Do health plans cover OPD expenses?

We offer multiple health covers with the OPD benefit as an optional cover for an additional premium. Under this benefit, the policyholder will get reimbursement for the OPD expenses, including OPD consultations, diagnostics, and medicines, up to a specified limit subject to T&C.

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Health Insurance

Health insurance is a security cover wherein the insurer bears the insured person’s healthcare costs in exchange for regular premium payments. You can opt for our best health insurance plans on an individual or family floater basis.

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Home / Health Insurance

What is Health Insurance?
Compare Our Best Health Insurance Plans in India
How Does Health Insurance Work?
Benefits of a Medical Insurance Policy
Which Type of Health Insurance Should You Buy?
Why Choose Care Health Insurance?
Types of Health Insurance Plans
Eligibility Criteria and Health Insurance Policy Details
What is Covered under Care Health Insurance Plans?
Exclusions
How to File a Claim under Health Plans
How to Buy Health Insurance Online?
Advantages of Buying Health Insurance Online
What are the Factors Affecting Premium of Medical Insurance Policies
How to Calculate Premium of Medical Insurance Plans?
Does Health Insurance Cover COVID-19 Expenses
How to Choose the Best Health Insurance Plans in India?

GET QUOTE IN 1 MIN

What is Health Insurance?

Health insurance is a type of insurance that pays for insured members' medical expenses due to accident, illness, or injury. It is an indemnity-based agreement under which the insurer promises to bear the hospitalisation costs, OPD charges, doctor’s fees, medications, and other medical bills concerning the insured. he importance of health insurance has shot up in the last few years due to the alarming spread of lifestyle diseases among people at all stages of life. Even a short trip to the hospital can quickly eat up your hard-earned savings in no time. In such a scenario, a health insurance policy can help you avoid a financial crisis.

Under the policy, the insurance company offers various sum insured options, which is the maximum amount the insurer would pay to the policyholder during a medical emergency. In return, the insured members promise to pay out a premium on a periodic basis.

Typically, there are two broad categories of health insurance:

Indemnity-Based Health Insurance Plans: Indemnity-based health insurance is a type of insurance that pays for insured members' medical expenses due to accident, illness, or injury. In an indemnity-based agreement, the insurer promises to bear the hospitalisation costs, OPD charges, doctor’s fees, medications, and other medical bills concerning the insured.
Fixed-Benefit Health Insurance Plans:A fixed-benefit health plan is one where a fixed benefit/sum insured is disbursed to the insured in case a pre-defined medical condition is diagnosed. So, unlike other health plans where you raise a claim for medical cover, in a fixed-benefit plan, you receive the sum insured upon diagnosis of the disease, and it depends on the insured how they utilise the sum insured.

Compare Our Best Health Insurance Plans in India

Care Health Insurance is one of the best Indian health insurance companies in the country. We ascertain that you and your family members receive optimum healthcare coverage complemented with an affordable premium. Here are some of our best health insurance policies in India:

Look for best health plan that suits your need!

Family Health Insurance

Health Insurance that Covers your Loved Ones

Annual Health Checkup & Save Tax
Modern Treatments Coverage

KNOW MORE

1 Crore Health Plan

Health Insurance with Higher Sum Insured

Upto 50% No Claim Bonus
Individual or Floater Option

KNOW MORE

Health Insurance for Senior Citizens

Your Parents have always cared for you, Now its your TURN

No Pre-policy medical check-up
Annual Health check-up for all insured persons

KNOW MORE

Pre-Existing Diseases Cover

Health Insurance for Diabetes, High BMI and Hypertension

Dialysis Cover
Day Care Treatments

KNOW MORE

Maternity Health Plan

Maternity Insurance Plan with Newborn Baby Cover

Newborn Baby Cover up to the first 90 days
Pre & Post Hospitalization Cover

KNOW MORE

Super Top up Health Plan

Boost Your Existing Health Cover With Super Top Up Plan

Financial Cushion for Medical Emergencies
Support for Critical Diseases

KNOW MORE

Heart Health Insurance

Health Insurance that Covers Pre-existing Heart Ailments

541+ Day Care Treatments
AYUSH Coverage

KNOW MORE

How Do Health Insurance Plans Work?

A health insurance plan works like any other insurance policy wherein the insurer agrees to pay the insured person’s hospitalisation cost up to the sum insured.The primary role of health or medical insurance is to lower the financial burden of unexpected life events like illnesses, accidents, and ailments.Let’s understand with an example:

Vyas purchased individual health cover from Care Health Insurance with a sum insured of ₹50 lakhs. A few months later, while going to the office, Vyas met with an accident and got hospitalised. Preferring to avail of cashless benefit, Vyas chose one of the network hospitals in his vicinity. The hospital bill was ₹5 lakhs where Vyas only paid 5% of the bill (deductibles). The remaining ₹4.5 lakhs was paid by insurer.

If he wanted, Vyas could also choose to get medical treatment from a non-network hospital. Once the treatment was complete, he could raise a reimbursement claim to receive the admissible costs.

