Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Care Plus Complete is sold by Care and Complete Healthcare Essential is sold by Universal Sompo. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are reasonably comprehensive. They do the basics quite well, but they won’t have all the bells and whistles (Think extensive coverage for international, dental, maternity and other such matters). So if you are looking for something else entirely, then both these policies may not cut it.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let’s start with Care Plus Complete. The product comes from Care’s stable:
Care Health Insurance (formerly Religare Health Insurance) was founded in 2012. And in that time, they’ve managed to corner a large part of the Indian Insurance market.
What’s more impressive?
Care Health Insurance has a remarkable claim settlement ratio of 90% and a network of more than 16,000+ hospitals.
Complete Healthcare Essential meanwhile comes from Universal Sompo’s stable:
Universal Sompo General Insurance Company is a public-private venture floated by two nationalized banks (Indian Overseas Bank and Allahabad Bank), one private bank (Karnataka Bank), an FMCG giant (Dabur Investment Corporation), and a well-known Japanese insurance firm (Sompo Japan Nipponkoa Insurance Incorporation).
The insurer also sells 135 IRDAI approved products and boasts over 5,000 network hospitals with a claim setllement ratio of 95%. Needless to say, the company isn’t exactly stellar when it comes to processing claims.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Care Plus Complete |  Complete Healthcare Essential |
|---|---|---|
| Network hospitals | 16,000+ | 5,000+ |
| Claim settlement ratio (avg. of last 3 years) | 90% | 95% |
| Co-payment | No | No |
| Room rent | Single Private room | Any Room |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 60/90 days | 30/60 days |
| No claim bonus | 50% per year (up to 200%) | 10% per year (up to 50%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (unlimited no. of times for any illness) | 100% restoration (once for different illness) |
| Health check-up | Once every year | Once every 2 years |
| Maternity | Available (up to ₹25,000 after 3 years) | |
| Out Patient Department | Up to ₹1,500 (cap of ₹350 on each consultation) | Up to ₹5,000 |
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Care Plus Complete doesn’t impose a co-payment clause. And neither does Complete Healthcare Essential.
Room rent
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Care Plus Complete only lets you stay in a single private room but you can pick any room you want with Complete Healthcare Essential.
Sub limits
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, neither Care Plus Complete imposes disease-wise sub-limits nor does Complete Healthcare Essential
Waiting periods for pre-existing diseases
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Care Plus Complete imposes a 3 year waiting period on pre-existing diseases and Complete Healthcare Essential will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
Pre and post Hospitalization expenses
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Care Plus Complete covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Complete Healthcare Essential covers expenses incurred 30 days before hospitalization and expenses incurred 60 after hospitalization, although there may be different sub-limits
No claim bonus
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Care Plus Complete offers a no-claim bonus of 50% whereas Complete Healthcare Essential offers a no-claim bonus of 10%. And the no-claim bonus may be capped at different levels too.
Domiciliary
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Care Plus Complete offers domiciliary cover. And Complete Healthcare Essential also coves domiciliary expenses.
Ayush treatments
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Care Plus Complete covers Ayush procedures and Complete Healthcare Essential also extends coverage for Ayush treatments.
Maternity benefits
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, however, Care Plus Complete doesn’t offer protection for maternity-related hospitalizations whereas Complete Healthcare Essential offers maternity cover.
Out Patient Department (OPD)
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Care Plus Complete offers OPD coverage, and Complete Healthcare Essential also offers OPD coverage, although the sub-limits may be different.
Final Conclusion
After considering all the features on hand and the claim settlement ratio of Universal Sompo, we believe that Complete Healthcare Essential is a better alternative to Care Plus Complete for most use cases that we’ve evaluated so far.
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