Care Joy Maternity Health Insurance Plan

Care Joy Maternity Insurance Plan – Everything You Need To Know

Care Insurance’s Care Joy Plan is tailored to cater to expectant mothers and their babies. This special health insurance scheme aims to provide comprehensive support throughout pregnancy, childbirth, and more. With this plan, all expenses related to prenatal care, hospital visits, postnatal care and newborn coverage are included. If you are thinking about becoming a parent, this is a suitable policy worth considering. It gives you peace of mind knowing that you will not have to worry about the financial needs of having a baby. You can choose from two options – Care Joy Today and Care Joy Tomorrow. Both are designed to make sure you and your growing family are well taken care of.
 

Who Is Eligible To Buy The Care Joy Maternity Insurance Plan?

To qualify for this policy, you need to meet certain age requirements –

• Minimum Age Of Entry: 18 years old
• Maximum Age Of Entry: 45 years old
   

Benefits and Limits of The Care Joy Maternity Insurance Plan

In addition to covering inpatient costs incurred when you're staying overnight in a hospital, such as room charges, nursing care, doctor fees, prescribed medications, intensive care unit (ICU) charges, and other related expenses, here's a quick look at some of the other expenses included in the Care Joy Maternity Insurance Plan –

• Pre- & Post-Hospitalisation Expenses
  The plan provides coverage for pre-hospitalisation expenses you incur within 30 days before hospitalisation, such as tests, medications, etc., up to the sum insured. It also covers expenses incurred after discharge, like follow-up consultations and tests, for 60 days, up to the sum insured. However, it's important to note that these expenses are only covered if they are directly related to the medical condition for which you get hospitalised and are approved as part of your hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatment coverage is essential for procedures or surgeries that once needed long hospital stays but can now be done in less than 24 hours, due to medical progress. With the Care Joy Maternity Insurance Plan, you will be covered for these procedures up to your sum insured. The plan includes 541 daycare treatments, as long as your doctor recommends them in writing.
   
• Modern Treatment Coverage
  Treatment methods are always improving as technology advances in healthcare – procedures that seemed impossible before are now becoming a reality. With the Care Joy Plan, you are covered for these modern treatments, up to the sum insured. It is reassuring to know you have support for the latest advancements in your healthcare journey.
   
• No Claim Bonanza
  The Care Joy Maternity Health Insurance Plan has a special bonus for those who do not make any claims. If you go three years without making a claim, your cover amount doubles, in case you choose this cover as an add-on. But if you do make a claim during a policy year, you will lose all the bonuses you have accumulated over the years.
   
• Room Rent Limit
  It is the highest amount your insurance policy will pay for your hospital room. If you choose a room within this limit, you won't have to pay anything extra. But if you go for a pricier room, you will have to cover a part of the bill yourself. This means you will pay a proportionate share of the whole bill, not just the additional room cost. Care Joy Maternity Insurance Plan has a room rent limit of up to a Single Private AC Room. Hence, it is important to choose your room wisely to avoid unexpected expenses.
   

Additional Notable Aspects Of The Care Joy Maternity Insurance Plan

• Maternity Cover
  When you are preparing to welcome a new baby, ensuring everything goes smoothly is a top priority, especially your health. This is why the Care Joy Maternity Health Insurance Plan offers maternity coverage. It helps cover the costs related to having a baby, up to a certain limit. It protects you against the expenses incurred before and after the delivery to make sure you and your baby stay healthy. However, there is a waiting period of 9 months for Care Joy Today and 24 months for Care Joy Tomorrow before this coverage starts. Just keep in mind, there are some terms and conditions to consider. The coverage specifics are as follows -

• Newborn Baby Cover
  Along with coverage for expecting mothers, the Care Joy Plan also includes protection for your newborn baby. It covers hospital expenses for your baby from the day they are born until they reach 90 days old, up to a certain limit. After that, you will need to pay an additional premium to keep your child covered under this plan. Just remember, these expenses are only covered if your claim has been approved under maternity coverage. The coverage details are listed below -

• Newborn Birth Defects Cover
  The Care Joy Maternity Insurance Plan provides coverage for newborn baby’s birth defects up to a limit of Rs. 50,000. So, if a child is diagnosed with conditions like Down's syndrome or cerebral palsy, a lump sum amount is given to the parents to help care for their baby. This benefit is available only for those who have chosen Joy Tomorrow. It is a special feature that offers peace of mind during a challenging time.
   

Waiting Period Under Care Joy Maternity Insurance Plan

When you get a health insurance policy, there is a specific time frame before certain illnesses or diseases are covered. This is called the waiting period. After this period, you can claim for these conditions. There are different types of waiting periods –

• Initial Waiting Period
  When you first get your health insurance, there is a 30-day initial waiting period for all medical conditions except accidents. This means that you cannot make a claim for hospitalisation during the initial 30 days of buying the policy, unless it is due to an accident.
   
