Care Advantage Health Insurance Policy

Care Advantage Health Insurance Policy

Care Advantage is an all-inclusive health insurance policy that welcomes you with coverage for up to Rs. 1 Crore. With this policy, you and your family members are adequately covered at all times. This policy covers you for hospitalization expenses incurred during hospitalization exceeding 24 consecutive hours. People (above 18 years) are eligible to purchase this policy for themselves and their family members on an individual or floater basis.

Eligibility criteria for Care Advantage Insurance Policy

Minimum entry age Individual: 5 years

Floater: 91 days

Maximum entry age Lifelong
For dependent child Floater: 91 days (with at least one insured person above 18 years)
Sum assured options Rs 1 Crore
Policy term 1 year/ 2 years/ 3 years
Premium payment Quarterly, half-yearly, and annually
No. of people covered Self, spouse and up to 4 dependent children

Key highlights of Care Advantage Health Insurance policy

  • This policy offers you a high sum assured amount (up to 1 Crore) so that you won’t face any financial difficulty under any health emergency. Choose your health insurance plan prudently so that you and your family members are adequately covered in case of a medical emergency.
  • This policy offers you cashless treatment at 16500+ network hospitals. With this policy, you won’t need to compromise with your treatment, as it covers all your medical expenses. So, admit to the nearest network hospital and avail the best treatment for your ailments.
  • This policy comes with automatic recharge of the sum assured. This policy reinstates the entire sum assured of your policy once. Now, you can utilize this for any future claims during the same financial year.
  • This policy covers all medical expenses incurred by you up to 30 days before your hospitalization.
  • There are lots of medical expenses including follow-up visits, medications, and healthcare tests even after you get discharged from the hospital. This policy covers all medical expenses incurred by you up to 60 days after your hospitalization.
  • In the case of a claim-free year, you are eligible for a bonus (10% increment of your sum assured amount for the next policy year). But no claim bonus should not exceed 50% of the sum assured amount under this policy.
  • Tax benefits are applicable as per the prevailing norms of the Income Tax Act.

Special features of Care Advantage Health Insurance policy

  • There is no capping for room rent and ICU charges.
  • For pre-existing diseases, the waiting period is 48 months.
  • The initial waiting period is 30 days under this policy.
  • With the Smart Select add-on feature, you can enjoy a 15% discount by restricting treatment at specially created smart select network hospitals.
  • You can opt for Care Shield rider to enhance the coverage of this policy. Care Shield add-on rider offers three benefits to policyholders. These are the claim shield, No Claim Bonus shield, and inflation shield.
  1. Claim Shield: This covers various non-payable expenses, including attendant expenses, gloves, masks, etc.
  2. No Claim Bonus Shield: If your total claim amount is less than 25% sum assured, then NCB will not be reduced.
  3. Inflation Shield: This feature enhances the sum assured amount of your base policy on a cumulative basis at every renewal based on the inflation rate in the previous year.

Inclusions in Care Advantage Health Insurance Policy

  • In-hospitalization: This plan covers hospitalization expenses (nursing expenses, specialist fees, room rent, ICU charges, etc.) if the admission for injury/illness in a hospital exceeds 24 consecutive hours.
  • Emergency road ambulance: This plan bears all the expenses for the necessary transportation of the insured policyholder to the hospital in an ambulance in case of a health emergency.
  • Pre and Post hospitalization: This plan covers all medical expenses incurred 30 days before the hospitalization and 60 days after discharge from the hospital.
  • Daycare procedures: This plan covers 540 daycare treatment methods like cataracts and many more.
  • Advanced treatments: several advanced treatments, like robotic surgery, etc., are covered under the plan.
  • Organ donor: This plan covers hospitalization expenses for major organ transplants.

Exclusions in Care Advantage Health Insurance Policy

  • Pre-existing diseases (waiting period 48 months)
  • Obesity or bariatric related treatment
  • Cosmetic or plastic surgery
  • Gender change treatment
  • External congenital disease
  • Drug addiction or alcoholism
  • Self-inflicted injuries from suicide or any suicidal attempt
  • STDs
  • Injuries or illness due to war or similar conditions

Care Advantage Health Insurance Policy cancellation

Policyholders are eligible to cancel their policies within a 15-days free look period. The insurance company will refund the amount, minus any expenses covered by them or stamp duty charges.

FAQs:

What are the floater combinations under Care Advantage Health Insurance policy?

The floater combinations under the Care Advantage Health Insurance policy are 1 adult+1 child, 1 adult+2 children, 1 adult + 3 children, 1 adult + 4 children, 2 adults, 2 adults +1 child, 2 adult+2 children, 2 adult + 3 children, and 2 adult + 4 children.

Is there any co-payment clause under Care Advantage Health Insurance policy?

Yes. A co-payment of 20% per claim is allowable where the insured policyholder or the eldest member is 61 years or more.

Does Care Advantage Health Insurance policy cover dental treatment?

No, this policy doesn’t provide any coverage for dental treatment.

What are the waiting periods under Care Advantage Health Insurance policy?

Care Advantage policy comes with an initial waiting period of 30 days. For specific ailments and pre-existing diseases, the waiting period is 24 months and 48 months, respectively.

How many claims can be made by the policyholders in a year for Care Advantage Health Insurance policy?

A policyholder can make multifarious claims in a year. But the total amount of different claims should not surpass the sum insured amount under this plan.

What is a health card?

Care Health Insurance will offer you an identity card that you need to show at the network hospital to get the benefits of the health insurance policy.

For what reasons can there be a reduction in the claim amount of Care Advantage Health Insurance?

Your claim amount may be reduced for the following reasons:
· Non-medical expenses.
· Inadequate documents like original bills and prescriptions for your treatment.
· If the sum insured is exhausted.
· If the policy has a co-payment clause.
· Experimental treatment expenses that are not related to your disease.

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