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Health Insurance 4111 views December 6, 2019
Today many people are vulnerable to numerous health risks. Absence of a strong Health Insurance results in incurring substantial medical expenses in case of any medical exigencies. This has a direct impact on the savings which depletes to a great extent or becomes zero. And, a situation also might arise where one has to borrow money and end up having debt in the market for medical treatment. To avoid such situations, health insurance is of great use which not only covers the hospitalization expenses but also covers many other aspects of diseases or injuries. Health insurance has become compulsory due to the constant increase in medical expenditures. Thus, protecting the family against any Health hazards is essential & must be a critical aspect of usual financial planning.
The heart is the most important organ in the body needs good protection in the aspect of Health Insurance. Therefore, there are health plans which give special attention to the heart only. Care Health Insurance Company, a renowned insurer, caters to the need of people in providing specialized and well-designed comprehensive health insurance products. One such product which the company offers is Care Heart Plan which we will study in detail in the article below.
Table of Contents
- 1 Care Heart Health Insurance Plan – What it is About and why it is Needed?
- 2 Main Features of Care Heart Health Insurance Plan
- 3 The Additional Benefits in Care Heart Health Insurance Plan
- 4 Eligibility of Care Heart Health Insurance Plan
- 5 List of Benefits Under Care Heart Health Insurance Plan
- 6 Claim Policy Under Care Heart Health Insurance Plan
- 7 Documents for Care Heart Health Insurance Plan
Care Heart Health Insurance Plan – What it is About and why it is Needed?
The plan offers extensive coverage of pre-existing heart diseases. For any heart patient, this product is an appropriate product to eliminate the risk of experiencing a huge medical cost.
Today’s lifestyle and bad food habits have become an integral part of life resulting in more and more heart or cardiac diseases. And to cure these heart ailments, one has to have a strong heart insurance plan. And hence, it has become a necessity to have such a dedicated plan.
Main Features of Care Heart Health Insurance Plan
Let’s understand the main features of the Care Heart Health Insurance Plan below.
All-inclusive Coverage for Hospitalization Expenses
The key feature of Care Heart is to provide an all-inclusive cover that is spent at the time of hospitalization. An insured can either use the cashless facility of can get a reimbursement from the company at a later stage. There are many expenses which get covered for daycare expenses, ex- room charges, nursing expenses other than the main treatment expenses like doctor’s fees, surgeon’s fees, etc.
Advantages of Pre-Hospitalization and Post-Hospitalization
Care Heart Insurance Plan covers the expenses for pre-hospitalization and post-hospitalization also which is 30 days prior and 60 days after the discharge.
Ambulance Expenses
Ambulance expense is also covered under this plan.
Coverage for Alternative Treatments
Care Heart Health Insurance Plan gives the facility to its heart patients to go for different treatments like Ayurveda or Unani treatments.
Automatic Recharge Facility
The insured gets a top-up facility on the sum insured once the same is finished.
Domiciliary Hospitalization Coverage
The insured can also get cover for meeting domiciliary expenses. In a situation, when the patient is sick and needs to be moved, home care is suggested to avoid the further tension of transfer.
No Claims Bonus
The plan has a structured feature of No Claim Bonus by which the sum insured increases by 10% in case there is no claim in the previous year.
Annual Health Check-up
A fantastic opportunity to stay healthy as, under this plan, the company gives the facility of an annual check-up at nil cost.
The Additional Benefits in Care Heart Health Insurance Plan
A Second Opinion
The plan allows the insured to go for a second opinion, if needed, which can be outside India as well at no additional cost.
Other Coverages Under OPD Charges
OPD charges that include diagnostics expenses, druggist’s charges, and other costs of consultations. Diagnostics charges cover is 50% of the entire coverage for OPD.
The Facility of Health Check-up
The plan provides a facility of Health check-ups that includes various tests, for example, sugar tests both PP and fasting, lipid profile and blood pressure tests till thrice in a policy year.
Treatment at Home
The plan also takes care of the patient after he/she is discharged which has to be used within 30 days of discharge and to be prescribed by a doctor.