The way a health insurance plan works is simple– your health insurer provides financial support during medical emergencies in return for a regular premium payment. Yet, there’s more to a health policy than only the premium and sum insured, as shown here-

Benefits of a Medical Insurance Policy

With over an 8% year-on-year increase in medicine prices, medical tests, and hospital charges across India, families have realised the importance of affordable health insurance while facing a healthcare crisis. Realising the importance of medical cover is just the first step to experiencing the immense benefits of a health cover, especially in light of health-related uncertainties. Here are the top benefits of health insurance that make it an essential healthcare security cover:

Financial Protection against Medical Inflation

As of now, the medical inflation rate in India is 14%, which makes healthcare costs skyrocketing. With our comprehensive healthcare insurance coverage, we’ve got your back.

Coverage for Hospitalisation Expenses

Expenses at the hospital can be financially exhausting. Having hospitalisation cover is a great help. At Care Insurance, we secure you against pre and post-hospitalisation expenses, ambulance charges, day-care procedures, domiciliary care expenses, and so on.

Coverage for Critical Illnesses

Treatment cover for life-threatening conditions comes as a blessing, which is available as a separate cover. Care Critical Illness Insurance is such an example, which covers 32 critical illnesses like cancer, cardiomyopathy, paralysis, blindness, and so on. The insured receives a fixed-benefit sum insured if any of these 32 diseases are diagnosed.

Protection above Corporate Health Insurance

Your corporate health insurance may not be sufficient for your family. At Care Health Insurance, we offer affordable plans that help you cope with expensive medical costs.

Cashless Claim Benefit

Over 21500+ cashless network hospitals are available for a convenient billing experience at the hospital.

Customised Plans at Affordable Rates

At Care, we do not want to add up more to your burden, so we aim to draft customisable plans at affordable rates. With a number of health plans to offer, like an individual, family, senior citizen, critical illnesses, etc., we aim to lower your medical expenses at competitive premium charges.

Avail Tax Benefits under Section 80D

The premium you pay for your health insurance can be utilised to avail of tax benefits, under Section 80D of the Income Tax Act, 1961. For example, individuals below 60 can avail of tax deductions of up to ₹25,000.

*Note: Tax deduction on medical insurance premium is subject to rules and regulations of the Income Tax Act.

Which Type of Health Insurance Should You Buy?

You should determine the ideal health plan for yourself and your family by evaluating the healthcare needs, age, and current health status of every member. To help you select the right health policies for every household member, we have created a scenario-based differentiation covering the different needs of individuals and families. Find out which scenario is most-relatable to you and secure yourself with our policy offerings-

If You Have Dependent Family Members

Want to safeguard the health of your immediate and dependent family, including your spouse, children, and parents? Here’s a perfect choice: The policy covers your entire family’s medical needs with one comprehensive plan eliminating the struggle of maintaining several policies. With sum insured options up to ₹6 crores, the family plan offers the following features:

● A Single and Affordable Premium Payout
● Wide-ranging Sum Insured Options
● Annual Health Check-ups for Every Insured Member
● Customizable Policy Benefits like OPD, PED, etc.

Family Floater Insurance Policy

If You are Young and Need Complete Coverage

Young adults aged 35 years and below need a complete package of healthcare and financial security. To meet this need, you should choose our inflation-proof insurance: The policy comes with all-inclusive healthcare benefits that help keep young adults safe against medical crises. With a no co-payment clause and personal accident coverage, this health insurance policy offers the following benefits to early birds:

● Available on Individual and Family Floater Basis
● 10% Renewal & 5% Digital Discounts
● Unlimited Automatic Recharge up to Sum Insured
● Value-added Services Like e-Consultations, Wellness Programs, etc.

Youth Health Insurance Plan

If You Have Elderly Parents to Look After

Your parents and elders need special care when they turn 60 and above. If you are looking for adequate coverage for your elders to enjoy a stress-free and financially secured retirement, here’s your go-to choice: The senior citizen health cover supports older people in paying hefty medical expenses due to old age-related ailments. Available to both individual and floater basis, the policy holds the following unique features:

● No Pre-policy Medical Check-ups*
● Annual Health Check-ups for all Insured Members
● Automatic Recharge of Sum Insured Once in a Policy Year
● ave Tax up to ₹75,000 u/s 80D

Senior Citizen Health Insurance Plan

If You Need Protection Against Critical Illnesses

The treatment of cancer, lung disease, and other critical ailments can completely wash away your savings. So, if you are anticipating any chronic conditions among your family, do check our: The policy offers a shield against the medical treatment expenses of 32 critical ailments, like stroke, paralysis, organ transplant, etc. with the following benefits:

● Mediclaim Policy with Low Premium & Optimum Coverage
● Easy EMI Option Available
● Quick Recovery Counselling
● Coverage for Cancer at all stages

Critical Illness Insurance

Why Choose Care Health Insurance?

