Care Advantage Plan: Get Higher Coverage Up To Rs. 6 Cr

Why Choose Care Advantage Plan

You and your family have adequately covered with Care Advantage's comprehensive medical insurance policy up to Rs. 1 crore. If you are hospitalized for more than 24 consecutive hours, the policy covers your hospitalization expenses. This policy can be purchased individually or as a floater by people over the age of 18 or their family members. Depending on your budget and other needs, you can purchase a policy for 1 year, 2 years, or 3 years. Fortunately, this policy has no maximum entry age restriction. The policy covers a variety of expenses, including inpatient hospitalization expenses, pre-hospitalization, and post-hospitalization expenses, organ donation expenses, and daycare expenses. The policy offers other benefits such as automatic restoration of the sum insured, a No Claim Bonus of up to 50% for every year without a claim, a free look period, and a grace period.

Benefits of Care Advantage Plan

1. Care in an inpatient facility - Hospitalization of at least 24 hours If you are admitted to a hospital for inpatient treatment due to an illness or injury, which should be medically necessary, for a minimum of 24 consecutive hours, we will pay for the medical expenses incurred by you at the hospital through Cashless or Reimbursement Facility up to the maximum amount insured. Hospitalization includes room charges, nursing costs, intensive care unit charges, surgeon's fees, doctor's fees, anesthesia, blood, oxygen, operating room charges, etc.
2. Providing daycare services - Hospitalization lasts less than 24 hours, Some surgeries do not require or need not necessarily require a 24-hour stay in the hospital. There may be a reason for this, or the surgery may have been minor or of intermediate complexity. Whenever possible, will pay for such daycare treatments through Cashless or Reimbursement Facilities, up to the sum insured.
3. Methods of advanced technology - If you take part in the following advance payment, you will be indemnified for all expenses incurred under in-patient care and/or daycare treatment technologies.

Embolism of the UTERINE artery
Sinuplasty of balloons
Intense brain stimulation
Chemotherapy by mouth
Treatments involving immunotherapy

4. Medical expenses prior to hospitalization - The procedures that lead to you being admitted to the hospital, such as investigative tests, consultation fees, and medication, can be quite expensive. It covers the medically necessary expenses (Up to the Sum Insured) incurred by You during the period of 60 days prior to Your admissible hospitalization, providing that it shall not be liable to pay for any Pre-hospitalization Medical Expenses that have not been incurred during the Policy Year.
5. Medical expenses after hospitalization - As soon as you are discharged, the expenses don't end. Follow-up visits to your doctor may be necessary. A physician, medication, and sometimes even further tests are needed to confirm the diagnosis. It also covers the medically necessary expenses (up to the sum insured) incurred by You for a period of 180 days immediately after your discharge from the hospital. The claim documents must be submitted within 30 days after the 180-day period has been completed.
6. Treatments offered by Ayush - The recovery process can be accelerated & aided by a combination of conventional medical treatment and AYUSH therapies. Therefore, it will pay You up to the Sum Insured for medical expenses incurred by You towards Your in-patient admission at any AYUSH Hospital or healthcare facility. To the extent covered under this benefit, treatments related to Ayurveda, Unani, Siddha, and Homeopathy will be superseded.
7. Coverage for organ donors - As much as it cares for you, we care about those who help you. As a result, it will not only cover your medical needs but also reimburse you for any medical expenses incurred by you in relation to your organ donor, as long as the donation conforms to the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and regulations. For the donor, 'Pre Hospitalisation Medical Expenses' and 'Post Hospitalisation Medical Expenses' are not payable.

Inclusions of Care Advantage Plan

1. Cover for ambulances - Getting you the medical attention you need as soon as possible is one of our utmost concerns. To that end, it will reimburse you for ambulance expenses incurred by you, up to a specified amount/limit per Policy Year An emergency service provider. As part of this cover, it will also pay for the necessary transportation from one hospital to another Provided medically necessary, a hospital can provide advanced/better equipped medical support and aid for your health condition.
2. Bonuses cumulative - Every year that you enjoy uninterrupted good health, your bonus increases! Just a way of letting you know we're with you. There are good times and bad times. If the policy is renewed without a break, the sum insured (excluding cumulative bonus) will increase by 50%.
3. Recharge without limit - There is always room for A refill! When you need the sum insured most, it is reinstated.

It reinstates the entire sum insured if you ever exhaust/run out of your health coverage because of claims made The base sum is insured immediately, for an unlimited number of times during the policy year.
Recharges that are not utilized cannot be carried forward to a subsequent policy year.
The recharge amount can be used for the same illness as well as for different illnesses.
Only claims admissible under Benefit: Hospitalisation Expenses will be eligible for the Recharge
Under Unlimited Automatic Recharge, the Sum insured is available only for Benefits under 'Hospitalisation Expenses' and 'Benefits'
The policy includes 'Road Ambulance Cover'.

