Operation Insurance

Operation insurance is a medical cover for critical surgeries and medical procedures requiring long and expensive treatment. Health insurance for surgery lowers the financial burden that comes with major operations.

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Reasons to Choose Care Health Insurance?

20,800+ CASHLESS HEALTHCAREPROVIDERS^^
95.2% INSURANCE CLAIMSETTLEMENT RATIO*
30 LACS+ CLAIMS SETTLEDSUCCESSFULLY*

Benefits of Operation Insurance

KEY FEATURES	₹10, 25, 50, 100 & 200 L
In-Patient Care Hospitalization for at least 24 hours We pay for – room charges, nursing expenses and intensive care unit charges, surgeon's fee, doctor's fee, anesthesia, blood, oxygen, operation theater charges, etc.; If you are admitted to a hospital for in-patient care, for a minimum period of 24 consecutive hours. Hospitalization less than 24 Hours We cover medical expenses if you undergo a day care treatment which might not require you to stay hospitalized for 24 hours or more. As a matter of fact we cover over 540+ day care procedures.	Upto SI
Day Care Treatment We cover medical expenses if you undergo a day care treatment which might not require you to stay hospitalized for 24 hours or more. As a matter of fact we cover over 540+ day care procedures.	Listed as per the Plan, Up to Sum Insured
Pre-Hospitalization We cover the relevant medical expenses such as investigative tests, routine medication, etc. incurred by you up to 30 days before your hospitalization.	30 days
Post-Hospitalization We cover the relevant medical expenses such as doctor consultation, Diagnostic tests, medications etc. incurred up to 60 days post your hospitalization.	60 days Maximum up to SI
Ambulance Cover In an emergency, we reimburse expenses incurred by you for availing a domestic road ambulance during your hospitalization.	Up to Rs 3000 per hospitalization
Organ Donor Cover We reimburse you the medical expenses that are incurred by an organ donor while undergoing the organ transplant surgery.	Up to SI or 15 L whichever is lower
Second Opinion If you feel uncertain about your diagnosis, you can opt for a second opinion, arranged by us.	Once per Covered Condition per policy year
Annual Health Check-up We give an Annual Health Check-Up for all insured members covered in the policy.	Annual from 2nd Policy Year on Continuous Coverage
No Claims Bonus(NCB)* We raise a cheer to good health for every year that you don't claim by increasing your Sum Insured by 10%, up to a maximum of 50% in 5 consecutive years.	50%/25%/25%-Corresponding increase in SI for 1st, 2nd and 3rd continuous claim-free Policy Years respectively, Max up to 100% of SI(50%/25/25%-Corresponding decrease in SI per Policy Year in case a claim has been paid; Such decrease is only in SI accrued as NCB)
International Second Opinion Covers expenses for consultation from international medical experts excluding India	Once per Covered Condition per policy year
Health Services
Quick Recovery Counseling Psychologist Counseling expenses covered	Up to Rs 1000 Per Session, Maximum 8 Sessions Post Hospitalization in a Policy year( can be availed twice in a month)
Health Portal	Value added services through Company’s Website
Global Coverage Coverage outside India - 45 continuous days in a single trip; Max. 90 days on a cumulative basis, in a Policy Year.	Up to SI; only for SI >=1Cr (Limited to In-Patient Care and Day-Care treatment with a Co-payment of 10% per Claim

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Care Operation Mediclaim Details

The Insured Person may access health related information and services such as health risk assessment, Doctor on chat, Special rates for OPD, Diagnostics and Pharmacy through Network Providers , etc as available on the Company's website.

SALIENT FEATURES

Search the best deal in your location
Discount on all Healthcare and wellness services like Doctor Consultations, Diagnostics, Pharmacy, Dental Consultation and treatment
Comprehensive details on Doctors like qualification & appointment details.
Access to Right Healthcare Service, at right time and place.
Symptom tracker
Ailment to specialty tracker
Automated discount coupon download
24x7 on call support

Entry Age Minimum is 5 years Individual Basis
Entry Age Maximum is 50 years on Individual Basis
Cover Type Individual: Maximum up to 6 Persons
Initial Waiting Period 90 days from any illness
Pre-existing Disease Waiting Period: 48 months of continued coverage

Download Terms & Conditions

Any item or condition or treatment specified in List of Non-Medical Items
Any treatment arising from or traceable to pregnancy (including voluntary termination), miscarriage (unless due to an Accident), childbirth, maternity (including caesarian section), abortion or complications of any of these.
Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline for which he is licensed or any kind of self-medication.
Unproven/Experimental or investigational treatments. Any Illness or treatment which is a result or a consequence of undergoing such experimental or unproven treatment.
Charges incurred in connection with routine eye examinations and ear examinations, dentures, artificial teeth and all other similar external appliances and / or devices whether for diagnosis or treatment.
Treatment of mental illness or psychological disorders or Parkinson's or Alzheimer's disease even if caused or aggravated by or related to an Accident or Illness.
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline for which he is licensed or any kind of self-medication.
Act of self-destruction or self-inflicted Injury, attempted suicide or suicide while sane or insane or illness or injury attributable to consumption, use, misuse or abuse of intoxicating drugs, alcohol,tobacco(smoking/non-smoking)or hallucinogens.
All preventive care (except eligible and entitled for Benefit 9: Annual Health Check-up), Vaccination, including Inoculation and Immunizations (except in case of post-bite treatment), vitamins and tonics.
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent
Investigation and evaluation
- Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
- Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

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 from 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 response 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 response to the query raised by the claim management team

Rejected

We will communicate the reason in case of rejection

Voice of Our Customers

Arvind Tiwari

Highly impressed with the Care Health Insurance team in making me carefully understand Operation insurance plan. The claim settlement was not stressful as I thought, and I also received lifelong renewability.

