Care Insurance Care Heart

Let’s Get To Know The Plan Better

Here’s introducing Care Heart Insurance from Care Health Insurance Company – a tailored health insurance policy crafted especially for individuals with pre-existing cardiac conditions. The mission of this plan is simple: to ease the burden of expensive cardiac surgeries and procedures by offering comprehensive coverage. This plan is a lifeline for those with a medical history of heart ailments or individuals with a medical background of heart conditions. It lets individuals embrace the peace of mind that comes with knowing that they are covered.
 

Who is Eligible To Get The Care Insurance Care Heart Plan?

• Adults must be at least 18 years old to enrol in the policy, while dependent children should also be a minimum of 18 years old.
• The policy is open to adults up to the age of 90 and dependent children up to the age of 24.

Please Note: This policy is specifically designed for individuals who have previously been diagnosed with a cardiac ailment or disorder and have undergone a cardiac surgical intervention or procedure related to the same.
 

Benefits and Limits Explained

In addition to covering expenses related to inpatient hospitalisation, which includes costs incurred during stays exceeding 24 hours such as room boarding, nursing charges, medical practitioner’s fees, prescribed medicines, ICU charges, and other related expenses, here's a glimpse of some other expenses covered under the Care Heart Insurance Plan.

• Pre & Post Hospitalisation Expenses
  Don't stress if your doctor recommends a battery of diagnostic and other tests before or after your hospital stay. This plan has got you covered. The Care Heart Insurance Plan safeguards you by covering pre and post-hospitalisation expenses up to 5% of the sum insured for a generous period—30 days before admission and 60 days post-discharge. It's important to note that these expenses are eligible for coverage only if they are directly linked to the medical condition for which you are hospitalised, and approval is granted as part of the inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatments, referring to medical procedures or surgeries that historically demanded prolonged hospital stays but can now be efficiently completed within 24 hours, are covered by the Care Insurance Care Heart Plan. With a comprehensive coverage of 541 daycare procedures, this plan imposes no restrictions on the expenses related to any daycare treatment, ensuring that they are covered up to the sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments, a pivotal aspect of the Care Insurance Care Heart Plan, extend coverage to medical interventions essential for illnesses or injuries demanding immediate attention. These treatments are uniquely administered at home, either due to the patient's critical condition, making transportation to a hospital unsafe, or owing to the unavailability of hospital beds in the patient's immediate vicinity. Under the Care Heart Insurance Plan, expenses linked to domiciliary treatment, excluding 15 specified illnesses, are covered up to the sum insured. This ensures that extensive support is provided during critical health episodes, even at home.
   
• Modern Treatment Coverage
  In the ever-evolving landscape of healthcare, where technological advancements continue to redefine possibilities, modern treatments once deemed implausible have become a reality. The Care Insurance Care Heart Plan is meticulously crafted to align with these breakthroughs, ensuring coverage for the expenses linked to modern treatments up to the sum insured. As medical science progresses, rest assured that your plan is equipped to support you through it.
   
• No-Claim Bonus
  A No-Claim Bonus serves as a token of appreciation from the insurer for your prudent management of the policy. If you refrain from filing any claims during a policy year, you become eligible for a reward. Under this policy, you'll receive 10% of the sum insured as a No Claim Bonus, with a maximum cap set at 50% of the sum insured. It's essential to note that making a claim within the policy year will result in a reduction of the accumulated bonus at the same rate at which it was earned. However, you can safeguard your accrued bonus by choosing an add-on, ensuring its preservation if your annual aggregate claim payable remains below 25% of the sum insured.
   
• Restoration Benefit
  The Restoration Benefit is a valuable feature designed to replenish your sum insured once it has been fully utilised within a policy year. This benefit comes into play when both the base sum insured and any cumulative bonus have been entirely used. It becomes available for subsequent claims under the in-patient benefit during the same policy year. The Restoration Benefit can be utilised once in every policy year for a lifetime, provided you consistently renew your policy. Note that it is applicable exclusively for unrelated illnesses.
   
• Non-Medical Expenses
  The Care Insurance Care Heart Plan goes beyond covering medical expenses by extending its protection to non-medical costs. Non-medical expenses, in this context, encompass the expenditures associated with essential consumables like gloves, nebulization kits, oxygen masks, and other items crucial for treatment. Often, these consumables come with a substantial price tag, contributing significantly to overall healthcare expenses. This plan ensures coverage for such non-medical expenses up to the sum insured, providing a financial safety net to ease the burden associated with these costs. This additional coverage can be availed by opting for an add-on by paying an additional premium, ensuring a more holistic protection for your healthcare needs.
   
