Health Insurance

Why Choose Care Health Insurance?

Given below are some of the reasons why a health insurance policy from Care Health Insurance may be the best option for you:

Features of Health Insurance Plans

Addressed below are the features of the best health insurance plans from Care Health Insurance:

Comparing Our Health Insurance Plan with Other Insurers

There is no universal health insurance policy that suits everyone. Different plans have varying benefits, coverage, and premiums. Hence, it is important to compare plans to choose the one that meets your needs. Take a look at how our plan compares to other options in the market:

Benefits of Health Insurance

According to a report by Business Standard, wholesale prices in India rose to 0.53% in March 2024. This inflation has also been significant in the medical sector! The constant year-on-year increase in medicine prices, diagnostic tests, and hospital charges across India have made having an affordable mediclaim policy the need of the hour! Mentioned below are a few benefits of having health insurance:

• Financial Safety: Health insurance ensures that you are protected against the financial strain that may arise due to the hefty medical bills.
• Coverage for Critical Illnesses: An expansive health insurance can ensure that you get access to quality healthcare even if you are inflicted by a critical illness.
• Protection above Corporate Health Insurance: The comprehensive coverage and new-age benefits of an ideal health insurance plan ensure that you do not suffer upon the exhaustion of your corporate plan.
• Cashless Claim Benefit: During a medical emergency, a health insurance plan with an expansive healthcare network can ensure that your focus remains on recovery, not paperwork.
• Tax Benefits under Section 80D:Health insurance is not just a safety net for your health and finances but also an asset that can help you avail of tax benefits of up to ₹75,000 under Section 80D of the Income Tax Act, 1961.
• Wellness & Preventive Care: Health insurance plans nowadays come with new-age benefits such as annual health check-ups, fitness benefits, and others that may prevent chronic ailments.

Common Health Insurance Terms You Should Know

Understanding the terms and conditions of your health insurance is crucial for policyholders to avoid last-minute hassles. Read out these commonly used health insurance terms to make reading the policy documents easier:

• Co-payment: Some insurance policies have an inbuilt copayment clause. Copayment, or ‘Copay’, is a specific amount or percentage an insured individual must pay from his/her pocket every time a claim is raised. Simply put, it is a cost-sharing concept between the policyholder and the insurance company.
• Deductible: A deductible is the amount you pay from your pocket when a claim is raised. Here is an example of how deductibles in health insurance work: If your health insurance claim amount is Rs. 2,00,000 and your policy’s deductible amount is ₹50,000, then you pay ₹50,000. At the same time, the health insurance company pays the balance of ₹1,50,000.
• So, it is essential to check your medical insurance policy documents for a deductible clause and choose one without a deductible unless you are okay with bearing a part of the treatment cost.
• Sum insured: When you buy a health insurance policy, you must choose a coverage amount up to which your health insurance company will cover the medical expenses. The higher the sum insured, the higher the premium.
• Top-up plans: These are the best health insurance plans that help you get more coverage if your basic sum insured is exhausted during a medical emergency. Top-up or super top-up policies can be purchased along with a base policy.
• Pre-existing Diseases: If someone suffers from an illness before purchasing a health plan, it is called a pre-existing disease. Some common examples are diabetes, asthma, hypertension, or high BMI. People with a pre-existing illness can also be eligible for best health insurance policy in india. However, they generally have to pay a slightly higher premium or serve a pre-decided waiting period to be able to file a claim against the condition.
• Claim Intimation: Claim intimation in health insurance refers to informing insurance providers about the upcoming claim. This usually involves notifying the insurance provider about hospitalisation medical treatment before submitting detailed claim information. It enables insurers to be aware beforehand to streamline the subsequent claims processing. It is important to know that in some cases if the insured person does not submit an insurance claim intimation, the claim might be rejected.
• Cashless Hospitalisation Claim: A cashless hospitalisation claim is a facility offered by medical insurance providers to help policyholders access medical services without worrying about the availability of upfront finances. To use this facility best, one has to receive treatment at network hospitals affiliated with the insurance provider.
• Reimbursement Claim: The term reimbursement claim refers to the repayment of the claim. In this type of claim settlement, you pay the medical/hospitalisation bills for the medical treatment you avail of. Once you submit the bills to your health insurance provider, you can file a claim and get the covered amount from the insurer.
• No Claim Bonus: No claim bonus is an additional benefit offered under a health insurance plan to get a complimentary bonus for every claim-free year. It helps boost the coverage of your health insurance plan.
• Sublimits: A sub-limit is a predetermined capping applied by the insurer on certain medical expenses under your private health insurance. It works as a limit on how much claim amount the insurer will pay for a given healthcare expense. Sub-limits are usually calculated in percentage and apply to both cashless and reimbursement claims.
• Room Type: Room type refers to the kind of hospital room a policy covers. Common categories include general ward, semi-private room, and private room. The type of room you choose can directly impact the overall cost of your hospitalisation bill.
• Room Rent Proportionate Charge: Room Rent Proportionate Charge limits the amount an insurer will pay for room rent per day during hospitalisation. If you exceed the room rent limit, you must pay the difference out of your pocket.
• Smart Select Hospitals: Smart select at Care Health Insurance is an add-on benefit facility that allows an insured to pay 15% lesser premium and get coverage up to sum insured at Care’s Smart Select Network Hospitals. Please note that getting treatment out of the smart select network may borne a 20% copayment or as specified in the policy documents.
• Use of Preventive Care: Taking timely precautions is the need of the hour.Under preventive care, best mediclaim policy in india that 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 affordable medical insurance plans.
• Alternate Treatments in Health Insurance: Alternative medicines are better known as AYUSH treatments, which stand for Ayurveda, Yoga, Unani, Siddha, and Homeopathy. These treatments are deemed safe and effective not just in India but worldwide.

