Care Group Health Insurance

Care health insurance company formerly known as Religare health insurance offers health insurance policy. Care health insurance policy offers individual as well as group health insurance policy. The company has a strong presence across 1700 locations in PAN India. Care group health insurance policy provides flexible plans as per requirement, pre-existing diseases covered from day 1, newborn cover from day 1, direct claim settlement, and many more.

Benefits of Care Group Health Insurance

There are several benefits of Care group health insurance policy. Care group health insurance offers two plans and their benefits are mentioned in the table below.

Benefits	Plan 1	Plan 2
In-patient Care (Medical Expenses Cover)	Covered up to SI	Covered up to SI
Day-care treatment	Covered up to SI	Covered up to SI
Room rent Limit and ICU limit (respectively)	One percent & two percent of SI	Two percent & four percent of SI
Waiting period · 30 days, Second-year exclusion · Pre-existing diseases	Waived off	Waived off
Pre-hospitalization & Post Hospitalization medical expenses	30 days and 60 days respectively	30 days and 60 days respectively
Domestic road ambulance	Rs. 1000	Rs. 2500
Maternity expenses delivery (9 month waiting period in respect of maternity claims waived off)	25000 for normal and 35000 for LSCS first two living children only	35000 for normal and 50000 for LSCS first two living children only
Pre Natal and Post Natat (for a period of 30 days)	Rs. 2500 part of maternity limit	Rs. 5000 part of maternity limit

Inclusions of Care Group Health Insurance

If the policyholder is diagnosed with illness or suffers an injury during the policy tenure. The policy will provide cover for the following:

In-patient Care: The medical charges incurred during the hospitalization of the insured on the written advice of a medical practitioner are indemnified.
Day Care Treatment: The medical expenses incurred during the daycare treatment at a daycare centre or hospital on the written advice of a medical practitioner are indemnified.

The maximum, total and cumulative liability for the insured person while raising any claim incurred under the policy tenure will not exceed the sum insured amount.

Sum-limit on Room Rent: If the room rent incurred is higher than the 1% of the SI per day then the insured person will have to bear the extra charges of the medical expenses.
Sub-Limit on ICU charges: If the charges incurred are higher than than the ICU charges limit of 2% of SI per day then the insured member will have to bear the extra charges of the medical expenses.

Exclusions of Care Group Health Insurance

Care group health insurance policy does not provide cover for the following:

Waiting period: Claim 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.
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 for Non infective Arthiritis, Osteoarthritis and Osteoporosis.
The policy does not cover for Gout and Rheumatism
Spinal disorders are not covered.
The policy does not cover for 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 Fissure/Fistula in anus.
The policy does not provide cover for Hemorrhoids/Piles.
The policy does not provide cover for 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 for Hysterectomy for menorrhagia, fibromyoma.
The policy does not provide cover for any Internal tumors and skin tumours.
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 Stone and Ureteric Stone are not covered under the policy.
The policy does not cover for Gall bladder Stone and Lithotripsy
Varicose veins and varicose ulcers are not covered under this policy.

Pre-existing diseases:If the policyholder suffers from any of the illnesses mentioned above, he will not be provided coverage 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: The policy will provide cashless facility only at the network providers. The insured will have to provide a valid photo identification document (like: Voter ID card / Driving License /Passport / PAN Card / any other identification documentation as approved by insurance company).
Reimbursement:

At least 48 hours before the commencement of a planned hospitalization, the insured will have to tell the insurance company about it or within 24 hours of admission to Hospital if the Hospitalization is required in an Emergency.
All the documents and information should be submitted to the insurance company immediately an in any event within 15 days of insured person discharges from the hospital after the treatment is done.

Documents Required During Claim

The policyholder will have to provide following document and informations to the insurance company while raising the claim.

The form should be filled properly
Written letter by the doctor that advised for hospitalization
Doctor’s prescription that advised medicines, test.
Bill provided by the hospital, discharge card from the doctor.
Bill from the medical store.
Original test reports and payment receipts.
Case papers and documents.
FIR/ final police report, if required
Post mortem report, if conducted
Any other document as required by the insurance company or TPA to assess the Claim.

The insurance company will accept properly verified photocopies of the documents attested by insurance company or reimbursement provider submitted along with original payment certificate.
The insurane company is liable to accept the bills/invoice that are made in the policyholder’s name.
The insurenace company will entertain the delay only when the reason of delay is beyond control of the policyholder.

Care Group Health Insurance FAQs

Q: How much cover is provided for the ambulance charges?

Ans: Rs. 1000 to Rs. 2500 is provided as a cover for the ambulance charges.
Q: Does care group health insurance provide day care treatment cover?

Ans: Yes, Care group health insurance provide day care treatment cover.
Q: What is the ICU charges limit in Care group health insurance policy?

Ans: Care group health insurance policy provides 2% of the sum insured per day subject to maximum amount specified in the policy certificate.
Q: Does Care group health insurance provide cover for in-patient care?

Ans: Yes, Care group health insurance provide cover for in-patient care that is covered up to sum insured amount.
Q: What is the room rent limit in care group health insurance policy?

Ans: Care group health insurance policy provides room rent limit up to 1% of the sum insured per day subject to maximum amount specified in the policy certificate.
Q: Does care group health insurance provide a cashless claim feature?

Ans: Yes, Care group health insurance provides a cashless claim feature to the insured person.
Q: Does care group health insurance provide cover for STDs?

Ans: No, Care group health insurance policy does not provide cover for any STDs.