Care Health Insurance

Care has an extensive network of 7400+ network hospitals across India and this number has been growing steadily over the years. Hence it is important while seeking treatment following a sickness or an accident to ideally get admitted to a network hospital. One can get the hospital closest to them by going through the Care network hospital list available on Care health insurance.

Yes, Care Health offers Cashless treatment for inpatient hospitalisation of the insured. The important criteria to avail of the cashless facility is to seek admission into one of Care’s network hospitals across the country. Subject to the claim being admissible under the policy, Care will offer cashless settlement upto the policy limits of the insured’s policy.

Care Health offers a free look period to review it’s policy terms and conditions. In case one is not satisfied with the same, one can request for cancellation of their policy during this period. The insured will be charged the pro-rated premium for the period during which your policy was in-force, the cost of pre-policy health check-up, if any, and the stamp duty. The balance premium would be refunded.
Also, one can request for cancellation of your policy at any time during the policy period post the free look period. In this case, the refund of the premium amount is as per the short scale grid, which is shared as part of the Policy Terms and Conditions sent as part of the policy kit. However, in case you of any claim being reported with Care, the insured will not be entitled to any refund of premium on cancellation of the policy.

Yes, Maternity is an inbuilt coverage for all plans where the primary sum insured is ₹50, 60 and 70 lacs. For the remaining plans the Maternity coverage can be opted for by the insured.

One can log onto to select the Care Health insurance plan and make the premium payment accordingly.

Under their most comprehensive “Care Plan”, the sum insured options range from ₹4 lacs to ₹600 lacs (6 crs)

This concept works on the same lines as the no-claim bonus on car insurance. A Policyholder, who hasn’t made any claim in a year, can use the bonus to their benefit the following year.
Similarly, CARE offers a 10% increase in the policy sum insured for every claim-free year, with no change in premium. So, a policy with a sum insured of Rs 5 lakh, will get an extended cover of Rs 50,000 the following year at the same premium. A claim-free third year will see him earning another ten per cent extra cover on his base sum insured, taking the total to Rs 6 lakh. A maximum bonus of up to 50 per cent is permissible. For 5 consecutive claim free years by using No Claims Bonus (NCB) & No Claims Bonus – Super (Optional Cover). Incremental increase every year is applicable on base Sum Insured. If a claim is made in any particular year, accrued NCB and NCB-Super will be reduced at the same rate at which it is accrued.
In case of claim, the accumulated bonus is reduced by 10%.

Under the Care Personal Accident policy, the sum insured ranges from ₹10 lacs to ₹50 lacs.

Care Health Insurance (RHI), the health insurance arm of Care Enterprises Limited (REL), is a specialized Health Insurer offering health insurance services to employees of corporates, individual customers and for financial inclusion as well. Launched in July’12, Care Health Insurance is promoted by Care Enterprises Limited, a leading diversified financial services group based out of India; its other shareholders are Union Bank of India & Corporation Bank. The promoters are also the founders of Fortis hospitals, SRL Diagnostics and Care Wellness – India’s leading wellness and pharmacy retailers.

• Five Plans with Sum insured options from ₹4 lacs to ₹600 lacs (6 crs)
• 30/60 Pre and Post hospitalization medical expenses covered
• Room Rent, ICU Charges, Day Care charges remain covered
• Ambulance Charges remain Covered as per limits
• Domiciliary Hospitalisation
• No Claims Bonus (NCB) offered upto 150% of SI after 5 claim free renewals
• Covers more than 540 Day Care treatments
• Inbuilt Maternity coverage of upto ₹ 1 lac under specific plans
• Avail treatment anywhere in the world for 12 defined major illnesses under “Care Anywhere” on Cashless basis
• Auto Recharge of Policy Sum Insured, as well as an option to avail Personal Accident Cover
• Covers Non Allopathic treatment like Ayurveda, Homeopathy, Unani & Sidha (AYUSH)
• Coverage for Modern Treatments like Robotic Surgery, HIV/AID

• Any diagnosis of diseases / undergoing of surgery / occurrence of event, whose signs or symptoms first occur within 30 days of Policy Period Start date
• Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
• Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
• Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
• Congenital disease
• Tests and treatment relating to infertility and in vitro fertilization.
• War, riot, strike, nuclear weapons induced hospitalization

• Increase in the incidence of lifestyle-related illnesses - Sedentary lifestyle, unhealthy eating habits, increasing pollution and high stress levels are the growing norm day by day giving rise to chronic diseases like cancer, lung conditions and stroke, claiming younger lives.
• Increase in Treatment expenses - With the healthcare industry in India witnessing double-digit inflation, it is getting extremely expensive to treat ailments in India both for regular medical as well as specialised medical conditions.
• Group health cover may not be sufficient - Group employer plans, rarely have sufficient coverage to meet medical expenses incurred in many cases. In the event of switching jobs or remain unemployed, an individual an remain exposed to financial risks from medical exigencies.
• Health insurance coverage is more than just hospitalization - Many health insurance plans nowadays give coverage for day care procedures and OPD, cover for pre and post-hospitalisation, as well as doctor consultations, tests and medicines which are incurred during this period. There are also Care health plans that cover vector-borne diseases like dengue. Domiciliary treatments, Ayurveda, Unani, Siddha and Homeopathy (AYUSH) are also covered by the best health insurance plans in India.
• Credit Shield - Not everyone retains a high bank balance or cash at home for facing unforeseen medical emergencies. Hence having Health insurance helps one protect themselves from having to pay for treatment arising out of a sickness/accident and allows the health insurance policy to take over especially since the Care plans also offer Cashless facilities.

• During purchase of the first policy, if eldest member insured is
  • Below 61 years, no co-payment is applicable.
  • 61 years or above, 20% of the claim amount under the policy has to be borne by the insured

• Lower premium – Premiums are much lower when at a younger age.
• Waiting Periods – Care health insurance plans come with waiting periods of 30 days to 48 months – better to serve the waiting period when younger
• Rise of lifestyle diseases among the youth- Increasing sedentary lifestyles among the younger generation, many of them are getting predispositioned to lifestyle illnesses like obesity, respiratory and heart diseases.
• Employer provided health cover may not be enough
• Tax savings

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.

As on date Care Health have settled 4.7 lacs + health claims

• Cashless - For any emergency hospitalisation, the insured should intimate Care Health within 24 hours from the time of hospitalization. For any planned hospitalization, the Insured should seek cashless authorization from us at least 48 hours prior to hospitalization.
• Reimbursement - In case of a reimbursement claim, the insured pays the hospitalization expenses (which is otherwise claimable under his insurance policy) himself and then claims for a reimbursement of those expenses from Care. The Insured should submit all the bills and treatment papers in original to us and intimate regarding the hospitalization as per policy terms & conditions.

Care Health takes 15 days after receiving the required documents from the insured to process a health insurance claim. However, it can take a longer time depending on the verification process conducted by our claim management team depending on the case.

In a cashless claim/hospitalisation, the insured/hospital intimates us regarding the hospitalization and submits a pre-authorization request. On authorization, the claim is directly settled with the network hospital and the insured is not required to pay any charges except for expenses not covered under the policy. Cashless facility can only be availed at a Care Health Insurance network hospital.