Cardiac Care and Heart patient health insurance

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About Cardiac Care / Heart patient insurance

Rising cases of cardiovascular disease have rapidly increased in India. The number of cases within the country has more than doubled from 1990 to 2016.

In comparison, heart disease in the United States decreased by 41% in the same time period. Death as a result of cardiovascular disease has increased by 34 percent in India in the past 26 years alone.

In 2016, 28.1% of all deaths in India were caused by heart disease accounts for nearly 60% of the global impact of cardiac health even though India accounts for less than 20 percent of the global population.
cardiac care insurance
The India Heart Association is committed to increasing awareness of the severity of heart disease in India. This organization is nongovernmental and launched by individuals who have been personally affected by heart disease. The organization’s major goals include increasing awareness of heart disease in India through online campaigns and grassroots activities. The organization has been appointed to the Thoracic and Cardiovascular Instrumentation Subcommittee of the Bureau of Indian Standards by the Indian government. Efforts are multi-faceted, operating through partnerships with local governments, hospitals, and programming with donors. Organizations like this one are making effective strides in addressing the burden of heart disease in India.

Not only in India, but there is an alarming increase in the number of cardiac cases across the world and given the lifestyles of the current generation, this is likely to keep on increasing. Even if diagnosed early, it is important to be aware that the treatment can be pretty expensive for any individual/family and the stress is physical, mental and financial. While the physical and mental stress and anxiety is something that each individual/family needs to be prepared for, the financial burden is one that can be planned for and this is where Cardiac Care Insurance comes in handy.

Some statistics on the cardiac related cases in India :

  • Around 200 deaths/lac of population
  • Estimated that by 2030, 1 out of every 3 patients will be from India
  • Estimated to add around 1.6 million patients every year
  • In India 4 persons in the age group of 30-60 succumb every minute
  • Punjab has the highest burden of disease, with 17.5% of the population afflicted, while Mizoram has the lowest burden, a full 9 times lower than Punjab
  • Rates of heart disease are far higher in the urban Indian populations when compared to rural communities. Urban areas record between 400 or 500 cases in every 100,000 people, while rural populations record 100 cases per 100,000 people. Risk factors for heart disease include a sedentary lifestyle, obesity, central obesity, hypercholesterolemia, diabetes and metabolic syndrome. All of these factors are abundant in urban populations and limited in rural populations, thus accounting for the discrepancy.
  • On average, heart disease in India affects people 8 to 10 years earlier than other parts of the world, specifically heart attacks. This huge discrepancy can be explained by increased rates of tobacco consumption, the prevalence of diabetes and genetic predisposition for premature heart disease. A common genetic determinant of heart disease in Indians is familial hypercholesterolemia, a lipid disorder. Although this disorder is treatable with lifestyle changes and pharmaceuticals, it is often undiagnosed.
  • 53.4% of deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years
  • The leading overlapping risk factors for cardiovascular diseases included
    • Dietary risks - 56.4%
    • High systolic blood pressure - 54.6%
    • Air pollution - 31.1%
    • High total cholesterol - 29.4%
    • Tobacco use 18.9%
    • High Blood Sugar Levels - 16.7%
    • High body-mass index (BMI) - 14.7% (Obesity/Overweight)

Cardiac Care Insurance for Heart Patients

Health insurance is today witnessing the higher than industry growth rates among all other insurance products even though less than 20% of the Indian population have meaningful insurance coverage. The objective of the IRDAI to bring in specialised Health Insurance companies was to leverage this market opportunity and also for them to launch very customised health insurance products such as critical illness insurance, cardiac and cancer care, diabetes insurance and other fixed benefit plans apart from allowing a broader coverage on basic indemnity based insurance plans.

Health care costs have risen drastically over few years, thanks to medical inflation and better technology and expertise in healthcare and any medical treatment can make a dent on individual’s savings but with the help of these special health insurance plans, one can expect to have more comprehensive coverage than before.

What is covered under Cardiac Care / Heart Care plans?

