Care Health Insurance Covered Diseases List: Everything You Need To Know

What is the Care Health Insurance covered diseases list?

Care Health Insurance does not maintain a fixed “covered diseases list” for its standard health insurance plans. Like most indemnity-based health policies, coverage extends to all medically necessary treatments, except those explicitly excluded under the policy terms. The key factors to review are the waiting periods applicable to specific ailments and pre-existing conditions, as well as the permanent exclusions, which align with the IRDAI’s Standard List of Exclusions.

For Critical Illness (defined-benefit) plans, Care provides a specific list of major illnesses like cancer, heart attack, and stroke, defined according to IRDAI’s standardized guidelines.

So, if Care Health Insurance doesn’t publish a fixed list of covered diseases, how do you really know what’s included? The answer lies in understanding the fine print: the exclusions, waiting periods, and how pre-existing conditions are handled. Let’s break those down so you know exactly where your coverage stands.

If you have questions about which Care Health Insurance plan suits your needs best, or if you want personalized guidance on coverage, exclusions, and benefits, book a free call with our expert advisors at Ditto today.

Care Health Insurance Covered Diseases List: Overview

Care Health Insurance is a well-known standalone health insurer (SAHI) in India. This means they specialize primarily in health-related policies.

Care Health Insurance covers the costs of hospitalisation and medical treatment, provided the treatment is necessary (in the opinion of a medical practitioner). This is why looking for an exhaustive Care health insurance covered diseases list for their standard plans can be misleading. What helps is understanding not just what’s covered, but more importantly what isn’t.

If a person has a pre-existing condition, such as rheumatoid arthritis, Care Health Insurance may consider it too risky to include under standard coverage. In such cases, the insurer can offer the policy with a permanent exclusion for that condition, but only after obtaining the insured’s explicit consent. This way, all other treatments remain covered, while claims related to rheumatoid arthritis would not be.

Types of Plans Offered by Care Health

01

Indemnity-Based Health Plans

Standard health plans which pay or reimburse your hospitalisation costs up to the sum insured. This is usually what people mean when asking about which illnesses are covered under health insurance. For example,

02

Super Top-up Plans

These plans provide an extra layer of coverage after your base policy’s sum insured has been exhausted, often kicking in after a defined "deductible" limit.

03

Benefit-Based Critical Illness Plans

Unlike indemnity plans, a Critical Illness plan pays a lump-sum amount upon diagnosis of a covered severe illness. Care has a benefit-based plan called Assure.

04

Personal Accident Plans

These plans offer coverage for accidental death, disability, and injuries

05

Travel Insurance

Policies designed to cover medical emergencies and other mishaps while travelling abroad.

You can explore the full Care Health Insurance brochure with detailed plan features, coverage, and benefits here.

Which Diseases Are Covered by Care Health Insurance Plans?

To reiterate, when it comes to standard indemnity plans, it’s more useful to focus on two key aspects: Exclusions and Waiting Periods, rather than searching for a fixed Care Health Insurance covered diseases list.

1. General Coverage & Exclusions

Care Health Insurance’s indemnity plans generally cover almost all treatments that are medically necessary, except for a few standard exclusions. These exclusions are common across most health insurance policies and include:

Permanent exclusions in Care Health Insurance policies refer to specific diseases, medical conditions, treatments, or procedures that are never covered under any circumstances.

• Cosmetic and plastic surgeries (e.g., Botox, liposuction) unless medically necessary due to accidents or burns .
• Treatments related to fertility, pregnancy, and childbirth such as IVF, surrogacy, and elective abortions (except in plans specifically offering add-ons for these)).
• Self-inflicted injuries, attempted suicide, injuries arising from substance or drug abuse, and injuries due to illegal activities.
• External congenital anomalies like cleft palate present from birth that are treated as lifelong pre-existing conditions.
• Treatment related to mental health conditions beyond hospitalisation and alternative therapies that lack proven medical efficacy.
• Medical procedures or diagnostic tests not part of treatment (e.g., registration fees, service charges, and diagnostic scans without referral).
• Injuries sustained from hazardous sports or adventure activities done as a professional.
• Treatment costs resulting from war, terrorism, nuclear radiation, or civil unrest.
• Gender reassignment or sex change treatments.
• Treatment from non-recognized or blacklisted healthcare providers.
• External medical aids or appliances like hearing aids, spectacles, or prostheses unless specified.
• Treatments for obesity or weight control unless medically necessary and meeting defined conditions.
• Treatment for sexually transmitted diseases except HIV/AIDS.
• Treatment in non-medical establishments like spas, health hydros, or nature cure clinics.
• Costs related to dietary supplements or vitamins unless prescribed during hospitalisation.
• Treatment of sleep disorders and certain chronic illnesses might be excluded or permanently excluded based on policy specifics.
• Treatment outside India is generally not covered unless under specialized travel insurance.
• Some severe pre-existing conditions declared at the time of application (e.g., cancer, rheumatoid arthritis) may be permanently excluded by the insurer after a risk assessment.

Carefully review the policy wording before purchasing to understand the permanent exclusions applicable to your specific Care Health Insurance plan.

2. Waiting Periods

3. Critical Illness (CI) Plan Coverage

If you are specifically interested in a care health insurance covered diseases list for life-threatening conditions, their Critical Illness (CI) plans are what you need to look at.

CI plans are benefit-based and they cover a defined list of severe illnesses. It's a useful product considering loss of income, lifestyle adjustments due to critical illnesses and is not a replacement for comprehensive indemnity based plans.

Note: You must always refer to the specific CI policy wording for the exact care health insurance covered diseases list along with its waiting and survival periods.

The IRDAI Standard List of 22 Critical Illnesses

Insurance companies offering Critical Illness cover must adhere to the standardized definitions set by the regulator (IRDAI), which mandates a minimum set of 22 Critical Illnesses for standard CI products (as defined in circulars like IRDAI/HLT/REG/CIR/104/5/2022 and its reference documents). [refer to page 14 of this circular].

The 22 standardized critical illnesses are:

1. Cancer of Specified Severity
2. Myocardial Infarction (First Heart Attack of Specified Severity)
3. Open Chest Coronary Artery Bypass Graft (CABG) Surgery
4. Open Heart Replacement or Repair of Heart Valves
5. Coma of Specified Severity
6. Kidney Failure requiring Regular Dialysis
7. Stroke Resulting in Permanent Symptoms
8. Major Organ/Bone Marrow Transplant
9. Permanent Paralysis of Limbs
10. Motor Neurone Disease with Permanent Symptoms
11. Multiple Sclerosis with Persisting Symptoms
12. End Stage Liver Failure
13. Major Burns (Third Degree Burns)
14. Aorta Graft Surgery
15. Primary Pulmonary Hypertension
16. Alzheimer’s Disease
17. Benign Brain Tumour
18. Cardiomyopathy
19. End Stage Lung Disease
20. Brain Surgery
21. Major Head Trauma
22. Blindness (Total Blindness)

Conclusion

Understanding the care health insurance covered diseases list is less about finding a perfect index of ailments and more about knowing your policy’s limitations, i.e., the exclusions and waiting periods. 

For comprehensive coverage, a standard health plan combined with a Critical Illness policy offers the best protection. Always read your policy documents carefully to be completely sure of your specific care health insurance covered diseases list and what is covered in your plan. The lack of a simple care health insurance covered diseases list shouldn't deter you, as the coverage is much broader than a simple list could ever capture.

We hope this guide was helpful! If you need guidance on which health insurance plan or insurer is right for you, feel free to connect with Ditto’s experts. We’ll guide you based on your needs. Book a free call today to get personalized assistance.

FAQs