Care Health Care Insurance Plan (Formerly Religare Care)

Key Features of Care Health Care Insurance (Formerly known as Religare Care Health Insurance)

With Care Health Care Insurance (Formerly known as Religare Care Health Insurance), you can avail the following unique medical benefits:

• 92% Claim settlement ratio(as per the insurer’s website)
• Cashless treatment in more than 16500network hospitals
• Annual medical check-up facility for all the insured members
• In-house claim settlement team with cashless claim approval in 2 hours
• Up to 150% increase in sum insured withNo Claim Bonus discount and NCB Super
• Automatic recharge of the sum insured
• 12 critical illnesses are covered under the Care Anywhere cover
• Various riders, such as Covid Care, Global Coverage, etc. to meet various health concerns

Care Health Care Insurance Plan: Key Highlights

Inclusions of Care Health Care Insurance (Formerly Known as Religare Care Health Insurance) Plan

The following coverage is included under the Care Health Care Insurance policy:

• 30-day pre-hospitalization charges are covered
• Ambulance expenses are also covered under this plan
• In-patient hospitalization for a minimum of 24 hours including room rent charges, intensive care unit charges, nursing expenses, doctor and surgeon's fees, blood, anaesthesia, operation theatre, and oxygen charges.
• 540+day care treatments requiring hospitalization for less than 24 hours.
• 60-day post-hospitalization expenses are covered
• An Annual medical check-up is available.
• Reassurance of second medical opinion available
• Domiciliary hospitalization is also covered
• Organ donor expenses are also covered
• Alternate medical treatments are also covered
• Advance treatment methods are covered
• Daily allowance up to 5 days per hospitalization is available(under Rs 3 & 4 lakh SI)
• Global coverage for hospitalization expenses, excluding the USA, is available
• Vaccination cover for children available
• Care Anywhere cover with global coverage for 12 critical diseases available(under Rs 50 to Rs 75 lakh SI)
• Maternity cover available (under 50 to Rs 75 lakh SI)

Add-on Covers in Care Health Care Insurance (Formerly Known as Religare Care Health Insurance) Plan

• No Claim Bonus Super- It is an optional cover that will further enhance the sum assured amount for every claim-free year. NCB can increase by 50% for up to 100%. So, in total with No-Claim-Bonus & No-Claim-Bonus, the policyholder can enhance the sum insured up to 150% in five years.
• GlobalCoverage - Total – It is an extension to Global cover that provides coverage for medical treatment overseas without any geographical limitations, including the
• Unlimited Automatic Recharge- You should not run out of coverage anytime during your policy period that is why it is important to have This additional coverage reinstates the sum insured amount upon exhaustion every time. There is no limit as the policyholder can avail this benefit for an unlimited number of times.
• Everyday Care- It provides coverage for all OPD consultations up to 1% of the sum insured that includes diagnostic procedures and doctor consultations. The policyholder can avail this cover using a cashless health card.
• Air Ambulance Cover- This add-on benefit proves to be useful when immediate treatment is suggested miles away from the city of residence and an air ambulance service is required.
• Reduction in PED Wait Period –It reduces the waiting period for pre-existing diseases from 48 months to 24 months.
• Covid Care –It pays for the hospitalization and/or quarantine costs for COVID-19, provided the test was conducted at a government-authorized diagnostic centre.
• Covid Care with OPD –It covers the expenses incurred on hospitalization and quarantine due to COVID-19 along with coverage for OPD costs up to 1% of SI if the test was conducted at a government-authorized diagnostic centre.
• Co-payment Waiver– It eliminates the compulsion to pay a 20% mandatory co-payment for insured above the age of 60 years.
• OPD Care– It pays for the insured’s outpatient medical expenses incurred on doctor’s consultation, investigative tests and pharmacy.
• International Second Opinion –It covers the cost of availing a second medical opinion on an illness or medical condition from international medical experts.
• Care Shield –It enables the policyholder to stay protected from multiple expenses with the help of three covers, including claim shield, no claim bonus shield and inflation shield.
• Smart Select –It enables the policyholder to avail a 15% discount on premium along with agreeing to bear a 20% co-payment if admitted to a non-listed hospital.
• Personal Accident –It pays compensation to the policyholder if an accident leads to his/her death or permanent total disability.

Exclusions of Care Health Care Insurance (Formerly Known as Religare Care Health Insurance) Plan

The Care Insurance plan does not cover the following medical expenses:

• Expenses incurred on the treatment of congenital diseases are not paid by the insurer
• Hospitalization required due to self-inflicted injuries and suicidal attempts are not covered
• Medical treatment/hospitalization required due to an overdose of drugs and alcohol or intoxications are not recompensed
• Any disease/illness/surgery that has been diagnosed or has given symptoms within 30 days of the policy commencement date
• Medical tests and hospitalization pertaining to infertility and in vitro fertilization
• War, strike, nuclear weapons, and riots induced hospitalization

Refer to the policy wordings to get the complete list of exclusions.

Care Health Care Insurance (Formerly Known as Religare Care Health Insurance) Eligibility Criteria

Take a look at the eligibility criteria of the Care Health Care Insurance plan below:

• The minimum entry age is 5 years for individual coverage and 91 days for floater cover (with at least one insured above 18 years).
• There is no limit on maximum entry age.
• The plan offers a lifetime renewability benefit.
• There are 30 days of the waiting period for illness except for injuries

The waiting period of pre-existing illnesses is 4 years. Care Health Care Insurance (Formerly Known as Religare Care Health Insurance) Claim Process

Before filing a claim, it is always better to know the claim process that follows for different kinds of claims, including hospitalization, OPD, and everyday care. Take a look at the claim process below: Hospitalization Claim Process:

Emergency hospitalization treatment requires the policyholder to inform the insurance company within 24 hours of getting hospitalized. If it is a planned hospitalization, the insured should inform the insurer at least 48 hours before the hospitalization. The claim process for hospitalization is listed below:

• For Cashless Claims: Get admitted to a network hospital of Care Health Insurance Limited
• Submit the pre-authorization form at the hospital’s TPA desk who will fax it to Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited)
• The claim management team will send the approval letter
• Receive the treatment and the insurance company will settle the claim after discharge from the hospital
• In case a query is raised by the claim management team, either the insured or the hospital can respond to them
• In case the cashless claim is rejected, the insured may start with the treatment, pay the bills and file a fresh claim for reimbursement after getting discharged from the hospital

For Reimbursement Claims:

• Avail treatment at a hospital and pay all the bills at the time of discharge
• Submit the claim form and all the required documents to the insurance company as per the terms and conditions
• The Care Health InsuranceLimited (Formerly known as Religare Health Insurance Company Limited)’s claim management team will verify the documents and coverage details
• The insurance company will inform the policyholder about claim approval and pay the claim amount.
• In case of rejection, the insurance company will inform the policyholder along with the reason for rejection.

Everyday Care Claim Procedure:

• Check the list of Everyday Care network centres online on the website of the insurance company
• Visit the OPD service provider and carry the Everyday Care Card
• The policyholder would also need to carry an original copy of a government photo id proof.
• The service provider will deduct 80 percent of the total bill from the Everyday Care Card and the insured would need to pay 20% of the co-payment.
• An email and SMS notification of the services availed will also be sent.

OPD Care Claim Procedure:

• Download the claim form from the insurer’s website
• Attach the original bills and invoices and send the claim application to the insurer
• For the seamless settlement of claims, the insured can submit the claim application along with NEFT details
• Most of the claims are settled within 15 days from the date of receipt of all the documents.