Care Advantage in one table
Claim settlement and complaint figures are IRDAI-published and held centrally by nyvo, not taken from the insurer's marketing.
What Care Advantage covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from Care Health's own policy wording.
Swipe the table sideways to see every column.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | None in the base plan. You can choose a 5%, 10%, 15% or 20% co-pay to cut the premium, and Smart Select attaches a 20% co-pay to treatment outside its hospital list. | No Co-payment |
| Room Rent Limit | No sub-limit on room rent or ICU. The optional Room Rent Modification caps you at a single private room in exchange for a lower premium. | No room rent capping |
| Disease sub-limit | No disease sub-limits | No sub-limit |
| No Claim Bonus | 10% of the sum insured for each claim-free year, to a ceiling of 50%. A claim claws back 10%, though never below your original sum insured. You can take the bonus as a small renewal discount instead. | 50% each year (Minimum upto 100%) |
| Restoration Benefit | Full base sum insured reinstated once in a policy year, usable for the same illness as well as a different one. Unlimited restoration is a paid option. | 100% restoration once in a year |
| Pre-Hospitalization | 30 days. The optional Pre-Post Hospitalization Expenses Modification buys a longer window. | At least 60 days |
| Post-Hospitalization | 60 days. The optional Pre-Post Hospitalization Expenses Modification buys a longer window. | At least 120 days |
| Consumables | Not covered. The separate Care Advanced add-on policy, sold as Care Shield Plus, covers the non-payable items in Lists 1 to 4. | Consumables covered |
| Day-Care Procedures | A specified list of day care procedures, covered up to the sum insured | Covered without a capped list |
| Ambulance Cover | Road ambulance up to the sum insured. Air ambulance is a paid option capped at ₹5 lakh a year. | Included |
| Organ Donor Cover | Up to the sum insured, though the donor's own pre and post hospitalisation costs are not paid | Included |
| AYUSH Treatment | In-patient AYUSH treatment covered up to the sum insured | Included |
| Entry age | Individually from 5 years, or 91 days on a floater with at least one adult · no maximum entry age and no exit age | No maximum entry age |
Care Advantage add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Care Advantage discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise: what you actually get depends on the case.
Swipe the table sideways to see every column.
| Discount | Worth | When it applies |
|---|---|---|
| Tenure discount | Up to 7.5% and 15% | 7.5% off the second year and 15% off the third when you pay a multi-year policy up front. |
| Family discount | Up to 5% or 10% | On each member beyond the eldest, where everyone holds their own sum insured. |
| Deductible discount | Varies | In exchange for paying the first slice of each year's claims yourself, applied on an aggregate basis. |
From the plan's own prospectus. Discounts multiply rather than add.
Care Advantage waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Specified Disease or Procedure | 24 months |
| Pre-Existing Disease | 36 months |
The named illnesses that wait 24 months
These wait 24 months from the start of your first policy, whether the condition was pre-existing or picked up later. An accident is covered from day one. This list is indicative – the wording carries the full set.
Care Advantage exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Care Advantage falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Care Advantage questions, answered
Is pre and post hospitalisation 60 and 180 days on Care Advantage?
No. The base plan pays for 30 days before admission and 60 days after discharge, and both figures come straight from the current prospectus and Customer Information Sheet. There is an optional benefit, Pre-Post Hospitalization Expenses Modification, that extends both to a longer period you choose. If a quote or comparison shows you 60 and 180 on this plan, either the add-on is priced in or the figure is wrong – ask to see the schedule.
How high does the cover actually go?
₹6 crore. The tiers are ₹25 lakh, ₹50 lakh, ₹75 lakh, ₹1 crore, ₹2 crore, ₹3 crore and ₹6 crore, and the entry point of ₹25 lakh is what marks this out from Care Health's other plans. The pricing is deliberately keen at the top end, which is the plan's main argument for itself.
What happens to my bonus if I claim?
It goes backwards. The base No Claims Bonus adds 10% of the sum insured for each claim-free year to a 50% ceiling, and a claim removes 10% again, though it can never take you below your original sum insured. The optional No Claims Bonus Super adds 50% a year to a 100% ceiling but removes 50% on a claim, so a single admission can undo most of what it built. This is different from Care Supreme and Ultimate Care, where the bonus survives a claim untouched.
Is there a room rent limit or a co-payment?
Neither by default. Room rent and ICU both come with no sub-limit, and no co-payment applies unless you choose one. Two optional covers can introduce them: Room Rent Modification caps you at a single private room, and Smart Select puts a 20% co-payment on any claim from a hospital outside its shorter list. Both cut the premium, which is why they turn up on cheaper quotes – check your schedule.
How does the restoration work?
The full base sum insured comes back once in the policy year, once a claim has exhausted it, and the reinstated amount can be used for the same illness as well as a different one. On a floater every insured person can draw on it. Bonus amounts are not counted when the restoration is calculated. If you want it to refill more than once a year, that is the Unlimited Automatic Recharge option.
Can I shorten the three-year wait on pre-existing conditions?
Yes, to two years, through the Reduction in PED Wait Period option. One condition is easy to miss: the shortened wait only applies to the sum insured you held when you bought the option. Increase the cover later and the pre-existing exclusion starts again from scratch on the increase, which is standard across the market but catches people out at renewal.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other Care Health plans we have read
Care Health files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.