Some of the basic coverages under the specialised Cardiac and Heart care plans include:
  • Coverage for In Hospitalization expenses : This covers expenses that will be incurred during hospitalization as an inpatient. One can use the cashless facility or get the costs reimburse depending on where the treatment is taken.
  • Pre - hospitalization and Post - hospitalization benefits : Medical expenses are not just restricted to the hospitalization costs, but the insured remains covered for pre-hospitalization (normally 30 days) and post-hospitalization (mostly 60 days) expenses as well.
  • Ambulance expenses : Coverage for Ambulance expenses is a built-in feature of the plan, normally upto ₹2,000.
  • Domiciliary Hospitalization / OPD Treatment : If one is not in a condition to shift to the hospital for treatment, or there is no vacant bed in the hospital, or there are certain procedures which can be done as an outpatient, then you can avail domiciliary hospitalization/OPD treatment.
  • Recharge/Restoration of Sum Insured : The insured will get an automatic recharge of Sum Insured (upto 100% of base sum insured) if your claim amount gets exhausted due to a claim during the policy period. You can use this amount for the treatment of any other insured family member (under family floater plans) or yourself but the treatment should be for different ailments.
  • Annual Health Check-Ups / Wellness Programs : An annual health check-up for all the insured members covered under the same policy, or specific Wellness program aimed at improving lifestyle and dietary habits are also part of some plans.
  • Tax Benefit : According to section 80 D under Income Tax Act 1961, the premiums paid for health insurance for self, dependent parents, children, and spouses are exempted from tax.

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India health insurance companies offering coverage for Cardiac Care and Heart
  • Star Health Travel Insurance Plans
  • Religare Insurance Plans
  • Pramerica Insurance plans

Cardiac Care Insurance plans

  • Adults between 18 years and 65 years. Dependent children between 10 and 25 years
  • Care Heart is a heart insurance plan that offers coverage for pre-existing heart illnesses.
  • Comprehensive coverage: Covers different stages of Cancer and Heart conditions.

Who should invest in a Cardiac Care / Heart Care policy ?

Ideally everyone needs this policy but let’s look at a few customer profiles:
  • Individuals between ages of 35-65 irrespective of family medical history
  • Family patriarchs who are normally the income earners for the family. But ideally all income earners should have this plan
  • Persons with Pre-existing medical conditions like diabetes, hyper tension, heart conditions etc and family history relating to the same
  • Persons working in high pressure business environments which induce stress
The Cardiac / Health Care plans available in the market are in the table below. Kindly review and compare the same in more detail at eindiainsurance
star careinsurance
Star Cardiac Care Care(Formerly Religare) Care Heart
Sum Insured
Rs. 3, 4 Lakhs Rs. 3, 5, 7, 10 Lakhs
Policy period
1 year 1, 2, 3 years
Eligibility criteria
  • Entry age for adults is 18 years.
  • Exit age is 65 years.
  • Dependent children between 10 and 25 years
  • Entry age for adults is 18 years.
  • There is no limit on Exist age.
  • Section 1: Hospitalization Cover for Accidents and Non-cardiac ailments
  • Section 2: Hospitalization Cover for Cardiac Ailments
  • Section 3: Cover for Outpatient medical expenses
  • Section 4: Personal Accident cover for Accidental Death
  • Individual: Maximum up to 6 Persons
  • Floater: 2 Adults (Self and Spouse)
Lifelong renewal Lifelong renewal
In-patient Hospitalisation
Room Rent, Boarding and Nursing Expenses - Maximum of 5,000 per day Upto Sum Insured
Coverage 3 lakh 5, 7, 10 lakhs
Room Rent / Category Upto 1% SI per day Single Private Room
ICU Charges Upto 2% SI per day No limit
Pre Hospitalisation Expenses incurred
Upto 30 days 30 days
Post Hospitalisation Expenses incurred
Upto 60 days - Upto 7% of Hospitalisation Expenses, subject to a maximum of 5,000 60 days, Maximum upto 5% of Sum Insured
Ambulance Cover
Upto 750 per hospitalisation subject to a maximum of 1,500 per policy period
  • For Rs. 3, 5 Lakhs coverage - Upto 2,000
  • For Rs. 7, 10 Lakhs coverage - Upto 3,000
Day Care Procedures
All Day Care Procedures are covered Covered, Upto Sum Insured
Pre-policy Medical Check up
No No
Sub Limits for Treatment of Cataract
Expenses related to treatment of Cataract is limited to 20,000 per eye and 30,000 per policy period
  • For Rs. 3 Lakh coverage - Upto 20,000 per eye
  • For Rs. 5, 7, 10 Lakhs coverage - Upto 30,000 per eye
10% Co-payment applicable for all insureds above 60 years old and making a claim under Section 1
  • 20% Co-payment if the entry age <=70 years
  • 30% Co-payment if entry age>70 years
General waiting period
Section 1
  • 30 days for illness/diseases/treatments (Not applicable for accidents)
  • 24 months for specified illness/diseases/treatments
  • 48 months for Pre existing diseases
Section 2
  • 90 days waiting period irrespective of whether it is pre existing or not.
Section 3 and Section 4
  • No waiting period
  • Initial Waiting Period: 30 days
  • Specific Waiting Period: 24 month
  • Pre Existing Diseases: 24 months

