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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 Senior is sold by Care and Health Insurance Gold is sold by Edelweiss. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.

Second, we know that both products have massive differences in their core structure. Care Senior is specifically designed for senior citizens. However, Health Insurance Gold is quite comprehensive. It offers considerable protection and it doesn’t impose as many restrictions. So in many ways, you’re comparing apples and oranges here.

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 Senior. 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.


Health Insurance Gold meanwhile comes from Edelweiss’s stable:

Edelweiss Health Insurance company was founded in 2017 when they were hived off the homegrown Edelweiss Financial Services Limited. The company provides an array of products across multiple categories and they boast a claim settlement ratio of almost 92% with more than 6,200 network hospitals.

The only problem is - They’re still trying to find a firm foothold in the market.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
16,000+
6,200+
Claim settlement ratio

(avg. of last 3 years)

90%
92%
Co-payment

20%

No

Room rent

Any Room

(up to 1% of sum insured)

Single Private room

Disease sub-limit

Yes

No

Pre existing diseases waiting

4 years

3 years

Pre/Post hospitalization

30/60 days

60/90 days

No claim bonus

10% per year

(up to 50%)

50% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for different illness)

100% restoration

(once for different illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹50,000 after 4 years)

Out Patient Department
Day care

Feature Comparison

coPay

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. However in this case Care Senior imposes a mandatory co-payment of 20% whereas Health Insurance Gold doesn’t impose a mandatory co-payment clause.

roomRent

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 Senior only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured and Health Insurance Gold lets you stay in a single private room. In effect, both policies impose restrictions on the kind of room you can pick.

diseaseSublimit

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, Care Senior imposes disease-wise sub-limits on Cataract, Knee Replacement, Hernia, Hysterectomy, Benign Prostate Hypertrophy, Renal Stones, Cancer, Cerebrovascular, Cardiovasular disorders whereas Health Insurance Gold doesn’t impose a disease wise sub-limit.

ped

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. In this case, Care Senior imposes a waiting period of 4 years on pre-existing diseases while Health Insurance Gold extends a waiting period of 3 years on existing conditions.

prePost

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 Senior covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Health Insurance Gold covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits

ncb

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 Senior offers a no-claim bonus of 10% whereas Health Insurance Gold offers a no-claim bonus of 50%. And the no-claim bonus may be capped at different levels too.

domiciliary

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 Senior offers domiciliary cover. And Health Insurance Gold also coves domiciliary expenses.

ayush

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 Senior covers Ayush procedures and Health Insurance Gold also extends coverage for Ayush treatments.

maternity

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 Senior doesn’t offer protection for maternity-related hospitalizations whereas Health Insurance Gold offers maternity cover.

opd

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, neither Care Senior extends coverage for outpatient consultations, nor does Health Insurance Gold.

Final Conclusion

Since this isn’t a fair comparison, to begin with, we will only tell you this much. If you want something that’s comprehensive, you could go for Health Insurance Gold. However, if you are specifically looking to buy a policy for senior citizens, then you may want to consider Care Senior.

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