Ultimate Care – Customised Review

Care recently launched a new health insurance plan – Ultimate Care. The insurer is known for affordable and flexible health insurance policies with numerous add-ons. Following the same trend, Ultimate Care is designed to provide coverage that is close to no limits at reasonable premiums. But does this plan live up to its promise, or are there some hidden limitations you should be aware of? Let’s find out now!

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Comprehensive Review of Ultimate Care

Care Health Insurance is one of India’s oldest standalone health insurers. Founded in 2012, the company has gained recognition for eliminating the concept of loading charges and making its policies affordable. 

While Care has good policies and affordable premiums, this is not the only factor you must consider. You must also look at the insurer’s overall claim settlement to understand any pitfalls. Here’s a quick look at Care Health Insurance’s claim metrics over the last three years:

(The data above is an average of three years. The average of the data across 3 years is meant to provide you with a better insight into the insurer’s consistency across its overall operational proficiency and trend.)

Care also has ties with over 11,400 network hospitals, which is quite a good number.

Overall, Care has a good CSR that is around the industry average, which is certainly reassuring. However, like any other insurer, they also have drawbacks that you should consider. For example, Care has a high complaint volume compared to its peers. We would certainly like to see this come down. Now that we’ve spoken about the insurer, let’s briefly look at the pros & cons of the policy itself:

Advantages of Ultimate Care:

• Instant cover for PEDs: One of the stand-out features of Ultimate Care is the reduced waiting period for pre-existing diseases. Conditions such as diabetes, hypertension, asthma, hypothyroidism and coronary artery disease are covered after just 30 days.
• Unlimited Restoration: You can avail of an unlimited restoration of the cover amount. You can use this for any disease any number of times within the policy year. This is certainly an advantage for people who get ill quite often.
• Tenure multiplier: People opting for multi-year plans can combine their cover amounts across multiple years for higher coverage. For example, a three-year policy with ₹20 lakh coverage per annum can allow you to claim up to ₹60 lakhs cumulatively if needed.

Drawbacks of Ultimate Care:

• Post-hospitalisation coverage: One drawback is the reduced post-hospitalisation coverage. While Care Supreme provides 180 days of post-hospitalisation coverage, Ultimate Care only offers 90 days, which could be insufficient for people needing extended care.
• Essentials are add-ons: Another concern is that many essential features, such as premium payback, wellness benefits, OPD coverage, and grace period protection, are only available through paid add-ons. This means that the base policy may not provide all the necessary coverage without these additional costs.
• Porting not allowed: Ultimate Care is only available for fresh purchases, meaning that policyholders looking to switch from an existing policy cannot port or migrate to this plan.

Keeping these cons in mind, if you are still planning on availing of the Ultimate Care plan, here‘s a detailed look into the features. Make sure to go through these details carefully before you purchase the policy -

Should You Buy Ultimate Care?

Care as a health insurance provider: Care Health Insurance is undoubtedly one of the most popular health insurers in India. They are known for affordable health insurance plans and multiple add-ons that help you customise the policy and make it your own. As mentioned before, Care has decent claim settlement & incurred claim ratios. However, we feel that their complaint volume could certainly be reduced, considering that it is well above the industry average of 24 complaints per 10,000 claims. That said, if we take a look at Care’s plans alone, without considering the insurer metrics, they seem to be some of the most comprehensive plans across the industry.

Ultimate Care is one such plan from Care. You can choose a cover amount of up to ₹1 crore, with a loyalty bonus of 50% per annum, up to 100%, no room rent restrictions and no mandatory co-payment. There’s also an add-on where you can avail of an additional loyalty bonus of 100% per annum, with no limit. This in itself makes it quite a compelling option. But apart from this, there are several cherries on the cake. Let’s take a look at the built-in features now:

1. Loyalty Boost:
   If you don’t make a claim for seven consecutive years, your cover amount will be doubled without any additional waiting periods for this extra coverage.
2. Room Rent and ICU Coverage:
   There are no restrictions on room rent or ICU charges, allowing you to opt for any hospital room of your choice without worrying about co-payments or any additional costs.
3. Automatic Restoration Benefit:
   Ultimate Care provides unlimited restoration of the cover amount for any illness, even in the event of partial exhaustion. This ensures that if your cover amount is exhausted within a policy year, it will be replenished for the next hospitalisation.
4. Pre and Post-Hospitalisation Expenses:
   The policy covers pre-hospitalisation expenses for up to 60 days and post-hospitalisation expenses for up to 90 days. Although the post-hospitalisation coverage is lower than Care Supreme’s 180 days, it still provides ample support for follow-up treatments and medical expenses.
5. Daycare and Domiciliary Coverage:
   Ultimate Care covers all daycare procedures up to the cover amount, ensuring that medical treatments requiring less than 24 hours of hospitalisation are included. Additionally, domiciliary hospitalisation is also covered, allowing for medical care at home in case hospitalisation is not feasible. 
   PS: In-patient hospitalisation is considered if admitted for at least 2 hours.
6. Organ Donor Expenses:
   The policy includes coverage for organ donor expenses up to the cover amount, ensuring adequate financial support for transplant procedures.
7. AYUSH Treatment Coverage:
   Alternative treatments under AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) are covered up to the cover amount, allowing you to opt for traditional medical treatments.
8. Newborn Waiting Period Benefit:
   While maternity benefits are not included, the policy allows newborns to be covered immediately after birth if they are added to the policy within 90 days. If added after 91 days, a fresh waiting period will apply.
9. Emergency Ambulance Coverage:
   Road ambulance expenses are covered up to the cover amount, and air ambulance coverage is available without an upper limit. This ensures you have the financial bandwidth for emergency transportation wherever you are in India.

