disease.
6. Expenses for preventive care (excluding those incurred under the 'Annual Health Check-up' add-on), vaccination, inoculation, immunisation (except for post-animal bite treatment), and tonics.
7. Use of a ventilator for a patient in a vegetative state (brain dead) with no chance of recovery.
8. Non-allopathic treatment or treatment associated with unrecognised systems of medicine.
9. Injury or disease resulting from war, invasion, acts of foreign enemies, rebellion, and warlike operations.
10. Treatment related to intentionally self-inflicted injuries or attempted suicide by any means.
11. Injury or illness resulting from nuclear, chemical, or biological attacks or weapons.
12. Impairment of intellectual faculties due to the abuse of stimulants or depressants unless prescribed by a medical practitioner.
13. Treatment received in a clinic, rest home, sanatorium, nursing home, or similar institution.
14. Expenses for undergoing Hormone Replacement Therapy (HRT).

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

• Speed of claims: Care Health Insurance Company has successfully settled 100% of claims within 30 days. 
• Claim-related complaints: According to our research, Care Health Insurance Company has received a remarkably high number of complaints related to claims, amounting to 0.39%. This indicates that their claims settlement process needs better improvement.
• Claims incurred ratio: It is a metric that showcases the financial performance of the company, illustrating the total number of claims incurred by the insurance company in comparison to the total premiums collected during a specific financial year. Care Health Insurance Company maintains a claim incurred ratio of 57.69%.
• Claim settlement ratio: The claim settlement ratio indicates the percentage of claims successfully resolved by the insurer out of the total number of claims received in a financial year. Care Health Insurance Company boasts a claim settlement ratio of 90.50%.
• Network hospitals: Care Health Insurance Company provides the convenience of cashless treatments at an extensive network of healthcare facilities, spanning over 24,800+ hospitals.

How Is The Customer Service Of Care Health Insurance Company Limited?

• Policy purchase-related complaints: Our research highlights that Care Health Insurance Company boasts an exceptionally high complaint rate of 0.01% when it comes to their after-sales service, as compared to other insurers. 
• Response on toll-free: As per our research, Care Health Insurance Company's response on their toll-free number is average, when compared to other insurers.
• Response on Twitter: Care Health Insurance Company's response on their Twitter channel is average when compared to other insurance companies.

About Care Health Insurance Company Limited

Care Health Insurance, previously known as Religare Health Insurance Company Limited, is a dedicated health insurance provider in India. Offering a range of products including Health Insurance, Top-up Coverage, Personal Accident, Maternity, International Travel Insurance, and Critical Illness policies in the retail sector, the company also provides Group Health Insurance and Group Personal Accident Insurance for Corporates. Established in the year 2012 and headquartered in Gurugram, Haryana, the company is led by Mr. Anuj Gulati, serving as its CEO and MD.