Overview
The Care Heart plan is a specialized health insurance policy designed for individuals with pre-existing heart conditions. It offers sum insured options ranging from ₹3 lakhs to ₹10 lakhs and covers inpatient hospitalization (up to SI), pre- and post-hospitalization expenses (30-60 days respectively, maximum up to 5% of SI), daycare treatments (up to SI), and alternative treatments (up to SI). Unique features include annual cardiac health check-ups, automatic restoration of the sum insured, and optional add-ons like OPD care and home care. Unlike other Care plans, it focuses specifically on heart-related ailments with a shorter waiting period of 24 months for pre-existing conditions.
Experts Review
Written by Nikhil Nair
Senior Writer
The Care Heart plan is tailored for cardiac patients, offering a relatively short waiting period of 24 months for pre-existing heart conditions. Its annual cardiac health check-ups and automatic restoration of the sum insured are significant benefits, ensuring continuous protection against multiple claims. The plan also covers alternative treatments and daycare procedures, providing flexibility in healthcare choices.
On the downside, the plan has drawbacks such as a co-payment clause of 20% for those under 70 and 30% for those above 70, which increases out-of-pocket expenses during claims. Additionally, it imposes disease-specific sub-limits on treatments like cataract, knee replacement, and cancer, limiting full coverage for these conditions. Room rent is restricted to a single private room, which may limit flexibility during hospitalization.
Pros
Feature set is satisfactory.
Premiums are relatively well priced.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some. 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
Bad
Co-payment
The company will make you pay 20% of the bill every time you’re hospitalized — That is if you’re under the age of 70. If you’re 71 and above, then they’ll make you pay 30% of the bill. So co-payment in mandatory here.
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
Your insurance cover won’t be fully available in case you are treated for Knee Replacement, Hernia, Hysterectomy, Benign Prostate, Treatment of Cerebrovascular disorders, Treatment of Cancer and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
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 just 2 years. It’s probably the best deal you can get to be honest.
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 upto 5% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Care OPD
Mandatory
Total 8 doctor consultations with 4 from General Physicians capped at ₹500 and 4 from Specified Specialists capped at ₹500.
Care Shield
Recommended
Cover increases in line with inflation, consumables covered, and No Claim Bonus is protected.
Home Care
Get coverage Upto Rs.1000/- per Day for Hiring Qualified Nurse at home. It is available for a maximum of 7 Days per hospitalization. But remember, this benefit is available only post-discharge from the hospital and on the Doctor's written advice with valid reason.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Treatments rendered by a Doctor who shares the same residence as an Insured Person or who is a member of an Insured Person’s family.
STS other than HIV
Mental retardness
Organ Donor
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.
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
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
K
Kamaljeet Kaur
Finally, a plan that understands pre-existing heart conditions! Annual cardiac check-ups are a blessing.
M
Manisha Reddy
Sum insured options up to ₹10 lakhs specifically for heart patients is good.
P
Parthiban Sen
Daycare treatments are covered, which is useful for certain cardiac procedures.
S
Sarita Uniyal
Waiting periods for specific heart conditions, even within this plan, need careful checking.
I
Indu Sharma
Claim settlement is easy and simple with this plan.
M
Mohan Srivastava
Cardiac patients ke liye specially banaya gaya hai, waiting period for heart conditions sirf 24 months hai depending on underwriting.
S
Suresh Menon
Sum insured ka automatic restoration bhi hai, multiple claims mein help karta hai.
R
Rajendra Gupta
Knee replacement aur cataract jaise treatments pe sub-limits hain, pura cover nahi milta.
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Frequently Asked Questions
Does Care Heart 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
Does Care Heart have room rent restrictions?
Does Care Heart offer a restoration benefit?
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