Overview
The Care Supreme - Senior Premium plan is a specialized health insurance policy designed for senior citizens with complex pre-existing diseases (PEDs) like heart ailments or diabetes. It differs from the Senior Super variant by not imposing disease-wise sub-limits, ensuring full coverage up to the sum insured for all diseases. Both plans offer similar coverage, but the Senior Premium plan provides more comprehensive protection without sub-limits.
Experts Review
Written by Nikhil Nair
Senior Writer
The Care Supreme - Senior Premium plan is a robust health insurance solution for senior citizens with complex PEDs, offering comprehensive coverage without disease-wise sub-limits. This feature ensures full coverage up to the sum insured for all diseases, making it a standout option. However, the plan includes a 20% mandatory co-payment clause and room rent coverage limited to the most economical Single Private Room, which may increase out-of-pocket expenses.
Compared to the Senior Super variant, the Senior Premium plan offers more comprehensive benefits by eliminating disease-wise sub-limits, but both plans share similar co-payment and room rent restrictions. The premium for this plan is generally 5-10% higher than the Senior Super variant due to its enhanced features. Buyers should weigh these factors before opting for this policy.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
Your insurer doesn’t provide free health check-ups, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature. 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.
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 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 - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Wellness Benefits
Mandatory
Up to a 30% discount on renewal premiums for maintaining a healthy lifestyle
Room Rent Modifier
Mandatory
Change Any room to Single Private Room.
Cumulative Bonus Super
Recommended
Additional bonus of 100% up to a maximum of 500%, irrespective of any claim in the previous year.
Claim Shield
Recommended
Covers list of 68 non-medical items as per list I
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 2 years.
Care OPD Senior
Total 8 doctor consultations with 4 from General Physicians (capped at 1000 & 10% mandatory co-payment), 4 from Specified Specialists (capped at ₹2000 & 5% mandatory co-payment. Additionally, get Physiotherapy OPD up to ₹1000 per year and Psychologist consultation (Max ₹800 per session & capped at ₹1000 per year).
Disease Management Program
Total 4 in-person consultations in a year (with capping of ₹750/consultation related to hyperlipidemia or Diabetes Mellitus based on the condition diagnosed), Prescribed Pharmacy up to ₹6000/year and Diagnostic tests like SGOT & SGPT (for hyperlipidemia) and HBA1c, Urine proteins – microalbuminuria; Electrolytes (for Diabetes Mellitus).
Air Ambulance
You can avail an air ambulance in the event of an emergency up to Rs. 5 Lakhs per policy year.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Impairment of an Insured Person's intellectual faculties by abuse of stimulants or depressants unless prescribed by a medical practitioner.
Hormone replacement therapy
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.
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
Your insurer doesn’t provide free health check-ups.
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
N
Neha
Premium features for senior health, worth considering.
O
Om
Offers enhanced benefits for older age.
P
Priya
Happy with the premium coverage for seniors.
W
Wanda
The terms and conditions are a bit complex.
U
Umesh
This plan is very expensive.
S
Sameer
Feels like a very good investment for senior health.
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Frequently Asked Questions
Does Care Supreme - Senior Premium 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 Supreme - Senior Premium have room rent restrictions?
Does Care Supreme - Senior Premium offer a restoration benefit?
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