Care Heart in one table
| Insurer | Care Health Insurance Limited |
|---|---|
| Sum insured | ₹3 lakh, ₹5 lakh, ₹7 lakh and ₹10 lakh, with other tiers available on request |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Care Heart 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.
| Feature | This plan | What good looks like |
|---|---|---|
| Who can buy it | Only someone who has been diagnosed with a cardiac ailment or disorder in the past and has undergone a cardiac surgical intervention or procedure for it. On a floater, at least one of the two adults must meet that test. | Open to all applicants |
| Pre-existing disease waiting period | 24 months of continuous coverage – a year shorter than the 36 months on Care Health's mainstream plans, and the point of the product | 36 months or less |
| Pre-policy medical check-up | None | Not required |
| Co-payment | 20% of every claim if you were 70 or under when you joined, 30% if you were over 70. It is fixed by your entry age and applies for the life of the policy. | No Co-payment |
| Room Rent Limit | Capped at 1% of the sum insured a day on the ₹3 lakh tier. A single private room from ₹5 lakh upwards. | No room rent capping |
| ICU charges | Capped at 2% of the sum insured a day on the ₹3 lakh tier; no limit from ₹5 lakh upwards | No ICU limit |
| Disease sub-limit | Yes. Cerebrovascular treatment, cancer, renal complications and fractures are capped between ₹2 lakh and ₹3 lakh; knee replacement between ₹80,000 and ₹1.2 lakh a knee; cataract at ₹20,000 to ₹30,000 an eye; hernia, hysterectomy, prostate and kidney stone surgery between ₹50,000 and ₹80,000. | No sub-limit |
| No Claim Bonus | 10% of the sum insured for each claim-free year, to a ceiling of 50%. A claim removes 10%, though only from the bonus itself, never from your original sum insured. | 50% each year (Minimum upto 100%) |
| Restoration Benefit | Full sum insured reinstated once in a policy year, but only for an illness unrelated to the one already claimed. On a floater, only members who have not claimed can draw on it. | 100% restoration once in a year |
| Pre and Post-Hospitalization | 30 days before and 60 days after, but the two together are capped at 5% of the sum insured – on a ₹5 lakh policy that is ₹25,000 for both windows combined | At least 60 days pre and 120 days post |
| Consumables | Not covered, and this plan has no consumables option | Consumables covered |
| Day-Care Procedures | A listed set of day care treatments, covered up to the sum insured | Covered without a capped list |
| Cardiac Health Check-up | Arranged cashless once a policy year for every insured person, on request, with the test panel set by your sum insured | Included |
| Domiciliary Hospitalisation | Up to 100% of the sum insured, once treatment at home runs beyond three consecutive days | Included |
| Ambulance Cover | Up to ₹2,000 per hospitalisation on the ₹3 lakh tier, ₹3,000 from ₹5 lakh upwards | Included |
| Entry age | From 18 with no maximum entry age and no exit age, renewable for life | No maximum entry age |
Care Heart 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 Heart 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.
| Discount | Worth | When it applies |
|---|---|---|
| Family discount | Up to 2.5% or 7.5% | On the gross premium of every member where two to six people from the same family are covered in one policy on an individual sum insured basis. 2.5% for two or three, 7.5% for four to six. |
| Tenure discount | Up to 7.5% and 10% | 7.5% off the second year if you pay two years up front, plus 10% off the third year on a three-year policy. |
From the plan's own prospectus.
Care Heart 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 |
|---|---|
| Specific Waiting Period | 24 months |
| Pre-Existing Disease | 24 months |
The named illnesses that wait 24 months
Care Heart's named-ailment list runs well beyond the industry standard 14 entries, and for a cardiac plan the contents matter: heart failure, arrhythmia, cardiomyopathies and ASD, VSD or PDA all sit on it, alongside cancer, stroke and kidney failure. All of them wait 24 months from your first policy. An accident is covered from day one. This list is indicative; the wording carries the full set.
Care Heart 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 Heart 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 Heart questions, answered
Who is actually eligible for Care Heart?
The prospectus is narrow about this: the applicant, or on a two-adult floater at least one of them, must have been diagnosed with a cardiac ailment or disorder in the past and have undergone a cardiac surgical intervention or procedure for it. A bypass, an angioplasty or a valve replacement qualifies. A diagnosis managed on medication alone does not. Everything still sits under the insurer's underwriting.
How long do pre-existing conditions wait?
24 months of continuous coverage, confirmed in the current wording, prospectus and Customer Information Sheet. That is a year shorter than the 36 months Care Health applies on its mainstream plans, and it is the single reason the product exists. If a comparison shows three years for Care Heart, including our own page before this review, it is wrong.
How much of a claim will I pay myself?
20% of every claim if you were 70 or under when the policy was first issued, and 30% if you were over 70. It is fixed at your entry age and stays for the life of the policy – there is no waiver option, which is a difference from Care Freedom where the age-related increase can be bought off. On a ₹6 lakh cardiac admission at 20%, that is ₹1.2 lakh out of pocket, before any sub-limit is applied.
Is my next cardiac procedure covered straight away?
Not necessarily. Two clocks can catch it. If the condition existed before the policy, it waits 24 months as a pre-existing disease. Separately, myocardial infarction, heart failure, arrhythmia and heart blocks, cardiomyopathies and ASD, VSD or PDA are all on the named-ailment list, which also waits 24 months even if the condition first appears after you buy. Only an accident is covered from day one.
What does the restoration actually give me?
Your full sum insured back, once in the policy year, after a claim has exhausted it. Two restrictions matter. It can only be used for an illness unrelated to the one you already claimed for, so a second cardiac admission in the same year is unlikely to qualify. And on a floater, only the members who have not claimed can use the reinstated amount. Both restrictions are unusual and they narrow the benefit considerably.
Is there a room rent limit?
Yes. On the ₹3 lakh tier the room is capped at 1% of the sum insured a day, which is ₹3,000 – below the daily rate of most metro cardiac units. From ₹5 lakh upwards you get a single private room and ICU charges become uncapped. If you are buying this plan for cardiac care in a city, the ₹3 lakh tier is worth stepping past.
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.