Care Insurance Ultimate Care

The Ultimate Care plan from Care Health Insurance Company is crafted to give you solid health coverage with plenty of thoughtful benefits. It’s meant to take the stress out of unexpected medical bills, so when someone needs healthcare, money isn’t the first thing on their mind. What’s great is the variety of coverage options and handy add-ons that are designed to meet different healthcare needs, keeping your family's well-being front and centre. 

The Ultimate Care Plan offers great value with wide-ranging coverage and some really thoughtful features. You can reduce the waiting period for pre-existing conditions, enjoy an unlimited No Claim Bonus without any cap, and even get your premium back after five claim-free years. Plus, if a newborn is added to the policy within 90 days of birth, the waiting period already served by the primary insured will apply to the child too—pretty convenient for growing families.

One drawback is that the plan doesn't offer the option to pay premiums on a monthly basis. On top of that, there's been a noticeable number of complaints about both buying policies and settling claims, which isn't exactly reassuring.

What are the benefits offered by Care Insurance Ultimate Care?

• Inpatient hospitalisation coverage: The inpatient coverage is applicable if a patient is hospitalized for more than 24 hours. This includes charges for the room, nursing care, doctor consultations, prescription medicines, ICU charges, and other medical costs that are known to be essential. That's all about providing coverage for critical expenses while allowing you to focus entirely on recovery without the burden of bills piling up. The Care Insurance Ultimate Care plan provides coverage for the expenses related to inpatient hospitalisation. Inpatient cover comes with no cap on ICU or room rent charges, and you can thus opt for any care and comfort you want without any limits.
• Pre-hospitalisation coverage: Before getting admitted to the hospital, you might have to deal with several medical expenses called pre-hospitalisation costs. These typically include doctor consultations, lab tests, checkups, and medical reports. Once you're discharged, any post-hospitalisation expenses must be directly related to the condition you were treated for and will only be covered if your inpatient hospitalisation claim is approved. You can be assured of getting cover for your pre-hospitalisation expenses for 60 days up to the sum insured with the Care Insurance Ultimate Care Plan.
• Post-hospitalisation coverage: Post-hospitalisation coverage plays a crucial role in your recovery after being discharged. It helps cover the cost of follow-up doctor visits, ongoing care, and necessary medications. To be eligible for coverage, these expenses must be directly linked to your hospital treatment and fall within the scope of your inpatient hospitalisation plan. With the Care Insurance Ultimate Care Plan, you get comprehensive coverage for post-hospitalisation expenses up to the sum insured for 90 days after your hospitalisation.
• Daycare treatment coverage: Daycare treatments are medical procedures or surgeries that once required lengthy hospital stays but can now be completed within 24 hours, thanks to advancements in medical technology. The Care Insurance Ultimate Care Plan covers all daycare treatment procedures with no financial limit. 
• Domiciliary treatment coverage: Domiciliary treatments refer to urgent medical care provided at home instead of in a hospital. This usually happens when a patient is too unwell to be moved safely or when hospital beds aren't available nearby. With the Care Insurance Ultimate Care Plan, all expenses pertaining to domiciliary treatments are covered up to the sum insured. However, 12 illnesses are excluded under the plan.
• Organ donor coverage: The Care Insurance Ultimate Care Plan also covers organ donor expenses. The plan extends its support by covering the inpatient costs incurred by the organ donor for the transplantation procedure, up to the sum insured, ensuring financial aid during such critical times. 
• Modern treatment coverage: Modern treatments bring remarkable advancements to healthcare, offering solutions for conditions once thought untreatable. These include cutting-edge options like stem cell therapies, radiosurgery, and robotic surgeries, all designed to cater to individual patient needs. The Care Insurance Ultimate Care Plan is carefully crafted to keep up with these developments and covers the expenses associated with these modern treatments with no financial limit.
• Non-medical expenses coverage: Non-medical expenses coverage includes costs for essential items such as vaccinations, gloves, nebulization kits, oxygen masks, medical footwear, urine bags, hospital gowns, and more, ensuring you're not burdened by these additional expenses during treatment. With the Care Insurance Ultimate Care Plan, you can have peace of mind as these non-medical expenses are covered up to the sum insured. However, it's important to keep in mind that this benefit is offered as an optional add-on. 
• No Claim Bonus: The No Claim Bonus is a reward given by the insurance company for not making any claims during the policy period. Under the Care Insurance Ultimate Care Plan, the maximum bonus you can accumulate is 100%. There is no reduction in the accumulated bonus due to claims made in the previous year. For every year without a claim, you can accumulate a 50% annual bonus.
• Super No Claim Bonus: The Super No Claim Bonus is an upgraded version of the regular No Claim Bonus, offering similar benefits but at a higher level. The Care Insurance Ultimate Care Plan provides provisions for the super no-claim bonus. The Super No Claim Bonus allows you to accumulate an unlimited bonus as an add-on. There is no reduction in the accumulated bonus due to claims made in the previous year, also as an add-on. If no claims are made in the previous year, you can receive a 100% annual bonus, provided as an add-on. Also, Super NCB offers an additional boost to your sum insured, going beyond the regular increase you get through the standard No Claim Bonus (NCB).
• Restoration benefit: The restoration benefit is a unique feature that restores your sum insured if it's fully used up during the policy year due to unforeseen events. The Restoration Benefit in the Care Insurance Ultimate Care Plan allows for unlimited refills of coverage within a policy year. This benefit applies to subsequent claims once the Sum Insured and No Claim Bonus are fully exhausted. It covers both related and unrelated illnesses, ensuring that if the Sum Insured and No Claim Bonus are depleted, the benefit can be reinstated, providing continuous coverage. 