At Care Health Insurance, we aim at serving customers beyond basic health insurance services. We offer enhanced medical insurance policies with valuable features to meet the diverse medical needs of people across India. Our health insurance plans come with a wide range of sum insured, starting from ₹3 lacs to ₹6 crores, enhanced with various healthcare benefits like COVID and OPD-care, cashless hospitalisation, day-care treatment, and annual health check-ups, among others.

Here are some of the features that make us one of the best health insurance companies in India:

Comprehensive Health Insurance Plans

At Care Insurance, we strive to provide our customers with some of the best health plans with wider coverage. Along with in-patient expenses, pre and post-hospitalisation, domiciliary hospitalisation, and organ donation, we also cover AYUSH treatment to ensure our customers choose the medical treatments of their choice through our long list of the best health insurance policies in India.

Affordable Plans

We offer affordable premiums for all our health insurance plans. You can easily customise a plan as per your needs and pay the premium accordingly. To get an idea of the investment you’ll have to make, you can make use of the health insurance premium calculator.

Array of Options for all Kinds of Needs

There is no limit to your health insurance customisation. We believe in the different preferences of different customers and so you get an array of health plan options. Be it for individuals, family, your parents, an expecting mother, or critical illnesses like cancer, you get to choose from a number of available options.

Coverage for your Whole Family

If you want to insure your family, you can consider Care Health insurance plans such as Care Family Health Insurance, Senior Citizen health insurance, Care advantage with sum insured up to Rs 6 crores etc. Comprehensive coverage with a high sum insured can help you meet the medical needs of your whole family under one plan. Pick a plan that best suits your health needs.

Wide Network of Hospitals

Cashless benefit has further made health insurance a hassle-free experience. In order to avail of cashless claims, one has to receive medical treatment from one of the network hospitals. Care Insurance has 22900+ cashless healthcare providers with 9747+ network hospitals. Hence, it is very easy to avail cashless benefit during a hospitalisation.

Easy Claim Procedure

With the introduction of both online and offline claim filing options, the claim procedure has become quite easier. We understand the value of quick claim approval, and so, within a short span of time, the claims are approved and settled.

Efficient Customer Care Support-including Live Chat options

You may have several queries regarding your health insurance policy, and visiting a nearby office may not always be possible. Fret not, we got your back! With our live chat feature and quick customer care support, you can clear out all your doubts in no time.
On the website, you can easily spot the live chat feature or get a call back from our executive to resolve your query. Alternatively, you can reach us at our toll-free number 1800-102-4499 for sales and +91 88604 02452 for service-related queries. You can also receive policy updates on WhatsApp as well.

Add-on Benefits

We ensure people receive quality medical facilities without worrying about arranging funds to pay for hefty hospital bills. Along with the standard healthy policy offerings, Care insurance policies are complemented with add-on perks like:

Air-ambulance cover
Claim Shield
Co-payment waiver for senior citizens
Annual health check-up
Reduction in PED waiting period
No Claim Bonus Super

Thus, a health insurance policy is a vital protection shield to buy for oneself and the family's financial security against unexpected medical crises.

Types of Health Insurance Plans

With Care Insurance, you get some of India's best health insurance plans designed to meet our customers' diverse medical needs. Below are all the types of health coverage that we offer:

Individual Health Cover

As the name suggests, it is for individuals, primarily young-aged people with no medical condition to enjoy long-term healthcare security. This individual health insurance policy assures the entire sum insured solely for covering the insured individual's medical expenses. It also covers various other costs, including pre and post-hospitalisation expenses, maternity benefits, and much more. These plans are often a little more expensive than family floater plans as there is no sharing of the sum insured; each individual has their own coverage.

Family Floater Health Plans

Under family floater health insurance, you can cover a maximum of 6 family members in one policy against a single sum insured. This policy is to safeguard the health of your entire family. Also, you can add multiple nominees to this plan. The premium amount in family floater plans is comparatively lower than individual plans, as the sum insured is shared among all the members under the plan. It covers the medical expenses for hospitalisation and treatment during an emergency or planned admission.

Senior Citizen Health Cover

A common myth about health insurance is that there are not many options for seniors. This is absolutely incorrect. Senior citizen health insurance plans are aimed at offering specialised healthcare services suited for the elderly who have crossed 60 years of age. They can offer financial assistance to senior citizens who don’t have a fixed income. Under a senior citizen healthcare insurance plan, older people can also avail of services such as cashless hospitalisation, home and day-care cover, AYUSH treatment, COVID care, etc. It is the best way to give your old parents a healthy and peaceful life after retirement.

Maternity Insurance Plans

Motherhood is the most crucial phase in a woman's life. Although the journey is challenging, a sound medical policy ensures relaxed hospital coverage throughout pregnancy.If you are planning to get married or start a family in the near future, you should opt for maternity insurance in advance. It covers your pregnancy-related expenses related to normal delivery, caesarean, pre and postnatal, post-delivery care, and vaccination. Maternity insurance ensures premium medical facilities at affordable rates for the mother and her newborn.Buying it at the right time would help you serve the waiting period and thus make the most of the coverage.