What is Covered under Care Health Insurance Plans?

Care Health Insurance offers the best health insurance plans for medical expenses, which provide comprehensive financial protection in times of urgency 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 health insurance policies are:

The best medical insurance plans also offer maternity benefits as an optional cover for delivery-related expenses. Various add-ons are available at an additional premium, including OPD Care, which covers expenses such as OPD consultations, diagnostics, and medicines.

Disclaimer: For more details on product coverage, please check our product pages and policy documents.

What is Not Covered under Health Insurance Policies?

At Care Health Insurance, we want all our customers to be well-informed before purchasing a health insurance policy. Therefore, we urge you to review the policy documents within the free lookup period to avoid last-minute rejections of claims. Mentioned below are the common exclusions of a health insurance plan that you opt from Care Health Insurance:

• Self-inflicted injuries resulting from suicide or attempted suicide.
• Diseases, surgeries, or medical events(except accidents), 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.
• Cosmetic or aesthetic treatments that do not fall under the 'medically necessary' category.
• War, riot, strike, nuclear weapons induced hospitalization.

Which Add-ons are Included in a Care Health Insurance Policy?

Health Insurance plans from Care Health Insurance come with different add-on benefits that help you customise premiums and/or expand your coverage. Listed below are a few add-ons that our customers love the most.

• Air-ambulance cover: Financial cover for transportation by air ambulance if deemed medically necessary.
• Care Sheild: This benefit can be divided into three features:
  • Claim Shield: Covers expenses for specific non-payable items.
  • No Claim Bonus Sheild:The no-claim bonus remains unaffected even with small claims.
  • Inflation Sheild:Your sum insured increases annually based on inflation.
• Co-payment waiver for senior citizens:Removes the co-payment requirement for an extra premium.
• Annual health check-up:Provides free yearly check-ups for every insured member at network labs.
• Smart Select:Get a 15% premium discount by using network healthcare providers, but a 20% co-pay applies for non-network.
• Reduction in the PED Waiting Period: Waive the waiting period for pre-existing conditions.
• No Claim Bonus Super:Get a 50% increase in SI over 5 years if no claims are made in this time period.
• Care OPD:Get reimbursement for a limited number of general physician and specialist consultations annually.

