Overview
The Care Senior Health Advantage plan is a health insurance policy tailored to meet the needs of senior citizens aged 60 and above. It provides coverage for hospitalization, pre- and post-hospitalization expenses, AYUSH treatments, and domiciliary care. The plan includes annual health check-ups, unlimited e-consultations, and access to a wide hospital network (11,400+). However, the plan has only two options for cover amounts, which are ₹5 lakhs and ₹10 lakhs.
Experts Review
Written by Nikhil Nair
Senior Writer
The Care Senior Health Advantage plan is designed as a last-resort health insurance option for senior citizens, particularly those with critical pre-existing conditions who may not qualify for other plans. Its key strengths include coverage for pre-existing diseases after a waiting period of two years, annual health check-ups from Day 1, and unlimited e-consultations through a mobile app. These features make it suitable for seniors requiring frequent medical attention.
However, the plan has notable drawbacks. Room rent is capped at twin-sharing accommodations, which may limit flexibility during hospitalization. Additionally, sub-limits on treatments such as cataracts (₹40,000) and knee replacements (₹1 lakh–₹1.2 lakh) can lead to out-of-pocket expenses for major procedures. The absence of restoration benefits and a poor bonus structure (10% of Base Cover for every claim-free year, max up to 50% of Base SI) further reduces its appeal compared to more comprehensive senior citizen plans.
Despite these limitations, the plan’s affordability and accessibility make it a viable option for seniors with limited alternatives. It provides basic coverage at budget-friendly premiums but may not be suitable for those seeking extensive benefits or higher sum insured options.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
Premiums are relatively high.
No Restoration Benefit, 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.
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 50% of the bill every time you’re hospitalized — That is if you’re under the age of 70. If you’re 70 and above, then they’ll make you pay 60% of the bill. So co-payment is mandatory here.
Room Rent
Tough luck if you are thinking about opting for a single private room and a lower cover Because the policy only lets you stay in a shared room. If it’s an ICU they’ll restrict it to 2% of the sum insured, If you still want to pick a better room, then be ready to pay a lot more when the final bill shows up.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataracts, Knee replacement, Cancer, Modern treatments 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 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.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Mental retardness
Hormone replacement therapy
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.
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
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
K
Kailash Sharma
Tailored for senior citizens (60+), addressing their specific needs.
K
Kapil Gupta
Annual health check-ups from Day 1 are very beneficial for monitoring health.
K
Keshav Patel
Covers AYUSH treatments and domiciliary care, offering flexibility.
L
Lalit Reddy
Sub-limits on cataracts, knee replacement surgeries, cancer treatments, modern treatments, and No restoration this plan should be considered as a last resort option.
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Frequently Asked Questions
Does Senior Health Advantage 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 Senior Health Advantage have room rent restrictions?
Does Senior Health Advantage offer a restoration benefit?
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