Health Insurance Plans for Pre-existing Diseases

Pre-existing diseases are the illnesses one may suffer from before they purchase a health plan. With age, our elderly family members often suffer from specific medical conditions like diabetes, hypertension, or high BMI. At Care Health Insurance, we offer medical insurance plans that cover pre-existing conditions, too with a reduced waiting period. These healthcare plans come with special features like daycare treatments, home care, annual health check-ups, and more to care for people with diabetes, high B.P., and BMI.

Critical Illness Plans

Incidences of life-threatening diseases are increasing in India at an alarming rate. Critical illnesses such as cancer, stroke, heart ailments, and organ failure can eat away your savings in the blink of an eye. Insurance for critical conditions covers the treatment of all these diseases. It mitigates your hospitalisation expenses along with medication up to the sum insured. Most critical illness plans are fixed benefit plans where a defined payout is made at the time of diagnosis of the listed disease. The money can be used to pay for the treatment or for meeting any other financial requirements.

Eligibility Criteria and Health Insurance Policy Details

While most of our health insurance plans have standard eligibility criteria, you can check the desired policy for any specific conditions, like co-payment and waiting period,etc:

Minimum Entry Age	Individual- 5 years \| Floater- 91 days with at least 1 insured person of age 18 years or above
Maximum Exit Age	Lifelong for Adults
Tenure Options	1/2/3 Years
Cover Types	Individual and Family Floater basis
Waiting Period	30 days for illnesses, except injury \| 24 months for named ailments \| 48 months for pre-existing diseases
Grace Period	30 days to renew your policy post expiry

What is Covered under Care Health Insurance Plans?

Insurance for medical expenses provides you with comprehensive financial protection in the time of urgent need by covering various medical expenses apart from the bills you incur during hospitalisation. The coverage provided is subject to the policy terms and conditions. The expenses covered in in health insurance policies are:

Coronavirus Treatment

Stay safe amid the looming COVID-19 pandemic with the coverage of standard COVID-19 hospitalisation and medication expenses as per policy terms.

In-Patient Hospitalization

We cover your expenses like room rent, ICU charges, doctor’s fees, etc., during any planned or emergency hospitalisation up to the sum insured.

Pre-Hospitalization Medical Expenses

We cover your medical expenses like doctor’s consultation, medical tests, & medication up to 60 days before admission to a hospital.

Advanced Medical Treatments

Access advanced medical care and get coverage for modern treatments, including robotic surgeries, chemotherapies, etc., with our health insurance plans in india.

Daily Allowance

The everyday expenses during hospitalisation can be considerable! Our health insurance plans provide a fixed amount to cover them.

Post-Hospitalization Medical Expenses

The medical expenses, like follow-up visits and medical tests, are covered up to a period of 180 days immediately after discharge from the hospital.

Domiciliary Hospitalization

Need to take care of elderly members at home? We offer domiciliary hospitalisation expenses to ensure uninterrupted medical coverage as per terms.

AYUSH Treatments

Now treat your ailments with a combination of modern and traditional treatments. Our AYUSH coverage helps you avail of alternative treatment.

The best medical insurance plans also give maternity benefits as an optional cover for delivery-related expenses. Also, various add-ons are available at an additional premium, including OPD Care, where OPD expenses like OPD consultations, diagnostics, and medicines, are covered.

Disclaimer: Please check our product pages and prospectus for more details.

What is Not Covered under Health Insurance Policies?

Exclusions of a health insurance plan refer to the medical conditions that are not covered. It means that the insurer is not obliged to pay for such medical conditions. You cannot raise any claims for the following standard exclusions under health plans:

Self-inflicted injuries resulting from suicide or attempted suicide.
Diseases, surgeries, or medical events, occurring within 30 days of the policy start date.
Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences.
Tests and treatment relating to infertility and in vitro fertilization.
War, riot, strike, nuclear weapons induced hospitalization.

How to File a Claim under Health Insurance Plans

STEP 1

Emergency

Intimate within 24 hours of your hospitalization

Planned Hospitalization

Intimate us 48 hours prior to your hospitalization

STEP 2

Cashless

Request for pre-authorization

Reimbursement

Claim form submission

Complete the pre-authorization form available
at the hospitals' insurance/TPA Desk and send us through fax.

Approval

Approval letter sent by the claim management team

Query

Hospital/Insured to respond to the query raised by the claim management team

Rejected

You may initiate the treatment and file for reimbursement claim

Submission of claim form along with required
documents, as per the policy terms & conditions

Approval

Approval letter sent by the claim management team

Query

Insured to respond to the query raised by the claim management team

Rejected

We will communicate the reason in case of rejection

Documents required to File a Claim under Health Insurance

Whether you are filing for a cashless or reimbursement claim process, some paperwork would be required. Typically, in the case of a cashless claim, the documentation is minimal, and most of the formalities would be completed by the TPA. The reimbursement claim procedure would require you to submit all the paperwork so that there is no delay in verification. It is suggested that you keep the following documents handy to ensure a smooth and quick claim settlement process:

A duly filled and signed claim form
Insured person’s details like name, policy number, nature of the illness, address, etc.
All the diagnostics and medical test reports
Original payment receipts, hospital bills, and discharge summary papers
Original pharmacy bills with prescriptions
Doctor’s referral letter
Police FIR and post-mortem report in case of personal accident
Death certificate

How to Buy Health Insurance Online?

