Care Health Insurance

Religare Care is a comprehensive health insurance policy that provides financial coverage to the insured in their time of need. The plan covers all major medical expenses incurred due to an illness, injury, or accident.

The plan comes with hospitalization benefits, pre-hospitalization cover, day-care treatment benefit, health check-ups, and post-hospitalization benefits. The care plan also comes in five different variants. These variants are:

• Care 3 (Super Saver)
• Care 4 (Elite)
• Care 5 (Elite Plus)
• Care 6 (Global)
• Care 7 (Global Plus)

In all of these variants, the total sum assured value can vary from Rs.4 lakh to Rs.6 crore. Free annual health check-ups are provided for all members who are covered under the policy. A No Claim Bonus (NCB) is provided for up to 150% if one has the NCB Super option benefit. One can also avail of unique unlimited automatic recharge and get global medical treatments done for 12 major illnesses. Other key features of the plan include.

• No maximum entry age limit
• If any claim is made, then the premium value will not increase
• Free annual health check-ups for all insured members irrespective of their claim history
• An additional feature to reduce the PED wait period
• Automatic policy recharge if the claim amount exhausts the coverage. This is provided at no additional cost
• To meet incidental costs, the daily allowance is provided
• The total sum insured can be selected between Rs.2 lakh to Rs.60 lakh
• Cashless treatment benefits
• Settlement of claims is done directly by the organization
• The total policy term can be 1 year, 2 years, or 3 years
• Tax benefits are provided on the premium amount paid under Section 80D of the Income Tax Act, 1961
• A free look period of 15 days is allocated from the receipt of the policy document
• On the basis of individual underwriting, an extra premium of up to 50% can be levied on the premium amount payable during the year
• No limits or caps are placed on room rent, intensive care unit charges, operation theatre charges, fees of the doctor, and fees of the surgeon
• If one opts for a policy term of 2 years or more, then he or she is eligible to get a 7.5% discount on the premium amount
• In the case of claim-free years, one can get a 10% increase in the total sum assured value. This increase is provided to a maximum of 50%

Other details related to the eligibility and some restrictions placed on the policyholder are given below.

There are different benefits that are provided to the insured in this policy. Let’s look at what those benefits are by going through the list given below.

• In-Patient Care: All hospitalization charges, including nursing, room rent, ICU charges, fees of surgeon, fees of doctor, blood, oxygen, anesthesia, and operation theater charges are covered
• Day-Care Treatment: In the case of any hospitalization for less than 24 hours, all medical expenses will be covered
• Pre-Hospitalization Benefit: Medical charges incurred 30 days before admission into the hospital are covered
• Post-Hospitalization Charges: Medical expenses incurred by the insured for up to 60 days after being discharged from the hospital are covered. These expenses can include follow-up visits to the doctor and medication
• Ambulance Charge Cover: Expenses of ambulance provided by a private service provider or the hospital will be reimbursed
• Daily Allowance: Any out-of-pocket expenses like attendant’s cost and transportation incurred while visiting the doctor or the hospital will be provided. A lump-sum value for every completed day of the hospital will be paid under the daily allowance benefit
• Organ Donor Cover: All medical charges incurred by the organ donor while undergoing the surgery for an organ transplant are covered. This benefit is provided if the organ is being transplanted to an insured individual
• Second Medical Opinion: If the policyholder is suffering from any major illness and wishes to get a second medical opinion, then Care Health Insurance will arrange for the same at no cost. This benefit is provided for illnesses stated in the insurance document. Further, this benefit can be availed by every member covered in the policy each year
• Domiciliary Hospitalization Benefit: If the insured is getting a treatment done at home, then charges for the same will also be reimbursed. It should be noted that the medical treatment should not exceed for a period of 3 consecutive days or merit a hospitalization
• Free Health Check-Up: The policy pays for annual health check-ups of the insured and the family members who are not covered under the policy. Those family members must be the policyholder’s children to be eligible for this benefit
• Recharge of Sum Assured: In case of exhaustion of the sum assured value, the company will reinstate the entire sum once in a policy year. This amount can be used for future claims but not for illnesses for which a claim has already been made during the same year
• Global Treatments: For some pre-selected diseases or illnesses, one can get treatments done internationally. It should be noted that all payments will be made in India, on a reimbursement basis, and in Indian Rupees only.

As mentioned earlier, there are some plan variants in the Care Health policy. You can look at the details of those variants by going through the table mentioned below.

Tax benefits are also applicable as a deduction from the taxable income each year. This is applicable under section 80D of the Income Tax under the existing tax laws of the Income Tax, 1961 on premiums paid up to Rs.25,000 for individuals and Rs.30,000 for senior citizens.

It should also be noted that no medical tests are required for individuals of 24 years of age and below for any sum assured. For individuals not falling in the above category, you can refer to the table mentioned below.

The key inclusions applicable in this policy are:

• In-patient care benefit is applicable up to the sum insured value
• Global coverage on a cashless basis is also provided in hospitals falling under the company network
• Domiciliary hospitalization benefit up to a limit of 10% of the total sum insured value is valid

The key exclusions applicable in the policy are mentioned in the list below.

• This insurance policy does not provide coverage for congenital diseases
• Medical expenses for the treatment of AIDS
• Medical charges for the treatment of alcohol addiction, drug abuse, and tobacco abuse
• Expenses incurred due to suicide attempt or self-inflicted injury are not covered
• Hospitalization due to nuclear weapons, riot, and war
• Any pre-existing ailment or injury which has been diagnosed within 48 months of issuing of the first policy
• Expenses for spectacles, contact lenses, or dental treatment
• Treatments incurred due to or traceable to pregnancy, miscarriage, childbirth, abortion, and its consequences
• Charges of tests and treatments related to in-vitro fertilization and infertility
• A few treatments, including joint replacement and non-infective arthritis, are not covered in the first two years of the policy term