• Room Rent Limit
  The room rent limit signifies the maximum amount covered by your insurance company for the room during your hospitalisation. Staying within this predefined limit ensures that you won't face any additional out-of-pocket expenses. However, choosing a room with a rent exceeding your eligibility will result in a proportionate deduction.
  
  In practical terms, this implies that you'll be responsible for paying a proportionate share of the total bill amount, and not just the difference in room rent. Under the Care Heart Insurance Plan, individuals who opt for a sum insured of 5 Lakhs and above enjoy a room rent limit of up to a single private room. For those who choose a sum insured of 3 Lakhs, the room rent limit is capped at 1% of the sum insured per day. Being mindful of these limits ensures a smoother and more predictable financial experience during your hospital stay.
   

Additional Product Features

Here are some of the important features of the product –

• OPD Care Cover
  Recognizing that health concerns often extend beyond the confines of a hospital room, the Care Insurance Care Heart Plan goes beyond conventional coverage. It embraces outpatient department (OPD) expenses, encompassing consultations, diagnostics, medicines, and more, ensuring comprehensive support for your wellness journey at every step.
  
  This coverage allows you access to a multitude of healthcare professionals, including physicians, specialists such as cardiologists, dieticians, etc. This proves especially beneficial for cardiac patients, providing regular health monitoring and timely preventive measures. Each consultation is eligible for a maximum payout of INR 500. You have the flexibility to utilise this optional benefit twice within a policy year, as per your convenience. However, do note that this coverage is subject to specific terms and conditions.
   
• Home Care Treatment:
  Dealing with heart-related conditions requires an added layer of care, and the financial strain of hiring a qualified nurse at home is considerably eased with Care Heart Insurance. In recognition of this, the plan extends coverage for appointing an authorised nurse, as recommended by a doctor, up to a specified limit, with a maximum of 7 days per hospitalisation. It's important to note that the plan provides this coverage for a maximum of 45 days in a policy year, with additional coverage conditions to be considered. By opting for this add-on, you and your family can rest assured knowing that professional medical support is available at home during crucial times.
   
• Cardiac Health Checkup:
  Taking proactive steps is essential for maintaining a resilient heart, and a cardiac health checkup serves as a guide toward a heart-healthy life. With this coverage, you can undergo health checkups, including a set of medical tests based on the sum insured you choose, annually to monitor your heart's health. All expenses incurred for these tests are covered on a cashless basis, provided you undergo the tests at the insurer's network providers, ensuring a streamlined process. This plan allows you to prioritise your cardiac health with the financial support it provides.
   

Waiting Period

Upon acquiring a health insurance policy, it's important to be aware of the waiting period—a designated duration during which certain illnesses and diseases may not be covered. After the waiting period concludes, you become eligible to make claims for these specific conditions. Various types of waiting periods exist, including:

• Initial Waiting Period: There is an initial waiting period of 30 days for all medical conditions, excluding accidents. This means that for the first 30 days after obtaining the health insurance policy, you cannot make a claim for hospitalisation unless it is related to an accident.
   
• Waiting Period for Pre-existing Diseases: A pre-existing disease is defined as any medical condition or illness experienced in the 48 months preceding the application for the health insurance policy. Under the Care Insurance Care Heart Plan, a waiting period of 24 months is applicable for pre-existing diseases. During this period, the policy will not cover expenses related to any treatment for your pre-existing medical conditions.
   
• Waiting Period for Specific Diseases: Insurers typically have a specified list of medical conditions or illnesses, distinct from pre-existing conditions, subject to a waiting period. This waiting period is decided by the insurer and is not affected by your current health status. The Care Insurance Care Heart Plan, for instance, has a waiting period of 24 months for certain diseases outlined in the policy.
   