The best part about the online availability of health covers is the secure payment gateways. With easy-to-follow steps and trust-backed payment partners, we offer you a seamless experience of buying online health insurance. Also, our digital portal enables you to make premium payments through a hassle-free digital payment gateway.

Here is a quick 6-step guide you should follow for making online insurance payments:

Visit our website and select a health policy based on your needs and sum insured requirements.
Click on ‘Get Quote’ and provide relevant details.
Enter the required information and customise your policy.
You will be redirected to the payment section.
Make payment through any secure digital payment mode.
You will get the new health policy documents on your registered email-id.

Advantages of Buying Health Insurance Online

With our digitally-enhanced portal, it is now easier to buy online health insurance. All you need to do is simply select your preferred health cover, fill up the details, and pay through secure transaction modes. Here’s why and how we ensure customer-friendly purchase a medical insurance plan online:

Convenient Policy Selection
Don't worry about scheduling countless appointments with agents to understand policy details. We provide an all-digital policy selection experience wherein you can study, compare, choose, and pay for your insurance anywhere, anytime across India.
Chat Option for Queries
Our team is always available for all your queries concerning the terms and conditions of our healthcare policies. By accessing the live chat option, you can quickly discuss any policy-related matter at your convenience.
Instant Premium Quote Calculation
We facilitate digital premium calculators to help you evaluate and opt for customised healthcare insurance for your family members.The ability to choose your desired health coverage and optional benefits helps us serve you the best mediclaim policies.
Secure Payment Modes
Our policy portals offer various digitally secure payment modes, including credit/debit cards or net banking. Once purchased, you will receive authentic policy documents immediately.This way, we help you get an instant mediclaim policy in less than an hour.
Transparent Policy Evaluation
What we promise on paper is what you get in times of emergencies. All our healthcare insurance plans include all the terms and conditions for your ready reference.
Readily Available Value Added Services
While browsing online through our mediclaim policies, you can easily check out other add-on benefits. These include OPD care, co-payment waiver, and reduced wait time for pre-existing diseases, among others, to cover your specific needs.

How to Renew Health Insurance Policy Online?

Every medical policy terminates when the term for policy ends. That’s why renewing a mediclaim is crucial to ensure uninterrupted healthcare coverage and added advantages like no claim bonus, coverage for a pre-existing ailment, etc. The process of renewing insurance involves the following steps:

Visit our official website for health insurance policy renewal.
Go to the renew section.
Enter the complete details, such as policy number, contact number, etc.
Under the payment section, pay the renewal premium through any secure payment mode.

The way you buy health policy online, you also have the facility to renew your health plan through the digital mode, thus saving much effort.

What are the Factors Affecting Premium of Medical Insurance Policies

We adhere to the underwriting process and consider many factors on which your insurance premium will depend. Listed below are some determining factors:

Age Factor: The risks of illnesses go up as we age, so the premium will cost you more as you grow older since there are health risks to consider.
Pre-existing Conditions: Premium costs are high if one has any pre-existing medical condition, such as hypertension, asthma, and diabetes when buying a health cover.
Body Mass Index: A high BMI indicates that a person may have higher health risks; thus, one is likely to spend more on the premium.
Lifestyle: Some risky lifestyle habits, including tobacco consumption, drinking, and smoking, can lead to a high premium.
Type of Plan: Depending on the type of plan you choose, the premium also changes. For instance, the premium for a family health insurance is typically lower than that of an individual health plan.
The Sum Insured: Sum insured is the maximum coverage that your health plan offers. The higher the sum insured, the higher the premium charged.If you pick a plan with ₹1 crore sum insured, the premium charged will be higher than that of a health plan with ₹50 lakhs sum insured. So, it is essential that you assess your medical requirements carefully before deciding the sum insured.
Deductibles and Co-Payment: Deductibles and co-payment refer to the portion of a claim the insured has to pay during claim settlement.If you choose a higher deductible/co-pay, the premium charged will be low and vice-versa. If you are young or at low risk of medical conditions, you may opt for higher deductibles/co-pay to lower the premium.
Add-On Covers:If you wish to increase the coverage of your health insurance plan, you may purchase the required add-on covers. However, you must keep in mind that with each add-on, the premium increases. So, make sure you only buy the ones that you really need.
Your Location: Your health insurance premium tend to vary depending on the city you reside in. Areas with high medical costs have higher premiums as well. For instance, medical treatment in metropolitan cities like Delhi or Mumbai may be higher than that in non-metro cities. In such a case, your location may impact the premium charged.
Your Occupation: Your occupation also decides the premium of your health insurance plan. This is because certain occupations have higher medical risks than others, and so, the premium charged is also high. For example, workers at a factory or construction site have higher risks of accidents and mishaps than bank employees.
Medical History of Family: Certain diseases can be hereditary. For instance, if any of your parents has a history of diabetes, Alzheimer's, etc., you are also at risk of welcoming such diseases. In such a case, the premium charged may be higher than others with no such family medical history.