How to File a Claim under Health Insurance Plans

How Do Health Insurance Plans Work?

• Shortlist a health insurance plan:Choose a health insurance plan that meets your needs and budget.
• Make regular premium payments:Pay your premiums on time to keep your policy active.
• Seek medical treatment:Receive medical care from a healthcare provider.
• File a claim:Submit a claim to your insurance company for the medical expenses incurred.
• Claim assessment:The insurance company reviews your claim to determine settlement

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 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

Cover all your family’s medical needs under one plan. These plans have a single affordable premium, annual health check-ups, and customisable benefits for every member. We offer sum insured options of up to ₹ 6 crore

 

Family Floater Insurance Policy

If You are Young and Need Complete Coverage

This inflation-proof plan offers comprehensive financial and healthcare security for young adults. This plan has several benefits such as personal accident coverage, discounts, and no co-payment. These plans are available on individual and family floater basis

 

Youth Health Insurance Plan

If You Have Elderly Parents to Look After

Senior citizen health insurance plans offer complete coverage for elders, including automatic recharge, annual health check-ups, and tax benefits. Further, this policy does not require pre-policy medical check-ups.

Senior Citizen Health Insurance Plan

If You Need Protection Against Critical Illnesses

Our Critical Illness Mediclaim provides financial protection against the medical expenses of 32 critical illnesses, including cancer, stroke, and paralysis. It offers low premiums, easy EMI options, quick recovery counselling, and coverage for cancer at all stages.

 

Critical Illness Insurance

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 specific conditions, like co-payments, waiting periods, etc.
Tabulated below are the eligibility criteria to purchase health insurance plans from Care Health Insurance:

What are the Factors Affecting the Premium of Medical Insurance Policies

Given below are some of the factors that affect the premium of your health insurance policy:

• Age:The higher the age, the higher the premium, and vice versa.
• Pre-existing Conditions:Pre-existing leads to higher premium costs.
• Body Mass Index(BMI): High BMI leads to a higher premium amount.
• Lifestyle Habits:Unhealthy and risky habits like drinking can increase premiums.
• Type of Plan:Family plans typically have lower premiums than individual plans.
• Sum Insured:A higher sum insured has a higher premium.
• Deductibles and Co-Payment: Higher deductible/co-pay leads to lower premiums.
• Add-On Covers:Additional coverage increases the premium.
• Location:Areas with high medical costs have higher premiums.
• Medical History of Family:A family history of diseases can lead to higher premiums.

How to Calculate Premium of Health Insurance Plans?

You can now calculate the premium using a simple digital calculator designed especially for medical insurance 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.

How much Tax Benefit Can I get from Health Insurance?

If you fall into the taxable slab, then your health insurance plan can fetch you tax benefits. Here’s how:

• If you are paying the health insurance premium for yourself, your spouse, your children, or your parents, you can avail of tax benefits under Section 80D and save more.
• As a policyholder, you can also claim up to ₹5,000 when towards preventive health check-ups.
• Take a look at the table to understand the deductions in detail:

Documents required to File a Claim under Health Insurance

Given below are the set of documents that you will have to submit while making a claim:

Some Myths about Health Insurance Busted

Health insurance is vital to financial planning, yet various misconceptions surround it. Let us examine the most common health insurance myths and help you understand what is a myth and what is not.

