Care Insurance - Care Senior Plan

Let’s Get To Know More About The Plan

Care Senior is a health insurance plan brought to you by Care Health Insurance Limited. Specifically crafted for seniors entering their golden years, this policy offers a range of benefits, features, and additional options to cater to different requirements. With the Care Senior Plan, you can be worry-free, knowing that you will have access to necessary medical care, free from concerns about unforeseen healthcare costs.

Are You Eligible To Buy The Policy?

• Minimum Age Of Entry: At least one person in the policy must be 61 years old, while others can be 18 years or older to join.
• Maximum Age Of Entry: You can enrol in the policy until you reach 99 years old.
   

Benefits And Limits Of The Care Senior Plan That You Should Know

In addition to taking care of inpatient costs that are incurred when you stay in the hospital for over 24 hours, like room charges, nurse fees, doctor fees, prescribed medicine costs, intensive care unit fees, etc., the Care Senior Plan also covers various other related expenses. Let's take a quick look at some of these covered expenses.

• Pre- & Post-Hospitalisation Expenses
  You don't have to stress about paying for tests before or after your hospital stay, as your health insurance policy has got you covered. It will pay for these expenses up to the sum insured for a good amount of time, i.e., 30 days before you are admitted to the hospital and after 60 days of your discharge. Just keep in mind that these costs will only be covered if they are connected to the medical issue you are in the hospital for, and your claim needs to be approved as part of your inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatment coverage is included in the Care Senior Plan. These treatments used to require patients to be admitted to the hospital for a long time, but now, with medical progress, they can be done in just one day. The Care Senior Plan covers 541 different daycare procedures, and there is no cap on the coverage. This means that as long as it is within the sum insured, the plan takes care of all the costs.
   
• Domiciliary Treatment Coverage
  Domiciliary treatment refers to medical care given at home for serious illnesses or injuries that would normally be treated in a hospital. This might happen because the patient is too sick or injured to go to the hospital safely, or because there are no beds available nearby. With the Care Senior Plan, these costs are covered, except for a few specific illnesses or conditions. The coverage extends up to 10% of the sum insured.
   
• Organ Donor Coverage
  The Care Senior Plan also includes coverage for organ donation if you are the recipient. This means the plan provides coverage for expenses related to organ harvesting from the donor for transplantation up to either Rs. 50,000 or 1,00,000, depending on the sum insured you choose.

• Modern Treatment Coverage
  In today's healthcare world, treatments that seemed impossible before are now becoming a reality because of rapid advancements in technology. The Care Senior Plan is here to support you through these changes. It is designed to keep up with the latest developments and covers the costs of these modern treatments. It ensures that you get the care you need without worrying about the expenses, up to the sum insured.
   
• Non-Medical Expenses
  In addition to medical expenses, the Care Senior Health Insurance Plan also covers non-medical costs. These are the expenses for essential items like gloves, nebulizers, oxygen masks, etc., that are needed for treatment. These supplies can be pricey and can quickly accumulate, draining your finances. By choosing an add-on, the plan can cover these costs up to the total cover amount, easing the financial strain that these expenses might bring.
   
• No Claim Bonus
  If you stay healthy and do not make any claims during a policy year, you’ll be eligible for a no claim bonus. This bonus increases your sum insured by 10% in a claim-free year and up to a maximum of 50% of the sum insured. However, if you do end up making a claim later on, the bonus you have earned will decrease by the same percentage.
   
• Automatic Recharge (Restoration Benefit)
  Automatic Recharge, also known as Restoration Benefit, is a feature that kicks in when your sum insured runs out during a policy year. Once your base sum insured and any applicable No Claim Bonus are fully used up, the restoration benefit restores your coverage. You can use this coverage for subsequent claims during the same policy year, but it is important to note that it is only for unrelated illnesses. You can enjoy this benefit once every year for your entire life, as long as you keep renewing your policy.
   
• Room Rent Limit
  It is the maximum amount your insurance company will cover for the hospital room you stay in. If you choose a room within your plan's limit, you will not have to pay anything extra. But, if you pick a room with a higher rent, you will need to cover a proportionate share of the entire hospital bill, not just the difference in room rent. Care Senior Plan sets limits on the hospital room based on your chosen sum insured.

Some Additional Highlights Of The Care Senior Plan

• No Claim Bonus Super (NCB Super)
  No Claim Bonus Super (NCB Super) is another benefit you can add to your policy that adds to your regular No Claim Bonus. With NCB Super, you get a bonus increase of 50% in your sum insured amount for every year that you don’t make a claim, up to a maximum of 100%. It is a way of rewarding you for staying healthy and not needing to make a claim. However, if you do end up making a claim, the bonus you have earned will decrease at the same rate it was earned. All the terms and conditions that apply to the regular No Claim Bonus also apply to NCB Super.

• OPD Care
  OPD Care in the Care Senior Plan is an extra feature that covers expenses for outpatient visits. The outpatient department (OPD) is a part of the hospital where people get medical attention without being admitted. With this coverage, you are reimbursed for expenses like doctor consultations, prescribed tests, and medications. The amount covered depends on the coverage you choose, ranging from Rs. 5,000 to Rs. 50,000. You can use this benefit twice each policy year whenever you need it.
   