Mandatory Paid Add-ons:

1. Premium Payback: 
   If you don’t make any claim for 5 years, the insurer will return the premium you paid for the first year. You are eligible for this amount every 5 years if you don’t make a claim.
   Let’s understand this with an example: If you purchase a health insurance policy with an annual premium of ₹20,000 + GST, and do not make any claims for the first five years, the insurer will refund the ₹20,000 you paid in the first year. If you continue without making claims for another five years, you will receive another refund of your first-year premium. This cycle continues every five years, provided you don’t make any claim.
2. Grace Period Coverage: 
   Sometimes, people tend to miss paying for their health insurance. This is why insurers have a grace period – usually 30 days – during which their policy will be active, but you will not be eligible to make any claim. 
   However, if you opt for this add-on in Ultimate Care, the insurer will also cover you for any claims during this period.
3. Tenure Multiplier:
   Let’s say you have a cover amount of ₹20 lakh. But you had to make a claim of, say, ₹25-30 lakh in one go. Most other policies will cover only up to ₹20 lakh, i.e. your base cover amount. However, if you have a multi-year policy in Ultimate Care, the insurer will combine the base cover amounts for each year and cover any claim up to this amount. So, if you pay for 3 years at a time for a ₹20 lakh/annum policy, you can claim up to ₹60 lakh in total across the three years.
4. Wellness Benefit: 
   Care has a wellness program called Healthy Days, which tracks your workouts and exercises. If you hit a certain goal in a year, you will be eligible for up to a 30% discount on the premiums for the following year.

Other Paid Add-Ons:

1. Health Check-Up: 
   Ultimate Care provides an annual health check-up benefit as a paid add-on. You can avail yourself of free health screenings for certain tests at network facilities, which helps you stay proactive about your health and detect potential issues early.
2. Instant Cover:
   Ultimate Care offers instant cover for pre-existing diseases such as diabetes, hypertension, hyperlipidemia (high cholesterol), asthma, hypothyroidism, and coronary artery disease (PTCA done prior to 1 year) after a waiting period of just 30 days. This is significantly lower than the standard waiting periods seen in most policies, making it an attractive option if you have these conditions.
3. OPD Coverage:
   With the OPD add-on, you can claim outpatient consultation expenses, including visits to general physicians and specialists. The coverage includes up to four consultations per year, with a cap of ₹500 per consultation.
4. Consumables Coverage:
   Ultimate Care also offers an add-on called Claim Shield, which covers consumables such as syringes, gloves, bandages, and other medical supplies usually excluded from standard policies. This add-on helps reduce out-of-pocket expenses during hospitalisation.
5. Reduction in PED Waiting Period:
   If you want faster access to coverage for pre-existing diseases, Ultimate Care provides an add-on that reduces the pre-existing disease waiting period from three years to either one or two years.

Here is a quick look at the approximate base premiums for both policies -

Note: These premiums are for ₹10 lakh base cover amount for a person residing in New Delhi

While the difference between premiums is nominal, Ultimate Care provides a far better value proposition. But this differs from person to person. So, let’s take a look at whether you should buy Ultimate Care or go for another policy.

Should you buy Ultimate Care?

Ultimate Care is designed for youngsters and people who are purchasing a health insurance policy for the first time. The insurer offers wellness rewards such as discounts, premium refunds, and an excellent loyalty bonus. This, coupled with minimal restrictions on the cover amount, makes it quite an attractive proposition. However, you should also keep in mind that the insurer has a higher complaint volume compared to its peers. Care also does not allow you to port into this policy. This means that if you have an older policy, you won’t be able to transfer benefits such as the waiting periods. 

That said, Ultimate Care is a compelling option if you’re a youngster purchasing a health insurance policy for the first time. Ultimate Care is a promising new launch with enhanced features however, it is still relatively new.

On the other hand, Care Supreme has been in the market for over three years and has proven to be a stable, tried-and-tested product.

You should also keep in mind that the current premiums for this policy are quite low – slightly above Care Supreme. One reason is that the insurer is offering a 30% discount on the first-year premiums, 20% on the second, and 10% on the third-year premiums. Once this discount period is over, it will naturally cost more.

Another reason for the low premiums could be to woo people into purchasing the plan. If the incurred claim ratio of the policy becomes high in the coming years, the insurer will naturally increase the premiums (Although only after consulting with the IRDAI).

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What’s Unique About Ultimate Care?

Ultimate Care is one of the top health insurance plans from Care. It has instant coverage for some common pre-existing diseases after just 30 days, has unlimited coverage, and offers the first year’s premium back for every five years you don’t make a claim. Another stand-out feature is that it provides coverage, even during the grace period, which most other policies don’t.