Care Advantage Health Insurance: Coverage, Features & Review

A ₹25 lakh health plan looks enough until a treatment outside India runs into crores. 

Care Advantage health insurance helps solve this gap with coverage up to ₹6 crore and an optional global cover add-on for Indian residents who want access to treatment anywhere in the world. It works best for individuals and families with no or minor pre-existing conditions who want comprehensive coverage. But a larger sum insured doesn’t promise a smooth claim processing.

In this Care Advantage health insurance review, we discuss its features, claim performance, and premiums to help you decide whether it’s the best choice.

Care Advantage: Performance Metrics

Note: In the table above, CSR stands for claim settlement ratio, ICR for Incurred claim ratio, and GWP denotes gross written premium. 

Key Insights

• Care Health Insurance's CSR has been improving steadily over the past few years and is now safely above the industry average. 
• The ICR of 59.68% is within the healthy range (50%-80%), which means they are paying claims while staying financially stable.
• Complaint levels have been above average, which shows that there is room to improve service quality. Having said that, Care Health Insurance is open to escalations and review cases on their merits, as per our experience.
• Annual business numbers are considerably above the industry average, which indicates a strong market position and customer trust. 

Key Features of Care Advantage Health Policy

Care Advantage stands out as a solid option for someone seeking comprehensive coverage with meaningful add-ons like global coverage and care shield plus. While global coverage is appealing, it’s limited to planned hospitalizations unless you opt for emergency hospitalization at an additional cost.

Let’s have a look at some of the important features of the care health insurance advantage plan.

Noteworthy Points:

• Indian residents aged 25 and above, seeking coverage in India and globally, can avail coverage from ₹25 lakh to ₹6 crore.
• If the insured member is between 5 and 24 years, coverage starts at ₹1 crore. NRIs and non-residents are capped at ₹1 crore, regardless of age.
• A maximum of 2 adults and 4 children can be added to the policy. Children have to exit the plan as a dependent once they turn 25 years old.

Care Advantage Add-ons 

1. No Claim Bonus (NCB) Super: Increases coverage over and above the default bonus given in the policy. 

• Additional 50% up to 100% increase in sum insured (SI) per policy year in a claim-free year
• 50% decrease in SI per policy year in case a claim has been paid.

2. Unlimited Automatic Recharge: With this add-on, your cover amount will be refilled up to 100% of the base sum insured every time it is exhausted. You can avail this benefit unlimited number of times in the same policy year.
3. Air Ambulance Cover: Pays up to ₹5 lakh for air ambulance transport.
4. Care Shield Plus: This is a recommended add-on. It is an optional cover that gives a 3-in-1 benefit: 

• Provides coverage for consumables like gloves, PPE kits, syringes, etc.
• Protects NCB if the total claim in a year is less than 25% of the base sum insured. 
• Coverage increases in line with the consumer price index (CPI) to offset inflation.

5. Reduce PED Waiting Period: Reduce the pre-existing disease waiting period from 3 years to 2 years.
6. Annual Health Check-up: Ensures that every insured member stays proactive about their health. You get one cashless annual health check-up starting from the 31st day of policy inception. It is available every policy year at any of the insurer’s network facilities.
7. Unlimited E-Consultations: The add-on offers unlimited e-consultations with a general physician for each insured member. This might be mandatory for certain ages and pincodes. 

You can also check the Care Advantage brochure and policy wordings for full details. 

Drawbacks of Care Advantage Health Policy

• Bonus in the Base Plan is Low: A bonus of 10% upto 50% is not very high, especially for a large sum insured like ₹1 crore. You can increase the percentage from 50% upto 100% with the NCB super add-on.
• No Domiciliary Cover: This plan does not provide any domiciliary cover for those seeking hospitalization at home. Most plans like Care Supreme and HDFC Ergo Optima Secure cover this by default.
• Limited Modern Treatments: The plan covers only a certain list of modern treatments like robotic surgeries, oral chemotherapy, and balloon sinoplasty. This can be a restrictive feature given the medical and technological advancements taking place regularly. 
• No Free Health Check-ups: The plan does not provide built-in health check-ups. It is available as an add-on, which again increases the premium. 
• Maternity Coverage:  Maternity coverage is not available in the plan by default or with an add-on. This can be a concerning factor for some people. 

Premium Comparison for Care Advantage Plan 

Here is an indicative premium range for different profiles living in Delhi (110010)  and having no pre-existing conditions.

Note: Add-ons taken into account for calculation are: Unlimited automatic recharge, NCB super, care shield plus, annual health checkup, and unlimited e-consultations (Mandatory add-on). In the table, A = adult and C = child. 

Premiums vary by age, zone, add-ons, and the sum insured you choose. Care Health Insurance reviews your medical profile as well.

Why Talk to Ditto for Health Insurance?

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Conclusion

Care Advantage health insurance is a strong choice if you are specifically looking for a high coverage plan with zero room rent restrictions. The ₹6 crore coverage cap, combined with global cover options and a reasonably credible insurer, puts it in the conversation for anyone looking for overall protection.

That said, the base plan has some clear gaps: a lower bonus structure, no domiciliary cover, and a complaint volume that demands attention. Several of these gaps can be covered with add-ons, but that also increases your premium.

Before you finalize Care Advantage, compare it with other plans like HDFC ERGO Optima Secure and Aditya Birla Activ One Max, both of which have better settlement ratios and offer stronger in-built features. If you’re looking for a plan from the same insurer, Care Supreme is a good option.