How to Calculate Premium of Health Insurance Plans?

You can now calculate the premium using a simple digital calculator designed especially for medical policies. This tool helps you get the right estimate of the amount of premium you will have to pay for your policy. It considers various factors to calculate the premium, including the information you have entered. Here are the steps to calculate your premium:

Step 1: Visit the Health Insurance Premium Calculator page.
Step 2: Choose the desired policy and enter your mobile number in the 'Get Quote' section.
Step 3: Enter the pin code and email, followed by the details of all the members to be insured.
Step 4: Customize the policy by changing the sum insured and add-ons as per your needs.
Step 5: That's it! Your instant health insurance quote is calculated, including 18% GST.

We offer three policy estimation options: family cover, pre-existing diseases cover, and senior citizen insurance. The premium calculator will automatically calculate the amount you must pay to be eligible for the coverage. You can check the premium and critical benefits in your base mediclaim insurance policy.

Does Health Insurance Cover COVID-19 Expenses?

Yes, health insurance policies by Care Insurance provide standard coverage for COVID-19 treatment expenses across the network of hospitals.It helps individuals and families safeguard themselves from the constant risk of COVID-19 treatment costs. Our medical policies cover the standard hospitalization expenses related to COVID-19 infection contracted by any insured member. To deliver the best health insurance policy, we promise quick and quality COVID-19 treatment across our network of hospitals and health centres.Also, policyholders can enhance their health insurance plans by opting for additional COVID-related benefits, like COVID Care and COVID Care with OPD, as offered under specific policy terms.

How to Choose the Best Health Insurance Plans in India?

Buying the most suitable health plan involves careful planning and consideration of various factors. Investing in the right medical cover is a wise yet difficult decision for the well-being of yourself and your loved ones. But how choosing the right plan can be an overwhelming task.

To understand which is the best medical insurance in India, you must study the scheme for the following advantages:

Verify Eligibility: Often, health policies come with entry age restrictions. With Care Health Insurance, you face minimum age restrictions with a minimum entry age of 91 days on a floater basis and get lifelong renewability.
Ensure Maximum Coverage: Our health insurance plans provide pre and post-hospitalization expenses, diagnosis expenses, treatment, medication, organ donor cover, and annual health check-ups.
Look for Affordable Premium: A budget-friendly premium is always on your mind while buying a medical policy. In our digital portal, you can utilise the health policy calculator to estimate the premium rates by customising the covers and sum insured as per your needs.
Check Exclusions: Check the exclusions list carefully before choosing a health policy. There are certain pre-defined conditions under which you cannot make a claim. So, go for the cover that offers maximum coverage with minimal exclusions.
Understand the Co-Payment Clause: Before investing in insurance for medical needs, it's advisable to check the co-payment clause. Co-pay in health policies refers to a specified percentage of the claim amount that needs to be borne by the insured person.
Select Wide Cashless Network Hospitals: Easy access to our empanelled network hospitals provide you with cashless treatment in the least time. Ensure a widespread cashless hospital network, and don't forget to look for well-renowned hospitals in your vicinity.
Bid for Higher Claim Settlement Ratio: Claim Settlement Ratio proves the company's reliability in settling claims. We promise the highest claim settlement ratio of 95.2% CSR (F.Y. 19-20).

Key Things to Know Before Opting for Medical Insurance

Under healthcare plans, the insured is any individual or family trying to get sufficient financial help during medical emergencies. However, there's more to the process and terms of medical insurance than this. So, let's understand the nuts and bolts of medical insurance policies in India so you make a well-informed decision:

Assessment of Your Healthcare Needs

First of all, you need to consider your medical condition before opting for a suitable medical insurance policy. How old are you? Are you carrying any pre-existing diseases like diabetes or hypertension? Do you have a medical history in your family? Are there any specific treatments or surgeries you are anticipating? You must have solid answers to all these questions to land on the best health insurance plan.

Insurance Enrolment

Suppose you are a family man, aged 40, considering a medical cover for yourself, your wife (aged 35), and your daughter, aged 9. Being a middle-aged nuclear family, you are less prone to chronic diseases. Ideally, it would be best to have a comprehensive healthcare scheme covering all major health risks and treatments.

Regular Premium Payment

Generally paid monthly, the premium is the amount you invest with the insurer to receive health insurance benefits. The healthier and younger you are, the lesser premium rates you bear. However, factors like your lifestyle, drinking habits, city of residence, and family's medical history also affect your final premium pay-out.