Exclusions under the Cardiac / Heart Care Policy

Some of the major exclusions under the policy are as follows. However go through the entire set of exclusions as available in the policy wordings received from the insurance company along with the policy kit.
  • Benefits will not be available for any Pre- Existing conditions or related condition(s) or any complications arising thereof for which Insured has been diagnosed, received medical treatment, had signs and / or symptoms, prior to inception of Insured’s first Policy, unless such a condition is stated in the Proposal form and specifically accepted by the Insurer and endorsed thereon
  • Insurer shall not be liable to make any payment under this Policy in connection with or in respect of any Insured Event during the Waiting Period as defined under the Policy
  • Any congenital Illness/Conditions
  • Any Covered Critical Illness arising from Birth control procedures and/or hormone replacement therapy and any complications arising thereof from
  • Any treatment/surgery for change of sex or any cosmetic surgery or treatment/surgery /complications/illness arising as a consequence thereof
  • Use/Abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Medical Practitioner and taken as prescribed
  • War, invasion, act of foreign enemy, hostilities (whether war be declared or not), armed or unarmed truce, civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, riot or civil commotion, strikes
  • Any diseases causing the death of the Insured within the stipulated Survival Period, measured from the date of incidence of the illness
  • Participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sports, any bodily contact sport or any other hazardous or potentially dangerous sport for which Insured is untrained
  • Nuclear contamination, the radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature
  • Genetic disorders and stem cell implantation / surgery/storage
  • Any medical procedure or treatment, which is not medically necessary or not performed by a Medical Practitioner
  • Any Covered Critical Illness arising from Treatment by a family member and self medication or any treatment that is NOT scientifically recognized and any complications arising thereof / there from
  • Sexually transmitted conditions, mental or nervous disorder, , Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection
  • Failure to seek or follow medical advice following the diagnosis of any illness/disease/injury
  • Serving in any branch of the Military or Armed Forces of any country, whether in peace or War
  • Participation in a criminal or unlawful act with a criminal intent.
  • Attempted suicide (whether sane or insane) or intentionally self inflicted Injury or Illness

FAQ’s for Cardiac Care / Heart Care

Star Health Cardiac plan covers : Persons aged between 10 years and 65 years who have undergone any of the following
  • Percutaneous Transluminal Coronary Angioplasty (PTCA) / Coronary Artery Bypass Graft (CABG) within 7 years period prior to proposal or
  • Atrial Septal Defect (ASD) or Ventricular Septal Defect (VSD) that has been corrected or
  • Patent Ductus Arteriosus (PDA) that has been treated or
  • RF Ablation or RF Ablation done to correct the underlying cardiac condition or
  • Had an Angiogram done but no intervention was medically found necessary.
Care(formerly Religare) Health Cardiac plan covers : Persons above 18 years who have undergone any of the following
  • First time angioplasty / Stent / balloon or bypass surgery within 7 yrs
  • ASD/VSD/PDA closure done and corrected(follow up 2D echo to be attached for pre-login opinion)
  • PSVT, RFA done and corrected (PMR records to be attached for pre-login opinion)
  • Angiography with normal coronaries and no medicine prescribed

The Sum Insured option available are from ₹3 lacs upto ₹10 lacs on individual sum insured basis. Some insurers also offer a family floater option.

Yes, this product is eligible for portability. Portability would be limited to the extent of previous sum insured + Cumulative Bonus (if any) and waiting periods (2 years and PED) would be reduced based on number of continuous years of previous insurance.

Minimum entry age – 10 years and maximum entry age – 65 years for adults. Some plans are also available without any maximum age capping.

Yes, some plans come with a 30 day mandatory waiting period while other plans have a 90 day mandatory waiting period for Cardiac related treatment. Apart from that there are waiting periods on the plans for
  • 2 years waiting period for specified illnesses
  • 2-4 years waiting period on Pre Existing Diseases

No. All plans currently available in the market don’t’ have PPC requirements.

Yes, there are co payments which are between 10% and 20% on the claims paid. Kindly review the terms before finalising an ideal plan.

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