4. Coverage that is instant - The inclusion of this will waive off the applicable PED waiting period on Diabetes/ Hypertension/ Hyperlipidemia/ Asthma at the time of issuance of the first policy with it, regardless of anything to the contrary in the Policy.
5. Inclusion of wellness - Insured Persons who are covered as adults (over 18 years of age) in the Policy can avail of the following, provided this benefit opts for a Discount on renewal Premium. Through tracking apps, devices, etc., 10,000 steps can be recorded in one Healthy Day.

Exclusion of Care Advantage Plan

1. Diseases that preexist - The treatment of pre-existing diseases (PEDs) and their direct complications shall be excluded from coverage for 48 months after the inception of the first policy. If the sum insured is enhanced, the exclusion will apply afresh. It would reduce the waiting period for the same to the extent of prior coverage if the insured person is continuously covered without any breaks as defined under the portability norms of the current IRDAI (Health Insurance) Regulations. Pre-existing diseases are covered under the policy only if they are declared at the time of application and accepted by the insurer.
2. Waiting period for named ailments -

If the first policy is issued after the date of inception of the first policy with the Company, expenses related to the listed Conditions, surgeries/treatments will be excluded until the expiration of 24 months of continuous coverage. Accident-related claims are not excluded from this exclusion.
If the sum insured is enhanced, the exclusion will apply afresh.
The longer of the two waiting periods shall apply if any of the specified diseases/procedures fall under the pre-existing disease waiting period.
Contracts contracted after the policy or declarations and acceptances without a specific exclusion are subject to the waiting period for listed conditions.
As defined under the applicable norms on portability stipulated by IRDAI, if the insured person has continuously been covered without a break, then the waiting period will be reduced accordingly.

3. Waiting period of 30 days - Within 30 days of the policy commencement date, medical expenses related to any illness shall be excluded, except for claims resulting from an accident. Insured Persons with continuous coverage for more than twelve months are not subject to this exclusion. If a higher sum insured is granted subsequently, the referred waiting period applies to the enhanced sum insured.
4. Evaluation & Investigation - Expenses associated with admissions primarily for diagnostics and evaluation are excluded. Diagnostic expenses that are not related or incidental to the current diagnosis and treatment are excluded.
5. Rehabilitation, rest, and respite care - The costs associated with any admission are primarily for bed rest and not for treatment. Additionally, this includes:
a. Personal care such as bathing, dressing, and moving assistance at home or in a nursing facility Nursing assistants and non-skilled individuals can assist nurses.
b. The provision of physical, social, emotional, and spiritual support to people who are terminally ill.

6. Weight loss/obesity - Costs associated with obesity surgery that does not meet all the conditions below:
a. On the doctor's advice, surgery will be performed.
b. Clinical protocols should support the surgery/procedure.
c. Members must be 18 years or older
d. A measure of body mass index (BMI)
i. Equal to or greater than 40
ii. After the failure of less invasive methods of weight loss, have a body mass index greater than 35, as well as any of the following severe comorbidities:

Cardiomyopathy caused by obesity
Atherosclerosis
Sleep apnea of severe severity
Diabetes type 2 uncontrolled

7. Surgery for cosmetic or plastic reasons - Treatments to change appearance except for reconstructive surgery following an accident, burn(s), or cancer or as part of the medically necessary treatment to remove a direct and immediate health risk. In order for this to be considered a medical necessity, the attending physician must certify it as such.
8. Sports that are hazardous or adventurous - As a professional, you may be required to pay for any treatment you require as a result of participating in hazardous or adventure sports, such as para jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, or scuba diving, hand gliding, skydiving, and deep sea diving, among others.

FAQ

How old must you be to enroll in a Care Advantage plan?

Care Advantage policies have a minimum entry age of 5 years for adults and 91 days for children (floater policies). For adults, there is no maximum entry age. The maximum entry age for children is 24 years old.

How long are the waiting periods under Care Advantage?

There is a 30-day waiting period for Care Advantage policies. The waiting periods for specific ailments and pre-existing diseases are 24 and 48 months, respectively.

Does Care Advantage have a co-payment clause?

Yes, of course. When the insured or the eldest member is 61 years or older, there is a 20% co-payment per claim.

Under Care Advantage, what are the floater combinations?

The Care Advantage policy covers floater combinations such as one adult plus one child, one adult plus two children, one adult plus three children, one adult plus four children, two adults plus one child, two adults + two children, two adults + three children, and two adults plus four children.

Care Advantage policy terms: what are they?

There are three types of Care Advantage policies: one-year, two-year, and three-year.

Download Brochure