Overview
The Care Senior plan is a health insurance policy tailored specifically for individuals aged 60 and above. It offers a sum insured ranging from ₹3 lakhs to ₹10 lakhs, covering in-patient hospitalization (up to SI), pre- and post-hospitalization expenses (30-60 days respectively), AYUSH treatments (up to 20K, depending on SI), and domiciliary care (up to 10% of SI). The plan includes annual health check-ups, coverage for 541 daycare procedures (up to SI), and organ donor expenses (up to 1L, depending on SI).
Experts Review
Written by Nikhil Nair
Senior Writer
The Care Senior plan is a practical option for senior citizens seeking affordable health insurance with essential coverage. Its strengths lie in comprehensive benefits such as inpatient hospitalization, pre- and post-hospitalization expenses, AYUSH treatment coverage, and domiciliary hospitalization. The inclusion of annual health check-ups and daycare procedure coverage enhances its utility for older individuals requiring frequent medical care. Additionally, the plan’s wide hospital network (11,400+) ensures access to cashless treatment across India.
However, the mandatory 20% co-payment clause increases out-of-pocket costs during claims. Room rent restrictions (max capped at 1% of the sum insured, ICU 2% of SI per day) may limit flexibility during hospitalization, and disease-specific sub-limits on conditions like cataracts and knee replacements can lead to additional expenses. These limitations make it less suitable for seniors with high-cost medical needs.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
Premiums are relatively high.
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 policy will only cover 80% of the final bill. The rest is on you. They call this a co-payment.
Customisable
Waives off 20% of the co-payment if purchased at the age of 61 years or above.
Customisable
Get 15% discount on premiums with 20% Co-payment for the insured members if treatment is taken in Non-Smart Select Network Hospitals.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataract, Knee Replacement, Hernia, Hysterectomy, Benign Prostate Hypertrophy, Renal Stones, Cancer, Cerebrovascular, Cardiovasular disorders 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 you wait for 3 years.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 years 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 years to 2 years.
Care Shield
Recommended
Cover increases in line with inflation, consumables covered, and No Claim Bonus is protected.
NCB Care
Recommended
Additional bonus of 50% up to a maximum of 100%, with a clawback of 50% if claimed in the previous year.
Co-Payment Waiver
Recommended
Waives off 20% of the co-payment if purchased at the age of 61 years or above.
OPD
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.
Smart Select
Get 15% discount on premiums with 20% Co-payment for the insured members if treatment is taken in Non-Smart Select Network Hospitals.
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
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
F
Fatima L.
Annual health check-ups and 541 daycare procedures covered are good for seniors.
H
Hina N.
Wide hospital network (11,400+) ensures easy access to cashless treatment.
K
Karan Q.
Organ donor expenses are covered, which is a good inclusion.
N
Neeta T.
Room rent capped at 1% of SI is very restrictive, especially in cities.
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Frequently Asked Questions
Does Care Senior 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.
Does Care Senior have room rent restrictions?
Does Care Senior offer a restoration benefit?
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