Exclusions

Exclusions are instances or situations that fall outside the coverage scope of your health insurance policy. These  include:

• Standard Permanent Exclusions: The IRDAI mandates 'standard permanent exclusions' that have to be followed by all insurance companies. Some of these are –
  • Investigation and Evaluation: Hospital admission solely for observation or monitoring.
  • Rest Cure, Rehabilitation, and Respite Care: Admission for bed rest without any ongoing treatment.
  • Obesity/Weight Control: Treatments or even surgeries that are for weight control or obesity.
  • Change of Gender Treatment: Treatments undertaken for altering the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures to modify the body’s appearance or even the bodily characteristics.
  • Profession in Hazardous or Adventure Sports: Costs of treatment while participating professionally in activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach of Law: Expenses related to treating a person attempting a breach of law with criminal intent.
  • Excluded Providers: Treatment from a practitioner or hospital excluded by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction and so on.
  • Treatments in Establishments for Domestic Purposes: Expenses for treatment carried out in health spas, nursing homes, or similar establishments arranged for domestic reasons.
  • Dietary Supplements, Unprescribed Substances: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Costs for correcting refractive errors up to 7.5 diopters for improved eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven effective.
  • Costs related to Birth Control, Sterility and Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like GIFT, ICSI, IVF, ZIFT and similar procedures.
  • Maternity Expenses: Pre/post-natal costs and any childbirth-related hospitalisation costs, etc.
     
• Additional Permanent Exclusions: Other than the standard permanent exclusions mentioned earlier, insurers may add extra exclusions for certain situations or medical conditions. If you have specific diseases or medical conditions that insurers view too risky to cover, they might permanently exclude them from your policy. It is, however,  essential to note that insurers can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
   
• Non-Standard Exclusions (Specific Exclusions): Non-standard exclusions, also known as specific exclusions, represent restrictions that extend beyond the standard permanent exclusions outlined by the Insurance Regulatory and Development Authority of India (IRDAI). These exclusions can vary among insurance companies and are contingent on the specific terms and conditions of the policy. Here are some notable specific exclusions under the Care Insurance Care Heart Plan:
• • Any kind of condition that is a result of or associated with any sexually transmitted disease except arising out of HIV.
  • Expenses related to instruments used in the treatment of sleep disorders or sleep apnea syndrome, oxygen concentrator for asthmatic conditions, cost of cochlear implants, and related surgery.
  • Screening, counselling, or treatment of any external Congenital Anomaly or Illness, defects, anomalies, or treatment relating to external birth defects.
  • Circumcision except for when it is necessary for the treatment of an illness or necessitated due to an accident.
  • All expenses (or Treatment undergone) related to donor treatment, this also includes surgery in order to remove organs from the donor, in case of transplant surgery.
  • Non-allopathic treatment or treatment related to any unrecognised systems of medicine. This exclusion does not apply for inpatient hospitalisation covered under alternative treatments.
  • Expenses incurred for Artificial life maintenance, including life support machine use, post confirmation of vegetative state or brain death by treating medical practitioner where such treatment will not lead to the recovery or return of the earlier state of health under any circumstances.
  • 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.
  • Damage to the insured person's intellectual faculties because of the abuse of stimulants or depressants unless prescribed by a medical practitioner.
  • Alopecia, wigs, and/or toupee and all hair or hair fall treatment and products.
  • Taking part currently or in the future in naval, military, air force operations or even aviation which is of a professional or semi-professional nature.
     

Summary

Brochure and Policy Wording Links

• Brochure:https://cms.careinsurance.com/cms/public/uploads/download_center/care-heart-(health-insurance-product)---brochure.pdf?rv=0.79027000%201702024930
   
• Policy Wording: https://cms.careinsurance.com/cms/public/uploads/download_center/care-heart-(health-insurance-product)---prospectus-cum-sales-literature.pdf?rv=0.79070300%201702024930
   

Frequently Asked Questions (FAQs) about the Care Heart Plan:

1. Are consumables covered under the Care Heart Plan?
   Yes. The plan covers the costs associated with consumables such as gloves, masks, syringes, etc., up to the sum insured if you opt for an add-on.

2. Does the Care Heart Plan provide coverage for modern treatments?
   Yes, it covers the 12 modern treatments mandated by the IRDAI up to the sum insured.

3. Does Care Heart cover alternative AYUSH treatments?
   Yes, Care Heart covers AYUSH or alternative non-allopathic treatments such as Ayurveda, Unani, Siddha, and Homeopathy, up to 25% of the sum insured.

4. Does Care Heart have room rent restrictions?
   Yes. There is a room rent limit of up to a Single Private Room for a sum insured above 3 Lakhs, and a sub-limit of 1% of the sum insured per day if you have opted for a sum insured of 3 Lakhs.

5. Under Care Heart, what is the maximum cover one can opt for?
   Care Heart offers you a health cover up to INR 10 Lakhs.