• Annual Health Checkup
  As you get older, your chances of facing health issues go up. This is why it is important to keep an eye on your health. This plan gives you the chance to undergo a thorough health check-up once a year. It covers a set of medical tests, and you can have them done on a cashless basis, up to your sum insured. The insurer will handle all the arrangements with their network hospitals, so you don't have to worry about paying anything upfront.
   

Navigating Waiting Periods

When you buy a policy, there is a certain time frame during which some illnesses are not covered yet – this is called the waiting period. After this period passes, you can claim for these conditions. Waiting periods are of different types, and they include –

• Initial Waiting Period
  There is a waiting period of 30 days for all medical conditions right after you buy the policy. During this time, you cannot make a claim for hospitalisation, except in case of accidents.
   
• Waiting Period For Pre-Existing Diseases
  Any health issue you had in the 36 months before getting the health insurance policy is called a pre-existing disease. With the Care Senior Plan, a 48-month waiting period applies for pre-existing diseases. You also have the option to reduce your waiting period to just 24 months. However, this is available only if you have included the NCB super add-on. During the applicable period, the policy will not cover any costs related to your pre-existing conditions.
   
• Waiting Period For Specific Diseases
  Besides your pre-existing conditions, insurers also have a list of certain medical issues with their own waiting period and it does not matter if you had these diseases before or not. This waiting period is set by the insurer, not based on your current health. For the Care Senior Plan, there is a 24-month waiting period applicable for specific diseases.
   

What Are Excluded From Coverage?

Exclusions in your health insurance policy are those situations that will not be covered. Some of them include –

• Standard Permanent Exclusions
  The IRDAI, the regulatory body of insurance companies, has set some exclusions that all insurance companies must follow. Here are a few of them –
• • Hospital Observation: When someone is admitted to the hospital just for observation or monitoring.
  • Rest Cure And Respite Care: Admission to a facility for bed rest or relaxation, without active treatment.
  • Obesity / Weight Control: Treatment or surgery for managing weight or obesity.
  • Gender Change Treatment: Medical procedures aimed at altering physical characteristics to match the opposite sex.
  • Plastic / Cosmetic Surgery: Surgeries or treatments intended solely for changing appearance.
  • Adventure Sports: Medical expenses incurred while participating in hazardous or adventure sports professionally, like river rafting, mountaineering, etc.
  • Breach Of Law: Expenses related to treating someone involved in criminal activities.
  • Excluded Providers: Treatment from medical practitioners or hospitals not covered by the insurance company.
  • Narcotics: Treatment for alcohol addiction, drug use, etc.
  • Domestic Establishments: Expenses for treatment in places like health spas, nursing homes, or similar establishments used for domestic purposes either entirely or partially.
  • Dietary Supplements: Costs for vitamins, minerals, etc., not prescribed by a doctor.
  • Refractive Error Correction: Expenses for improving eyesight up to 7.5 diopters.
  • Unproven Treatments: Surgeries or medical procedures not proven to be effective.
  • Birth Control And Infertility: Expenses related to contraception, sterilisation, artificial insemination, or infertility treatments like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Costs associated with prenatal care, childbirth, postnatal care, etc.
• Additional Permanent Exclusions
  Beyond the standard permanent exclusions we discussed earlier, insurance companies might add more exclusions for specific situations or medical issues. If you have severe medical conditions or certain diseases that insurers think are too risky to cover, they might permanently exclude them from your policy. But remember, insurance companies can only exclude illnesses listed by the IRDAI for permanent exclusion.
• Non-Standard Exclusions (Specific Exclusions)
  Non-standard exclusions, also known as specific exclusions, are additional exclusions that go beyond the standard exclusions set by the IRDAI. These exclusions can vary among insurance providers and may be based on the terms and conditions of your policy. Here are some key specific exclusions under the Care Senior Plan –
• • Charges related to routine eye and ear examinations, as well as expenses for dentures, artificial teeth, or similar external devices for diagnosis or treatment.
  • Treatment for external congenital anomalies, illnesses, or defects, including those related to birth defects.
  • Treatment for mental retardation, subnormal intelligence, or other mental intellectual disabilities.
  • Circumcision unless required for medical treatment or due to an accident.
  • Expenses for artificial life support, such as life support machine usage, if they do not lead to the recovery or restoration of previous health status.
  • Treatment from unrecognised systems of medicine.
  • Costs for alopecia wigs, hairpieces, and treatments for hair fall.
  • Injuries sustained while participating in professional or semi-professional naval, military, air force operations or aviation activities, etc.
  • Exclusions include acts of war, invasion, civil war, rebellion, or similar hostilities, whether declared or not.
  • Injuries or illnesses resulting from self-destruction, suicide attempts, or the use of intoxicating drugs, alcohol, hallucinogens, etc.
     

A Quick Summary

Brochure And Policy Wording For The Care Senior Plan

• Brochure: https://cms.careinsurance.com/cms/public/uploads/download_center/care-senior-brochure.pdf
• Policy Wording: https://www.careinsurance.com/cms/public/uploads/download_center/care---kypb---a5---web.pdf?rv=0.10697300%201598590756

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