• Waiting Period For Pre-Existing Diseases
  If you have any medical condition or illness in the 36 months before getting your health insurance, it is considered a pre-existing disease. With the Care Joy Maternity Health Insurance Plan, there is a 48-month waiting period for pre-existing diseases. During this time, the policy will not cover any expenses related to these conditions. It is important to keep this in mind when planning your coverage.
   
• Waiting Period For Specific Diseases
  Apart from your pre-existing conditions, insurers have a list of specific medical conditions or illnesses with a waiting period. This waiting period applies whether you have had those diseases before or not. It is set by the insurer and does not depend on your current health. With the Care Joy Plan, there is a waiting period of 24 months for these specific diseases.
   

Exclusions Under Care Joy Maternity Insurance Plan

Exclusions are situations where your health insurance will not cover you, and these include –

• Standard Permanent Exclusions: The IRDAI has set standard exclusions that all insurance companies must follow. Some of these exclusions include –
  • Observation And Monitoring: Hospital stays for mere observation or monitoring without active treatment.
  • Rest And Respite: Admission for bed rest without active medical intervention.
  • Weight Management: Procedures or surgeries related to controlling weight or treating obesity.
  • Gender Alteration: Treatment aiming to change a person's biological characteristics to those of the opposite sex.
  • Cosmetic Procedures: Surgeries or treatments done for aesthetic reasons like appearance or body characteristics.
  • Hazardous Activities: Treatment expenses for injuries sustained during hazardous sports or activities, such as mountaineering, scuba diving, river rafting, horse racing, etc.
  • Illegal Activities: Expenses for treating injuries resulting from criminal activities.
  • Excluded Providers: Treatment from healthcare providers not covered by the insurance policy.
  • Substance Abuse: Treatment for conditions related to drug, alcohol addiction, etc.
  • Domestic Treatments: Expenses incurred in health spas or nursing homes primarily used for domestic reasons entirely or partially.
  • Non-Prescription Substances: Costs for dietary supplements or substances bought without a doctor's prescription.
  • Eye Correction: Expenses for correcting refractive errors up to 7.5 diopters.
  • Unproven Treatments: Surgeries or medical procedures lacking evidence of effectiveness.
  • Reproductive Procedures: Expenses related to contraception, sterilisation, or advanced reproductive technologies such as ZIFT, IVF, ICSI, GIFT, gestational surrogacy, etc.
  • Maternity Costs: Pre and post-natal expenses,childbirth-related hospitalisation, etc.
• Additional Permanent Exclusions: Apart from the standard exclusions mentioned earlier, insurance companies might add more exclusions based on medical conditions or specific situations. If you have certain diseases or severe medical issues that insurers think are too risky to cover, they might permanently exclude them from your policy. However, it is essential to know that insurers can only exclude illnesses listed by the IRDAI for this purpose.
• Non-Standard Exclusions (Specific Exclusions): Besides the usual exclusions mandated by the IRDAI, there are some unique exclusions that certain insurance companies apply. These exclusions can differ among insurers and might hinge on the terms and conditions of your policy. Let's take a look at some of the notable specific exclusions outlined in the Care Joy Maternity Insurance Plan –
  • Conditions resulting from sexually transmitted diseases (STDs), with the exception of those arising from HIV.
  • Costs associated with routine eye and ear exams, dentures, artificial teeth, and similar external devices, whether for diagnosis or treatment.
  • Treatment for mental retardation, arrested or incomplete mental development, subnormal intelligence, or intellectual disability.
  • Circumcision except in cases where it is medically necessary due to illness or accident.
  • All expenses related to donor treatment, including organ removal surgery for transplant purposes.
  • Treatments related to unrecognised systems of medicine.
  • Preventive care, including vaccinations, except for post-bite treatment and tonics.
  • Injuries or illnesses resulting from self-harm, suicide attempts, or consumption of tobacco, drugs, alcohol, or hallucinogens.
  • Expenses related to hair, including alopecia, wigs, hairpieces, and treatments for hair loss.
  • Injuries or illnesses resulting from war, invasion, civil unrest, rebellion, or similar events.

Summary

Links To Brochure And Policy Wording Of The Care Joy Maternity Insurance Plan

• Brochure: https://cms.careinsurance.com/cms/public/uploads/download_center/joy-(maternity-insurance-product)---policy-t&c-(effective-from-01-october-2020).pdf?rv=0.88151900%201680604309
• Policy Wording: https://cms.careinsurance.com/cms/public/uploads/download_center/joy-(maternity-insurance-product)---brochure.pdf?rv=0.35144100%201709551159

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