Care Insurance Care Plus

Care Plus is a health insurance policy provided by Care Health Insurance Company Limited. It's intended to provide cover for expenses incurred during hospitalisation, as well as expenses incurred before and after hospitalisation. The plan provides you and your family with a protective shield for your savings from medical expenses so that you can live a stress-free, secure life. Especially designed for people aged between their 30s and early 40s, the Care Plus plan is accompanied by a set of benefits, features, fitness rewards, and add-ons to cater to your healthcare expenses and those of your family.

The plan is accompanied by various desirable features and provides multiple discounts. In addition to hospitalisation expenses, it also offers OPD coverage, inflation protection, and more. However, it is relatively expensive when compared to other plans in the market and does not offer a monthly premium payment option. As per our research, the insurer has received a higher volume of complaints related to both claim settlement and policy purchase. This indicates a weaker track record in terms of both claims and customer service experience.

Let’s now take a closer look at the features and benefits offered by the Care Insurance Care Plus Plan.

What are the benefits offered by the Care Insurance Care Plus Plan?

Here are the main features and benefits that make up the Care Insurance Care Plus Plan:

• Inpatient hospitalisation coverage: The Care Insurance Care Plus policy provides inpatient hospitalisation cover, which takes care of the majority of costs when you're hospitalised for more than 24 hours. It covers room rent, nursing fees, medicines prescribed by your doctor, physician consultation fees, ICU fees, and other expenses that you incur in the hospital, assisting in safeguarding you from a significant financial burden.
• Pre-hospitalisation expenses coverage: Pre-hospitalisation costs are also covered for a maximum of 60 days prior to hospitalisation up to the sum insured, provided that they are directly attributed to the condition that caused your hospitalization and your inpatient claim for the same is approved. This would involve the likes of blood test analysis, X-rays, CT scans, as well as other medical examinations.
• Post-hospitalisation expenses coverage: Post-hospitalisation costs are paid for 90 days post-discharge, up to the amount insured. These may involve follow-up tests or consultations, and are covered only if these are in respect of the same disease that led to hospitalisation and your inpatient claim is settled.
• Daycare treatment coverage: Daycare treatment is covered under this plan for all procedures that no longer need 24-hour hospitalisation, thanks to medical advancements, up to the full sum insured.
• Domiciliary treatment coverage: Domiciliary treatment is also covered when hospitalisation isn’t possible, due to either medical condition or unavailability of beds. However, 12 specific illnesses are excluded under this cover.
• Organ donor coverage: The policy also pays for organ donor expenses, up to the sum insured.
• Modern Treatment coverage: Modern treatments, advanced procedures that are medically necessary and fall under the listed ones, are covered with no financial cap.
• Non-medical expenses coverage: Non-medical expenses like nebulisation kits, gloves, oxygen masks, and other consumables used during treatment are not covered under this plan.
• No Claim Bonus: You also get a No Claim Bonus (NCB) of 50% each year you don’t make a claim, up to a maximum of 200% of the base sum insured. If you do make a claim, your NCB is reduced in the same proportion as it was earned. However, the NCB will not reduce if your total claim is less than 25% of the sum insured, or if you have had four consecutive claim-free years. 
• Super No Claim Bonus: There is no Super No Claim Bonus available in this plan.
• Restoration benefit: The restoration benefit under this policy allows for unlimited refills in a policy year, triggered when your base sum insured is partly exhausted. It applies to both related and unrelated illnesses. For related illnesses or diseases, the refill will be available only if the next admission takes place at least 45 days after discharge from the earlier claim.

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

Care Insurance Care Plus: Financial Limits

• Room rent limit: The room rent limit refers to the maximum amount your insurance plan will cover for your hospital room charges. As long as you choose a room within this limit, you won’t need to pay anything out of pocket. However, if the room costs more than the eligible limit, the proportionate deduction will apply. Under the Care Insurance Care Plus plan, there is no room rent limit up to a single private AC room.
• ICU rent limit: The ICU rent limit refers to the maximum the insurer will pay for your stay in the Intensive Care Unit. With the Care Insurance Care Plus plan, there is no cap on ICU rent. ICU charges are covered in full, up to the total sum insured.
• Copayment: Copayment means paying a fixed percentage of the total claim yourself, while the insurer pays the rest. The Care Insurance Care Plus plan does not include any copayment.
• Deductible: A deductible is the amount you must pay out of your own pocket before the insurer begins covering your expenses. The Care Insurance Care Plus plan does not offer any deductible options.
• Limits on surgeries/treatments: Limits on surgeries or treatments refer to caps on how much the insurer will pay for specific procedures. While some plans include such limits, the Care Insurance Care Plus plan covers cataract treatments and joint replacement surgeries up to the full sum insured.

Please note: The financial limits above are applicable for a 30-year-old individual with a sum insured of Rs. 10 lakhs.

Care Insurance Care Plus: Waiting Periods & Exclusions

👉 Waiting period

The waiting period is the initial span of time after you buy a health insurance policy during which specific illnesses or treatments won’t be covered. You can only make claims for these conditions after the waiting period has elapsed.

Here are the key types of waiting periods:

• Initial waiting period: For all diseases, other than those resulting from accidents, there is a 30-day initial waiting period. You cannot claim hospitalisation for any reason during this period, except if caused by an accident.
• Waiting period for pre-existing illnesses: Pre-existing illness is any sickness or health problem you suffered from during the 36 months prior to purchasing the policy. In the case of the Care Insurance Care Plus plan, a 36-month waiting period exists for pre-existing illnesses. For this duration, you are not allowed to claim any amount towards expenses on account of these pre-existing conditions.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers maintain a list of specific illnesses that come with a waiting period, regardless of your past health history. For the Care Insurance Care Plus plan, there is a 24-month waiting period for various specific diseases and conditions.