Please note that the limitations and conditions outlined in the benefits above are based on a sum insured of Rs. 10 lakhs. 

Care Insurance Ultimate Care: Financial Limits

• Room rent limit: The room rent limit is the maximum amount your insurance will cover for hospital room expenses. If you opt for a room within this limit, you won’t incur any additional charges. However, if you choose a more expensive room, a proportionate deduction will be made from your coverage. With the Care Insurance Ultimate Care Plan, you can select any room without any restrictions.
• ICU rent limit: The ICU rent limit is the maximum amount your plan will cover for your stay in the hospital's intensive care unit. In the Care Insurance Ultimate Care Plan, there is no limit on ICU rent, ensuring that the plan covers the entire cost of your ICU stay up to the sum insured.
• Copayment: A copayment, or copay, is the portion of the approved claim amount that you are responsible for paying. Once you've made your payment, the insurer will cover the remaining expenses. The Care Insurance Ultimate Care Plan does not provide any provisions for copayment.
• Deductible: The deductible is the amount you must pay out of pocket for healthcare services before your insurance begins covering the rest of the medical expenses. However, deductibles are not available under the Care Insurance Ultimate Care Plan.   
• Limits on surgeries/treatments: When reviewing your health insurance policy, it’s important to understand the limits around surgeries and treatments. These limits outline the maximum amount your policy will cover for specific medical procedures or treatments. Some plans have fixed caps on coverage for certain procedures, while others may provide more flexibility. With the Care Insurance Ultimate Care Plan, joint replacement surgeries and cataract treatment are covered up to the sum insured.

Please keep in mind that the financial limits mentioned above apply to a 30-year-old individual choosing a sum insured of Rs. 10 Lakhs. 

Care Insurance Ultimate Care: Waiting Periods & Exclusions

👉Waiting period

A waiting period is the duration after you purchase a policy during which certain illnesses and medical conditions are not covered. You can only make claims for these conditions once the waiting period has elapsed. It's important to note that the length of the waiting period can vary between different insurance providers. Below are the various types of waiting periods-

• Initial waiting period: There is a 30-day waiting period for all medical conditions, except accidents. During this time, you won’t be able to file a claim for any hospitalization, unless it’s due to an accident. 
• Waiting period for pre-existing conditions: A pre-existing medical condition is any health issue or illness you’ve had in the 36 months before purchasing a health insurance policy. The pre-existing disease waiting period is 12 months as an add-on for the Care Insurance Ultimate Care Plan. However, conditions such as asthma, diabetes, hypertension, hyperlipidemia, obesity, hypothyroidism, and coronary artery disease are covered from the 31st day, also as an add-on.
• Waiting period for specific diseases: Apart from pre-existing conditions, insurers also have a list of specific medical conditions or illnesses that come with their own waiting periods, regardless of your medical history. These waiting periods are determined by the insurer and are not affected by your current health status. There is also a waiting period of 24 months for specific diseases under the Care Insurance Ultimate Care Plan.

👉Exclusions

Exclusions in health insurance policies are particular medical conditions or circumstances that aren't covered by the plan. Below are some examples of these exclusions -

• Standard Permanent Exclusions: All insurance companies are required to follow the ‘standard permanent exclusions’ set by IRDAI. These include -

1. Investigation and evaluation: Hospital stays solely for observation or monitoring purposes without active treatment.
2. Rest, rehabilitation, and respite care: Medical services that focus on recovery, rather than active treatments or surgeries.
3. Obesity/weight control: Treatments or surgeries aimed at weight loss or managing obesity.
4. Gender reassignment: Medical procedures or treatments for transitioning to the opposite sex or altering gender identity.
5. Plastic/Cosmetic surgery: Treatments or surgeries aimed at altering physical appearance or body features for aesthetic purposes.
6. Profession in adventure or hazardous sports: Treatment costs resulting from injuries sustained while professionally participating in high-risk activities like river rafting, mountaineering, or scuba diving.
7. Breach of law: Medical expenses related to treating an individual involved in or attempting to commit a criminal offence.
8. Excluded providers: Treatment received from medical practitioners or healthcare facilities not covered by the insurance policy.
9. Narcotics: Treatment for addiction or disorders related to substance abuse, including alcohol, drugs, or other controlled substances.
10. Treatments in establishments arranged for domestic purposes: Medical expenses incurred for treatments in nursing homes or similar facilities primarily intended for non-medical, domestic care.
11. Dietary Supplements: Costs related to non-prescribed substances like vitamins, minerals, and other over-the-counter supplements that aren't recommended by a doctor.
12. Refractive error: Expenses for correcting refractive errors up to 7.5 diopters to improve vision.
13. Unproven treatments: Medical procedures, surgeries, or treatments that have not been scientifically validated or proven effective.
14. Expenses related to sterility, birth control, and infertility: Costs associated with contraceptive methods, sterilization procedures, artificial insemination, and advanced reproductive treatments like IVF, GIFT, ZIFT, ICSI, and gestational surrogacy.
15. Maternity expenses: Hospitalization expenses related to childbirth, including pre and post-natal care, as well as any costs incurred during delivery.