Deductibles and Co-payment Check

Deductibles are a standard clause across insurance policies that indicate the amount you initially pay before your mediclaim starts paying for your medical expenses. Co-payment is another insurance clause requiring people aged 61 years and above to bear a percentage of their hospitalisation claim. Thus, deductibles and co-payment are stepping stones to reap the benefit of your healthcare insurance finally.

Use of Preventive Care

Taking timely precautions is the need of the hour, especially under the current pandemic's constant health risks. Under preventive care, mediclaim policies cover COVID treatment, annual health check-ups, general OPD visits, diagnosis, medical tests, consultations, etc., done to analyse any severe health patterns beforehand. By paying the premium, you can avail of preventive care benefits under your medical insurance plan.

Hospitalization Process

Unfortunately, if you or a family member needs emergency hospitalisation, you should reach the nearest network hospital. At network hospitals, you get a cashless billing facility along with other discounts on pharmacy and other non-medical expenses. Cashless hospitalisation saves you from paying hefty medical bills from your pocket as the insurance provider settles the claim directly with the hospital.

Claim Settlement

Your health insurance policy comes into effect once you submit the claim form at the cashless hospital's TPA/insurance desk. However, if you happen to admit the patient to a non-network hospital, you can settle the claim but only through the reimbursement process. If you exhaust your sum insured, there's always a restoration benefit scheme provided by the insurer. That's why choosing an insurer with a high claim settlement ratio always helps.

Learn more about the cashless claim settlement ratio here

Porting Your Health Policy to Care Health Insurance

There are more than one reasons to port your policy to Care Health Insurance. As an insured person, we promise you unique benefits with lifelong renewability under most of our health insurance plans. Porting a medical plan is easy and can be done before the policy renewal stage. Just notify your existing insurer at least 45 days before the policy renewal date of an existing medical cover.

You will be able to retain your policy benefits and accrued bonuses and transfer the time-bound exclusions, including credit for the waiting period for pre-existing diseases. It is possible to port a policy from one insurance company to another and from one health insurance policy to another policy with the same insurance company.

How to Port a Medical Insurance Policy?

Here is a step-by-step guide to port your health insurance scheme and get covered under Care Health Insurance plans:

Step 1

Duly fill the portability form with the existing insurance details, including the name of the insured person, their age, etc.

Step 2

Fill up the proposal form with relevant details and submit the required documents along with it.

Step 3

The requisite data will be furnished on the official portal of IRDAI.

Step 4

The new insurance company will underwrite the proposal and inform the policyholder within 15 days.

FAQs on Health Insurance

Q. How much health policy insurance coverage do I need?

The amount of insurance coverage you will need depends on your medical needs, age and health risks, the city you live in, and various other factors. Also, you must consider the treatment costs for your specific health condition before deciding how much sum insured is enough for you and your loved ones.

Q. How much does health insurance cost?

At Care Health Insurance, a 5-lakh medical cover starts with a premium as low as Rs. 358/month, subject to specific policy terms and conditions. Factors like the sum insured, type of coverage, policy term, count and age of insured members, and their pre-existing medical conditions, impact the chosen health plan’s premium cost.

Q. Can I buy health insurance and use it immediately?

Yes, you can get immediate coverage under medical policies for any accidents or injuries. However, you can only avail of the policy's coverage for any illness-related hospitalisation after a standard waiting period of 30 days from the day your policy becomes effective.

Q. What is the right age to invest in Health Insurance? Which is the best health insurance for myself and my family?

The earlier you get a health cover, the lesser the premium you get to bear. The premium costs of health plans increase with age. Besides, the chances of having a pre-existing health condition also increase as we grow older– resulting in an increased premium. Thus, going for a health cover early in life is a wise decision.

Q. What do you mean by network and non-network hospitals?

Network hospitals are empanelled with a health insurer and provide you with cashless medical treatment. Here, you can present your health card to avail of a cashless hospitalisation facility and the insurer will directly settle the claim with the hospital. Whereas, non-network hospitals are not empanelled with the insurer and thus require reimbursement claim filing.

Q. What is Waiting Period under Health Insurance?

A waiting period is a pre-defined number of days you must wait before raising a claim under a standard health insurance plan. There are three types of waiting periods, namely– an initial waiting period of 30 days, a waiting period for pre-existing diseases, and a waiting period for specified ailments/ treatments.

Q. What happens if I don't pay my mediclaim insurance premium?

Your health plan will expire if you do not pay the premium by the policy period end date. However, even if you miss the premium due date, you will be allowed a grace period of 30 days immediately following the policy period end date to pay the renewal premium. The policy will not provide coverage during the period of unpaid premium.

Q. How does no claim bonus work in a healthcare insurance policy?

A no-Claim Bonus (NCB) that is given to the policyholder for not raising any claim during a policy year. It is a bonus amount that becomes available as an increased sum insured for every claim-free year. The NCB amount will not exceed 50% of the sum insured under any medical policy insurance. The accrued bonus is reduced by 10% in the next policy year, if the insurer claims in a policy year.