Eligibility of Care Heart Health Insurance Plan
Now let us see the eligibility criteria for Care Heart Health Insurance Plan:
| Minimum Entry Age | 18 Years |
|---|---|
| Maximum Entry Age | Lifetime |
| Exit Age | Nil |
| Term of Policy | 1 year, 2 years, 3 years |
| Renewal | Lifetime Renewability |
| Floater Combination | 2 Adults |
| Co-Payment | 20% per claim |
| Waiting period | 30 days |
| Specific waiting period | 2 Years |
| Pre-existing Disease Waiting Period | 2 Years |
| Who are covered (Relationship with Proposer) | Individual: Self, spouse, daughter, son, mother, father, brother, sister, mother-in-law, father-in-law, grandfather, grandmother, granddaughter, grandson, aunt, uncle, niece, nephew, employee. Family Floater: Self, spouse, daughter, son, mother, father, employee and his/her dependants like Children, Spouse and, Parents. |
List of Benefits Under Care Heart Health Insurance Plan
Now, we will have a view on the benefits that are available under various categories of the sum insured to have a clear understanding:
| Annual Sum Insured (Rs) | 2 Lakhs | 3 Lakhs | 4 Lakhs | 5 Lakhs | 7 Lakhs | 10 Lakhs |
|---|---|---|---|---|---|---|
| Hospitalization Expenses | Up to the Sum Insured | Up to the Sum Insured | Up to the Sum Insured | Up to the Sum Insured | Up to the Sum Insured | Up to the Sum Insured |
| Day Care Treatment | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured |
| In-Patient Care | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured | Till the Sum Insured |
| Pre and Post Hospitalization Expenses | 30 days and 60 days subject to a maximum of 5% | 30 days and 60 days subject to a maximum of 5% | 30 days and 60 days subject to a maximum of 5% | 30 days and 60 days subject to a maximum of 5% | 30 days and 60 days subject to a maximum of 5% | 30 days and 60 days subject to a maximum of 5% |
| Cover of Ambulance | Till Rs 2000/ hospitalization | Till Rs 2000/ hospitalization | Till Rs 2000/ hospitalization | Till Rs 2000/ hospitalization | Till Rs 3000/ hospitalization | Till Rs 3000/ hospitalization |
| Alternative Treatment Expenses | Till 25% of the Sum Insurance | Till 25% of the Sum Insurance | Till 25% of the Sum Insurance | Till 25% of the Sum Insurance | Till 25% of the Sum Insurance | Till 25% of the Sum Insurance |
| Automatic Renewal | 100% of the original Sum Insurance | 100% of the original Sum Insurance | 100% of the original Sum Insurance | 100% of the original Sum Insurance | 100% of the original Sum Insurance | 100% of the original Sum Insurance |
| Domiciliary Cover | Till Up to 100% of SI covered post 3 days | Till Up to 100% of SI covered post 3 days | Till Up to 100% of SI covered post 3 days | Till Up to 100% of SI covered post 3 days | Till Up to 100% of SI covered post 3 days | Till Up to 100% of SI covered post 3 days |
| No Claim Bonus | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance | 10% increase in SI, subject to a maximum of 50% of the Sum Insurance |
| Room Rent | Up to 1% of the Sum Insured /day | Up to 1% of the Sum Insured /day | Up to 1% of the Sum Insured /day | Single Occupancy Private Room | Single Occupancy Private Room | Single Occupancy Private Room |
| Replacement of Knee | Up to Rs 70000/ knee | Up to Rs 80000/ knee | Up to Rs 80000/ knee | Up to Rs 100000/ knee | Up to Rs 120000/ knee | Up to Rs 120000/ knee |
| Cataract Treatment | Up to Rs 20000/ eye | Up to Rs 20000/ eye | Up to Rs 20000/ eye | Up to Rs 30000/ eye | Up to Rs 30000/ eye | Up to Rs 30000/ eye |
| ICU Charges | Up to 2% of the Sum Insured /day | Up to 2% of the Sum Insured /day | Up to 2% of the Sum Insured /day | No Limit | No Limit | No Limit |
| Cover for the Second Opinion | Only once per main illness or injury per policy year | Only once per main illness or injury per policy year | Only once per main illness or injury per policy year | Only once per main illness or injury per policy year | Only once per main illness or injury per policy year | Only once per main illness or injury per policy year |
| Active Health Check-up (Refer the List A below) | 3 times in a year | 3 times in a year | 3 times in a year | 3 times in a year | 3 times in a year | 3 times in a year |
Annual Sum Insured (Rs) | 2 Lakhs | 3 Lakhs | 4 Lakhs | 5 Lakhs | 7 Lakhs | 10 Lakhs |
| Cardiac Health Check-up (Refer the List B below) | Once a year | Once a year | Once a year | Once a year | Once a year | Once a year |
List A – Active Health Check-up
- Lipid Profile
- Sugar – Both Fasting and PP
- Blood Pressure
List B – Cardiac Health Check-up
| For Sum Insured 2L, 3L, 4L and 5L | For Sum Insured 7L and 10L |
|---|---|
| Routine Urine Culture | Routine Urine Culture |
| Blood Count including ESR | Blood Count including ESR |
| TMT | TMT |
| Blood Group Test | Blood Group Test |
| HbA1C | HbA1C |
| Kidney Functions test | Kidney Functions test |
| Lipid Profile | Lipid Profile |
| Liver Fictions Test | Liver Fictions Test |
| Medical Exams Report | Medical Exams Report |
| TSH | TSH |
| Chest X-Ray | Chest X-Ray |
| Hbs Ag | Hbs Ag APTT and 2D Echo |
Claim Policy Under Care Heart Health Insurance Plan
Step by Step Procedure to Claim
- Emergency Hospitalization: Intimation must reach the insurer within 24 hours of hospitalization
- Planned Hospitalization: Intimation must reach the insurer 48 hours before hospitalization
- The toll-free numbers are 1800 102 4488 and 1800 200 6677
- In case of cashless, the preauthorization form needs to be filled in which is available at the hospital’s insurance desk post which the fax is sent. The approval letter is being sent thereafter. All queries, if asked by the insurer needs to be answered with details.
- In case of reimbursement, all required documents need to be sent to the insurer for further processing.
- The insurer will inform the insured in case of any rejection with reason.
Documents for Care Heart Health Insurance Plan
The claim should be made within 30 days from the date of discharge with the following documents:
- The Claim Form must be filled with accurate details and to be signed by the insured person
- Photo Identity proof of the insured
- Discharge Summary
- Doctor’s prescriptions
- Original bills and receipts
- All original and pathologic test reports.
- Receipt of Ambulance
- Home Care Benefit notes and receipts
- Any other appropriate document, if asked by the insurer.
Final Words
We can conclude from the above discussion that Care Heart – Care Health Insurance Plan is a well-designed heart plan which has all benefits which are needed in case of a patient with cardiac issues. One can completely rely on the company and apply for the plan to have a tension free life.