• Additional permanent exclusions: Insurance providers have the authority to apply additional exclusions for specific health conditions or scenarios, beyond the standard permanent exclusions. If an insurer considers certain diseases or serious medical conditions too risky to cover, they may choose to permanently exclude them from your policy. It’s essential to understand that health insurers are bound by a list of conditions set by the Insurance Regulatory and Development Authority of India (IRDAI), which defines the illnesses for which they can apply permanent exclusions. Insurers cannot impose permanent exclusions for conditions that fall outside this designated list. 
• Non-standard exclusions (Specific exclusions): Non-standard exclusions refer to additional exclusions beyond the standard permanent ones outlined by the IRDAI. These exclusions differ across insurance providers and are based on the specific terms and conditions of each policy. Here are the most important specific exclusions listed under the Care Insurance Ultimate Care Plan -

1. Any injury or illness arising, either directly or indirectly, from participation in professional or semi-professional naval, military, air force operations, or aviation-related activities.
2. Costs for external durable medical equipment used for diagnosis or treatment, unless required due to an accident.
3. Expenses incurred for hair fall treatments or related products.
4. Costs associated with screening, counselling, or treatment for congenital birth defects, illnesses, or anomalies.
5. Circumcision procedures, unless deemed medically necessary to treat a specific disease or injury.
6. Expenses related to preventive care, including vaccinations, inoculations, immunizations (except for post-animal bite treatment), and tonics, unless they fall under the 'Annual Health Check-up' benefit.
7. Use of a ventilator for patients in a vegetative state (brain dead) who show no potential for recovery.
8. Injury or illness caused directly or indirectly by civil war, acts of terrorism, or any war-related activities.
9. Injury or illness resulting from a nuclear, chemical, or biological attack, or the use of related weapons.
10. Injury or illness due to the abuse of stimulants or depressants that impair cognitive functions, unless specifically prescribed by a medical professional.
11. Treatment is provided in facilities such as clinics, rest homes, sanatoriums, nursing homes, or any similar institutions.
12. Hormone replacement therapy, unless medically indicated.
13. Any illness or injury resulting from the consumption, misuse, or abuse of tobacco, alcohol, intoxicating drugs, hallucinogens, or smoking.

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

• Speed of claims settlement: Care Health Insurance Company Limited has ensured a prompt and effective claim payment process by settling 100% of its claims within 30 days. 
• Claim-related complaints: Based on our research, Care Health Insurance Company Limited has a claims complaint rate of 0.39%, which is higher compared to other insurers. 
• Claims incurred ratio: The claims incurred ratio is an important indicator of an insurer's financial health, showing the proportion of claims paid out compared to the premiums collected in a particular year. Care Health Insurance Company Limited has a claims incurred ratio of 57.69%. 
• Claim settlement ratio: Care Health Insurance Company Limited boasts a claim settlement ratio of 90.50%, reflecting the proportion of claims successfully settled out of the total claims received during a specific fiscal year. 
• Network hospitals: Care Health Insurance Company Limited provides access to an extensive network of 24,800+ hospitals. Customers can receive cashless treatment without worrying about money thanks to this wide network. 

How is the customer service of Care Health Insurance Company Limited?

• Policy purchase-related complaints: Our research shows that Care Health Insurance Company Limited has received 0.01% of complaints regarding its after-sales service.
• Response on Toll-Free: In comparison to other insurers, our study indicates that Care Health Insurance Company Limited's toll-free number response time is average.    
• Response on Twitter(X): Our investigation indicates that, in comparison to other companies, Care Health Insurance Company Limited has an average reaction time on Twitter(X). 

About Care Health Insurance Company Limited

Care Health Insurance, previously known as Religare Health Insurance, is a prominent player in India's health insurance sector. Established in 2012 and headquartered in Gurugram, Haryana, the company offers a wide range of insurance products including Health Insurance, Top-up Coverage, Personal Accident, Maternity, International Travel Insurance, and Critical Illness plans for individuals. Additionally, they provide Group Health Insurance and Group Personal Accident Insurance tailored for corporate clients. Under the leadership of CEO and Managing Director, Mr. Anuj Gulati, the company has seen impressive growth, with a turnover of Rs 7,135.07 crores and over 1.87 crore policies in force. To date, they have processed nearly 11 lakh claims, solidifying their presence in the industry.