Q. What are the pre-existing diseases in health insurance? Will my health policy cover the same?

Pre-existing diseases are illnesses, injuries, or related conditions for which a medical practitioner diagnosed a person within 48 months before the effective date of policy issuance by the insurer or its reinstatement. Yes, Care Health Insurance policies cover pre-existing medical conditions but come with a waiting period as per the chosen policy.

Q. How can I get tax benefits from medical covers?

With our medical insurance, you get a chance to increase your savings as you become eligible to get income tax benefits under Section 80D of the Income Tax Act. That is, you will be allowed to claim a tax deduction on your policy premium for which you have made a payment to us.

Q. What does the sum insured mean under a mediclaim policy?

The sum insured refers to the maximum coverage amount or pay-out that an insurer will be liable to pay an insured in case of an unforeseen medical emergency or planned medical treatment. The claim amount that exceeds the sum insured will have to be borne by the insured person.

Q. Can I have multiple health insurance plans in India?

Yes, you can buy yourself multiple health policies. If you have opted for more than one indemnity-based plan with other insurers or us, then you can opt for any of these plans to settle your claims, provided that the claim amount payable is up to the sum insured of the chosen policy. If the claim amount under a single policy exceeds the sum insured, you have the right to select the insurer to settle the claim.

Q. Can I add my ageing parents to my medical insurance policy?

Yes, you can include ageing parents in your health insurance plan easily by informing us during renewal. However, for elderly parents above 60 years, we recommend medical insurance for senior citizens that will better meet their age-related healthcare needs.

Q. How does smoking affect the insurance premium for medical cover?

Insurers consider the habit of smoking as a factor when assessing your health risks and calculating insurance premium rates. Generally, smokers need to bear a higher premium for any health cover, given that smoking makes people more vulnerable to chronic diseases and other health hazards.

Q. Is there a grace period for renewal under health insurance?

Yes, an insured person is allowed a grace period of 30 days immediately following the policy period end date to pay the renewal premium for a Care insurance policy. You can the premium within the grace period to renew the benefits of your medical health insurane policy.

Q. I'm covered under a corporate group policy. Do I still need a separate health cover?

Yes, it is wiser always to have separate healthcare insurance besides the employer health plan because the corporate plan does not offer extensive coverage, no tax benefits, and customisable features. Thus, it is better to protect your finances and health with a separate cover that meets all your healthcare needs effectively.

Q. Can I take a health insurance policy for my 5 years old kid?

Yes, you can include your children aged 5 years or above under an individual health plan. For children under 5 years of age, you can include them in a family floater plan with other family members who are 18 years and above.

Q. Do health insurance policies cover robotic surgery & modern treatments?

Yes, our Yes, our specialised health insurance plans cover various expenses under advanced medical treatments, including robotic surgery and modern-day care treatments. We offer cover for more than 541 daycare procedures.

Q. Are medical tests mandatory while buying health and medical insurance?

Pre-policy medical tests are usually required for older individuals, those with a pre-existing condition, or opted for a higher sum insured. However, it is best to go for a medical check-up when opting for a health insurance plan to ensure hassle-free claim settlement.

Q. How can I increase the sum insured for my health insurance?

You can increase the sum insured of your health plan at the time of policy renewal. The same can be done after specific medical tests and a revision of the claim history. But the sum insured cannot be increased further if the existing sum has already met the sum insured limit of your policy.

Q. What are the details required for making a health insurance claim?

For a cashless claim, you need to submit the pre-authorization form at the hospital's TPA desk. Also, you need to present your health card and identity proof at the network hospital. Under a reimbursement claim, submit the claim form and documents, such as identity proofs and hospital bills. The details required include name, contact information, policy number, past medical history, proposed line of treatment, duration of treatment, etc.

Q. Can my claim get rejected? If yes, under what conditions?

Yes, your health insurance claim may get rejected for several reasons, like incorrect facts, non-disclosure of pre-existing conditions, claims under exclusions, etc.

Q. Will maternity expenses be covered under Care Health Insurance plans?

Yes. Under our Maternity Health Insurance plan, the expenses of an expecting mother and the newborn baby (up to 90 days) are covered. Expenses for daycare treatment, in-patient costs, expenses on pre and post-hospitalisation, room charges, etc. are covered.

Q. Will Care Health Insurance cover alternate treatments?

Yes. Alternative treatment like AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) is included in most of the Care Insurance plans.

Q. Can I get any discounts on the health insurance premium?

Yes. There are various ways in which you can enjoy a relatively cheaper health insurance premium. It depends on factors like who you are insuring, your location, credit score, past claim history, no claim bonus, any on-going discount/offer, higher deductibles, policy term etc.

*Please read the policy T & C, brochure, and prospectus to know more about our medical plans cover as it may vary.

# Feature available with Care Shield add-on

**Number of Claims Settled as of 31st May 2023

^10% discount is applicable for a 3-year policy

~~Premium calculated for an individual (Age 18) for sum insured 5 Lakhs in Zone 2 cities with Care Supreme Policy.

^^ Number of Cashless Healthcare Providers as of 30th June 2023

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