Meenakshi Khandelwal

I purchased this plan about a year ago when I had to undergo surgery. Since then, I felt it was one of the best decisions I made in life. It provided cover for my surgery and pre and post-hospitalization expenses.

Saurabh Singh

I am happy with this plan. It gave me coverage for my surgery and ICU expenses, all at an affordable price, making it an excellent deal for me.

Prateek Kumar

I was diagnosed with a serious ailment and had lost confidence in my doctor. But thanks to my Care Health Insurance Operation Insurance plan that I received a second opinion from a top doctor who diagnosed me correctly.

Akshita Gupta

This plan was an excellent investment for me as it offers organ donor cover, day-care treatment at the hospital, and an annual health check-up. I already recommended it to my friends and colleagues!

My appreciation for your prompt service

At the outset, I would like to express my appreciation for your prompt service in taking up the case regarding my claim. I have received timely intimation regarding the acceptance of my claim amount settled by you.

Ankita Sharma

Health Insurance

We will continue to avail of your scheme

Thank you for settling the claim amount. It helped me a lot during my tough time. The process is smooth and hassle-free. I will continue with Care Health Insurance and recommend it to my friends as well.

Indubala Nambiar

Health Insurance

Everything went very smooth

I would like to pass on my appreciation for Virender, who guided me during the difficult time. He helped me at every stage and didn't keep me waiting. Due to his efforts, I was relaxed and everything went very smooth.

Vikas Singh

Health Insurance

Really helpful explaining the process in advance

I just wanted to thank you for the exceptional response from you on the recent cashless hospitalization request related to my mother's operation. You were really helpful throughout.

Sahil Khattar

Health Insurance

Finalising my claim in a short period

I must express my profound appreciation for finalising my claim in a short period. I have heard of insurance companies holding payment or rejecting it outright on very flimsy grounds was not the case with Care health insurance, May your tribe grow more

Aditya Sharma

Health Insurance

Zeroing in on a health insurance plan for your family is a tricky choice, given the number of insurers in the market who offer similar policies. It is not wise to simply choose the policy with the lowest amount of premium. You need to compare different policies, their features and benefits. Care Health Insurance (CHI) is a specialist Health Insurer and offers products keeping in mind the needs of a customer in the event of a medical exigency. CHI offers a distinct set of benefits giving a clear choice for providing you with the best possible health insurance.

Awarded as Claims
Leader of the year

23 lakh + Claims settled*

Cashless claim processing
in approx. 2 hours

FAQs About Care Operation Mediclaim

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Most Frequently Asked Questions

Q. Why should one buy an Operation Cover?

Surgery may become inevitable for a person suffering from an illness or having a specific medical condition. Surgeries are performed effectively and quickly owing to the technological advancements in healthcare, thus benefiting the patients. A surgical operation demands great care, and therefore it becomes crucial to avail quality treatment at the best hospital. However, the cost of healthcare in India is quite expensive, particularly in private hospitals. Solely relying on one’s savings for bearing medical expenses is not a good idea. Hence, choosing the best medical insurance for surgery is necessary. This policy will protect you against a host of medical costs besides hospital bills. It would offer cover for expenses such as:

In-patient Hospitalisation including room rent, operation theatre, and ICU charges
Day-care treatment including day-care surgeries
Pre-hospitalization Medical Expenses incurred for 30 days before admission
Post-hospitalization Medical Expenses incurred for a period up to 60 days after discharge

Q. Is it Necessary to Get a Medical Check-up Before Buying an Operation Insurance Policy?

The operation insurance plan covers the expenses for defined surgeries. The policy will be issued based on tele underwriting. In a few cases, the insured may be asked to undergo a medical check-up.

Q. Does Operation Insurance Policy Offer Tax Benefits?

By opting for a medical insurance policy, such as surgical health insurance, you can avail of tax benefits that will help you in achieving financial savings. The policyholder is eligible to claim an income tax deduction on the premium paid, as per Section 80D of the Income Tax Act, 1961, as applicable. The tax benefits are subject to changes in the tax laws in India.

Q. How should one decide on insurance for Operation Insurance coverage?

If you are planning to buy an operation insurance cover, do remember to consider your age, health risks, and current medical condition and estimated costs of surgery. It is an ideal way to know how much sum insured you must select. Additionally, you should keep in mind the waiting period clause and exclusions so that you can prepare yourself for the scenarios where you cannot get coverage under your policy. Make sure the policy also has features such as annual health check-up and lifelong renewability.

Q. What is the benefit of an Operation Insurance policy?

An operation insurance policy reduces the burden of expensive medical procedures by offering a financial safety cushion. This policy is highly beneficial as it provides:

Cashless claim facility for treatment at a network hospital
Income Tax benefit under Section 80D of the I-T Act
The flexibility of equated monthly or quarterly installments
Additional benefits such as no claim bonus and annual health check-up

*Claim Settlement Ratio is for FY 19-20 and number of claims settled till February 2022.
^^Number of Cashless Healthcare Providers till 25th March 2022
**10% discount is applicable for a 3-year policy