Overview
The Care Health Insurance Plan is a comprehensive policy designed to cater to diverse healthcare needs for individuals and families. It offers sum insured options ranging from ₹5 lakhs to ₹75 lakhs and includes coverage for in-patient hospitalization (up to SI), pre- and post-hospitalization expenses (30-60 days respectively), daycare procedures (up to SI), AYUSH treatments (up to SI), and domiciliary care (up to 10% of SI). Unique features include annual health check-ups, no-claim bonus shield (10% up to 50% in case of no claims), and optional add-ons such as air ambulance cover and reduction in the waiting period for pre-existing diseases. With access to over 11,400 network hospitals, it ensures seamless cashless treatment.
Experts Review
Written by Nikhil Nair
Senior Writer
The Care Health Insurance Plan is a versatile option that balances affordability with extensive coverage. Its standout features include the ability to reduce the waiting period for pre-existing diseases from three years to two years with an add-on, making it appealing for individuals with pre-existing conditions. Coverage for AYUSH treatments, domiciliary care, and annual health check-ups adds value by broadening healthcare options and promoting preventive care.
That said, the plan has some limitations. The mandatory co-payment clause (up to 20%) for senior citizens increases out-of-pocket expenses during claims. Room rent restrictions (single private AC room) may limit flexibility during hospitalization. Imposes a limit up to ₹3L (depending on SI) on organ donor expenses. While the plan is competitively priced, premiums can escalate with add-ons like air ambulance cover or OPD Care.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
Doctor consultations are not covered, which is a notable gap. Need to opt add-on for doctor consultations.
Care
Key Insights
Founded
2012
Care was established 13 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
90% claims settled in 30 Days
Care settles 90% of all claims it receives. This is reasonable performance, though there is room for improvement compared to top insurers.
Network Hospitals
11,400+
Care has a strong network with over 11,400 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
36 complaints per 10,000 claims registered
Care has a relatively high volume of complaints, which may point to ongoing issues in customer service or claim handling.
Features
All
Great
Good
Co-payment
If you bought this policy after you turned 61, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
Customisable
Waives off 20% of the co-payment if purchased at the age of 61 years or above.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 to 2 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 3 to 2 years.
NCB Super
Recommended
Additional bonus of 50% up to a maximum of 100%, with a clawback of 50% if claimed in the previous year.
Care Shield
Recommended
Cover increases in line with inflation, consumables covered, and No Claim Bonus is protected.
Restoration
Recommended
Restores the cover unlimited times up to 100% of the sum insured for any illness.
Co-Payment Waiver
Recommended
Waives off 20% of the co-payment if purchased at the age of 61 years or above.
OPD Care
Get coverage for outpatient consultations along with coverage for prescribed diagnostics and pharmacy up to defined limits between Rs. 5,000 and Rs. 50,000 based on the amount chosen for the OPD coverage.
Air Ambulance
You can avail an air ambulance in the event of an emergency up to Rs. 5 Lakhs per policy year.
Everyday Care
Get OPD coverage up to 1% of the sum insured and pharmacy cover up to another 1% of the sum insured on a cashless basis. But remember, you have to co-pay 20% for each claim made and this add-on is available only in Delhi NCR, Mumbai, Pune, Bengaluru and Chennai.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Mental retardness
Expenses related to any kind of RMO charges, Service charge, Surcharge, night charges levied by the hospital under whatever head.
Remicade, Avastin or similar injectable treatment which is undergone other than as a part of In-Patient Care Hospitalisation or Day Care Hospitalisation is excluded.
Impairment of an Insured Person's intellectual faculties by abuse of stimulants or depressants unless prescribed by a medical practitioner.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Arthritis (if non-infective), including:
Osteoarthritis
Osteoporosis
Gout
Rheumatism
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to 2 years for all diseases.
What's missing in the policy
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
K
Kiaan Aggarwal
Pre-existing disease waiting period ko add-on se 3 saal se 2 saal kar sakte hain.
V
Vihaan Mishra
Annual health check-ups se proactive health management ho jaata hai.
S
Shanaya Bhatia
Wide network of hospitals (11,400+) for cashless treatment.
K
Krishiv Menon
Room rent pe single private AC room ka restriction hai.
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Frequently Asked Questions
Does Care have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2 years waiting period before you can make claims related to pregnancy and childbirth. Yes. The policy offers maternity benefits up to Rs. 1 lakh if your insured sum is 50 lakhs or above. For any amount less than these, the maternity benefits are excluded from the policy.
Does Care have room rent restrictions?
Does Care offer a restoration benefit?
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