Care Group Health Insurance

About Care Health Insurance Company

Care Health Insurance Company, formerly known as Religare Health Insurance, is a specialised provider of health insurance products across various segments, including retail health insurance, top-up cover, personal accident, maternity, international travel insurance, and critical illness. The company also offers group health insurance and group personal accident insurance for corporates, as well as micro-insurance products catering to the rural market and a comprehensive range of wellness services. With a core philosophy centred on 'customer-centricity,' Care Health Insurance consistently leverages technology to enhance customer service, drive product innovation, and deliver cost-effective solutions.

Plans Under Care Group Health Insurance Along With Their Benefits

Care Group Health Insurance offers two distinct plans, with their benefits detailed in the table below:

Inclusions of Care Group Health Insurance

If the policyholder is diagnosed with illness or injured during the policy tenure, the policy will provide cover for the following:

• In-patient Care: Covers medical expenses during hospitalisation, as advised in writing by a medical practitioner.
• Day Care Treatment: Covers medical expenses for treatments that do not require prolonged hospitalisation, carried out at a hospital or daycare centre on a medical practitioner's written advice.

Coverage Limits:

• Maximum Liability: The total claims made during the policy period cannot exceed the sum insured.
• Room Rent Limit: If room rent exceeds 1% of the sum insured per day, the insured must pay the difference.
• ICU Charges Sub-limit: If ICU charges surpass 2% of the sum insured per day, the insured must cover the excess expenses.

Exclusions of Care Group Health Insurance

Care Group Health Insurance policy does not provide cover for the following:

1. Waiting period: Claims raised for any medical expenses incurred for treatment of any kind of illness in the starting 30 days of the cover tenure will not be admissible. The medical expenses incurred due to an injury will be covered.
2. Specified Waiting period: For the starting 24 months, no claims raised by the insured will be admissible for the following illnesses or surgical procedures.
• The policy does not cover Non-infective Arthritis, Osteoarthritis and Osteoporosis.
• The policy does not cover Gout and Rheumatism.
• Spinal disorders are not covered.
• The policy does not cover Joint Replacement Surgery.
• ENT disorders and surgeries are not covered.
• The policy does not provide cover for nasal septum deviation.
• Sinusitis and related disorders are not covered.
• The policy does not provide cover for Benign Prostatic Hypertrophy.
• Cataract, Dilatation and Curettage are not covered under this policy.
• The policy does not provide cover for Fissures/Fistulas.
• The policy does not provide cover for Hemorrhoids/Piles.
• The policy does not provide cover for the Pilonidal Sinus.
• Gastric and Duodenal Ulcers are not covered.
• Genito urinary system surgery is not covered.
• The policy does not cover any kind of Hernia or Hydrocele.
• The policy does not cover Hysterectomy for Menorrhagia or Fibromyoma.
• The policy does not provide cover for any Internal or Skin Tumors.
• The policy does not provide cover for Cysts and Nodules.
• Polyps and Breast lumps (each of any kind), unless malignant, are not covered under the policy.
• Kidney Stones and Ureteric Stones are not covered under the policy.
• The policy does not cover for Gall bladder Stone and Lithotripsy
• Varicose Veins and Ulcers are not covered under this policy.
3. Pre-existing diseases: If the policyholder suffers from any of the illnesses mentioned above, they will not be covered under the policy.

Care Group Health Insurance Claim Procedure

To avail of the cashless claim, the insured has to follow the procedure mentioned below:

• Cashless Claim:
• Cashless treatment is available only at network hospitals. The insured must present a valid photo ID (such as a Voter ID, Driving License, Passport, PAN Card, or any other insurer-approved identification).
• For planned hospitalisation, the insured must inform the insurer at least 48 hours in advance.

• Reimbursement Claim:

• In case of emergency hospitalisation, the insurer must be notified within 24 hours of admission.

• All required documents and information must be submitted to the insurer immediately, and no later than 15 days after discharge from the hospital.

Documents Required for Claim Processing

To ensure a smooth claim process, the policyholder must submit the following documents to the insurance company:

• Duly completed and signed claim form
• A written recommendation for hospitalisation from the treating doctor
• Doctor's prescription for medicines and diagnostic tests
• Original hospital bills and discharge summary
• Pharmacy bills for prescribed medicines
• Original test reports and corresponding payment receipts
• Case papers and relevant medical documents
• FIR or final police report (if applicable)
• Post-mortem report (if conducted)
• Any additional documents requested by the insurer or TPA for claim assessment

Note:

• The insurance company will accept properly verified photocopies of the documents attested by the insurance company or reimbursement provider submitted along with the original payment certificate.
• The insurance company is liable to accept the bills/invoices that are made in the policyholder's name.
• The insurance company will consider a delay only when the reason for the delay is beyond the policyholder's control.

Care Group Health Insurance FAQs