• Health Insurance is only meant for seniors: Health insurance is crucial for people of all ages, owing to the increase in health risks in younger individuals. Further, early purchases also lead to lower premiums.
• Coverage Begins Immediately Upon Purchase: Usually, a waiting period of 30 days applies before you can make a claim. Specific conditions may also have additional waiting periods.
• The Cheapest Plan is the Best Choice: The cheapest plan may not offer comprehensive coverage. To be properly covered, choose adequate benefits over price.
• Pre-Existing Diseases Disqualify You From Health Insurance: Pre-existing diseases often result in higher waiting periods or premiums, but you can still get coverage. Specific add-ons are also available to reduce waiting periods.
• Group Health Plan is Enough: Group plans usually have limited coverage and can be ineffective in case of job switch. Consider purchasing an individual plan to supplement existing group coverage.
• All Hospital Bills are Covered: Even the most comprehensive health insurance plans have specific exclusions. Read your policy documents to understand policy limitations.

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 medical insurance 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.

Things to Keep in Mind When Porting Health Insurance

Inform your previous insurer

Before switching to a new health insurer, it is vital to inform the current insurer. You should write an application for this purpose. You can make this request to your insurer at least 45 days before your policy’s expiry date. Also, keep in mind that you should avoid making this request before 60 days of the renewal. Let’s understand how to make the portability permission request. You should write an application in which you have to mention the name of your new insurer and other personal and details. Once you apply, your application will be reviewed and you will receive an acknowledgement within 3 business days.

Keep an eye on the premium

When you decide to port your health insurance policy to a new insurer, you should enquire about the premium. You should check whether its premium will increase or decline on porting. The change in premium indicates the changes in your coverage or benefits. So, gather this information before you finalise the porting.

Check for the available add-ons

If you are thinking of switching to a new insurer to enhance coverage or benefits, you should check for the available add-ons. You can buy the add-ons of your current insurer to avail of the extended benefits.

Understand the waiting period

You should understand the waiting period cycle before you port to a new insurer. Simply put, the waiting period is divided into three parts.

• The first waiting period starts with buying the policy. This is for only 30 days.
• The second waiting period is from 1 year to 2 years for the diseases of kidney stones and appendicitis.
• The third waiting period is 3-4 years, and it applies to pre-existing diseases. The good news is that when you switch to a new insurer, your waiting period does not start from the beginning. It starts where you left it with the previous insurer.
  Suppose you have completed the waiting period of 2 years for a pre-existing disease that has a total waiting period of 3 years. Then, you need to complete the waiting period of only one year.

Give correct details about your medical health

Hiding your medical history when you make a porting request to the new insurer can be a mistake. Your new insurer may or may not make you undergo a medical test. In case you have been suffering from any chronic illness or severe comorbidities, your porting request may be rejected. Because in such medical cases, the threat of hospitalisation and the frequent visits to check-ups or treatment always persists.

Choose a higher sum insured

Obviously, you have decided to port to a new insurer because you are optimistic about new benefits there. Hence, you should try to choose a higher sum insured when you port.

Check Insurer Details

Before you decide to port your mediclaim policies to a new insurer, it might be a good idea to be aware of a few metrics. You should always check for details like discounts being offered, any consumer complaints, company’s empanelled network healthcare providers and the claim settlement ratio. It might also help to check the ratings on the company’s social media handles to understand the overall customer experience.

Hassle-free Claim Settlement Through Care Health Customer App

Care Health Insurance strives to make quality health care accessible to everyone while maintaining a quick and hassle-free claim experience. The Care Health Customer App is an integrated app for all your health insurance needs. You can use this app for claim intimation, fill out a claim form online, upload the necessary claim documents, and track your claim status. Given below is the step-by-step process to file claim intimation using ‘Claim Genie’

• Step 1:Open the Care Health-Customer App on your phone.
• Step 2:Click on ‘Claim Genie’ on the home screen. Click ‘claim intimation’
• Step 3:Select claim type.
• Step 4:Select the member and enter all the claim related information.
• Step 5:Upload any claim related medical documents.

You can also track the status of the claim, just click on the ‘Claim Tracking’ option on the homepage. The list of active claims will be presented on the screen. Click on “Track Claim” on the relevant claim. The latest claim status will then be displayed on top of the screen. This app can also be used to download the query/settlement letter or approval letter.