👉 Exclusions

Exclusions are particular situations or conditions that an insurance policy does not cover. Described below are some of the common exclusions:

• Standard Permanent Exclusions: According to the directives of the Insurance Regulatory and Development Authority of India (IRDAI), each health insurance provider must adhere to a specified list of standard permanent exclusions. Some examples include:
  • Investigation and evaluation: Hospital stays are done only for observation or monitoring.
  • Rest, rehabilitation, and respite care: Admission to a facility purely for rest or recovery, without any active medical treatment.
  • Obesity/weight control: Surgeries, treatments, or procedures aimed at weight loss.
  • Gender reassignment: Medical procedures intended to change physical characteristics to match a different gender identity.
  • Plastic/Cosmetic surgery: Treatments or surgeries done to change or enhance physical appearance.
  • Profession in adventure sports: Injuries that occur during professional participation in activities like river rafting, mountaineering, scuba diving, etc.
  • Breach of law: Treatment for injuries sustained while attempting to commit a criminal offence.
  • Excluded providers: Care obtained from hospitals or medical practitioners not included in your policy.
  • Narcotics: Rehabilitation for alcohol, drug, or other allied substance addiction.
  • Treatments in establishments arranged for domestic purposes: Health care administered in facilities such as nursing homes, spas, or any such arrangements intended for domestic or non-health purposes.
  • Dietary supplements purchased without prescription: Vitamins, minerals, or other supplements that are not prescribed by a registered medical professional.
  • Refractive error: Expenditures for the correction of refractive errors up to 7.5 diopters for improving vision.
  • Unproven treatments: Any surgery, treatment, or procedure not proven to be effective.
  • Sterilisation, conception, and infertility costs: Expenditures on sterilisation, contraceptives, artificial insemination, or high-tech fertility treatments like IVF, GIFT, ZIFT, ICSI, and gestational surrogacy, among others.
  • Maternity costs: Fees charged for maternity care, both prenatal and postnatal, childbirth, etc.
• Additional Permanent Exclusions: In addition to the standard list, insurers can also opt for other permanent exclusions for specific diseases or conditions they find too risky to insure. The exclusions should be from the approved list provided by IRDAI. Insurers cannot exclude any illness or condition from coverage unless it is on this approved list.
• Non-standard exclusions (Specific exclusions): Non-standard exclusions are more than the general permanent exclusions prescribed by the IRDAI. They are individual-specific and derived from the policy's detailed terms and conditions. The following are some of the specific exclusions referred to under the Care Insurance Care Plus plan:
  • External durable equipment used for diagnosis or treatment is not covered, unless necessitated due to an accident.
  • Expenses related to hair fall treatments and products are not covered.
  • Screening, counselling, or treatment for external birth illnesses, defects, or anomalies is excluded.
  • Circumcision is not covered unless required for treating a disease or injury.
  • Expenses related to preventive care (except those incurred under 'Annual Health Check-up' Benefit), vaccination, inoculation, immunisation (except post animal bite treatment) and tonics.
  • Use of a ventilator for a patient in a vegetative state (brain dead) without any chance of recovery is not covered.
  • Treatment related to the abuse of stimulants or depressants that impair intellectual abilities is excluded, unless prescribed by a medical practitioner.
  • Treatment received in a clinic, rest home, sanatorium, nursing home, or other similar institutions is not covered.
  • Hormone replacement therapy is excluded.
  • Any injury or illness resulting from the use, misuse, or abuse of tobacco, intoxicating drugs, alcohol, hallucinogens, or smoking is not covered.

What can you expect in terms of Claims Experience if you buy from Care Health Insurance Company Limited?

• Speed of Claims: Care Health Insurance Company Limited has settled 100% of claims within 30 days, ensuring a quick and hassle-free claims process for insured individuals.
• Claim-Related Complaints: As per our research, the insurer has received 0.39% of complaints which is higher compared to other insurers. This suggests that there may be certain gaps in their claim settlement process.
• Claims Incurred Ratio: The claims incurred ratio for Care Health Insurance Company Limited stands at 57.69%. This reflects how much the company pays out in claims compared to the premiums it collects in a financial year.
• Claim Settlement Ratio: Care Health Insurance has reported a claim settlement ratio of 90.50%, which is the percentage of claims an insurer receives that are settled in a financial year compared to the total no. of claims received.
• Network Hospitals: The insurer has a wide network of over 21,600 hospitals, making it easier for customers to access cashless treatment across various cities and towns.

How is the Customer Service of Care Health Insurance Company Limited?

• Policy purchase complaints: Our research reveals that Care Health Insurance Company Limited has a complaint ratio of 0.01% for its after-sales service, which is higher than that of other insurance corporations.
• Response on Toll-Free: Our research indicates that the response time on toll-free for Care Health Insurance Company Limited is average compared to other players.
• Twitter(X) response: Care Health Insurance Company Limited's Twitter(X) response time is average compared to others in the insurance industry.

About Care Health Insurance Company Limited

Care Health Insurance (previously known as Religare Health Insurance Company Limited) is a dedicated health insurance company in India. They provide comprehensive products such as health insurance, top-up covers, personal accident cover, maternity cover, international travel insurance, and critical illness cover for individuals. The company also offers group health and group personal accident coverage for Corporates, etc. Founded in 2012, it is headquartered in Gurugram, Haryana, and is led by its Managing Director and CEO, Mr. Anuj Gulati.