Care in one table
| Insurer | Care Health Insurance Limited |
|---|---|
| Sum insured | ₹1 lakh to ₹6 crore across nine variants (Care 1 to Care 9), in tiers of 1 / 2 / 3 / 4 / 5 / 7 / 10 / 15 / 20 / 25 / 30 / 40 / 50 / 60 / 75 / 100 / 150 / 200 / 300 / 600 lakh |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Care 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 |
|---|---|---|
| Co-payment | None as standard. A 20% co-payment is only ever applied if you choose it – it is an optional cover offered to buyers aged 61 and over as a way of cutting the premium. Smart Select and Everyday Care carry co-payments of their own. | No Co-payment |
| Room Rent Limit | A single private room on the ₹5 lakh tier and above, upgradeable one level from ₹15 lakh if a single private room is unavailable. On the ₹1 lakh to ₹4 lakh variants it is capped at 1% of the sum insured a day. | No room rent capping |
| ICU charges | No limit from ₹5 lakh cover upwards. Capped at 2% of the sum insured a day on the ₹1 lakh to ₹4 lakh variants and on the Care 9 option. | No ICU limit |
| Disease sub-limit | None on the mainstream Care 1 to Care 7 variants. The cheaper Care 8 and Care 9 variants do cap cataract, knee replacement, hernia, hysterectomy, prostate and kidney stone surgery, and cardiac, cancer, renal and fracture treatment. | No sub-limit |
| No Claim Bonus | 10% of the sum insured for each claim-free year, to a ceiling of 50%. A claim takes 10% back, though never below your original sum insured. The paid No Claims Bonus Super adds 50% a year to a further 100%, taking the combined ceiling to 150%. | 50% each year (Minimum upto 100%) |
| Restoration Benefit | Full 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, up to the sum insured, on every variant | At least 60 days |
| Post-Hospitalization | 60 days, up to the sum insured, on every variant | At least 120 days |
| Consumables | Not covered in the base plan. The separate Care Shield add-on policy pays for the 68 listed non-payable items. | Consumables covered |
| Day-Care Procedures | A specified list of day care surgical treatments, covered up to the sum insured | Covered without a capped list |
| Maternity Cover | Only on the highest variants and only on a floater – up to ₹1 lakh at ₹50 lakh to ₹75 lakh cover, and up to ₹2 lakh above that, after a 24-month wait. Nothing at all below ₹50 lakh. | Included |
| Annual Health Check-up | Once a policy year for every insured person, including children, on a cashless basis | Included |
| Second Opinion | Arranged within India, once per major illness or injury per policy year, from the ₹2 lakh variant upwards | 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 aged 18 or over · no maximum entry age for adults, children up to 24 | No maximum entry age |
Care 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 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 5% or 10% | On each member beyond the eldest, where everyone holds their own sum insured. 5% for two or three people, 10% for four or more. |
| Tenure discount | Up to 7.5% and 10% | 7.5% off the second year on a two-year policy and 10% off the third year on a three-year policy. |
| NRI discount | Up to 15% | For non-resident Indian policyholders. |
| Smart Select | Up to 15% | In exchange for using a shorter hospital list, with a 20% co-payment on any claim from outside it. |
| Deductible discount | Varies | In exchange for bearing 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, and the total is capped at 45% of the premium.
Care 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 |
|---|---|
| Named Ailment | 24 months |
| Pre-Existing Disease | 36 months |
| Maternity (where covered) | 24 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 all 14 entries.
Care 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 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 questions, answered
Why does my Care quote look nothing like someone else's?
Because Care is nine different plans sold under one name. The Customer Information Sheet lays them out as Care 1 to Care 9, spanning ₹1 lakh to ₹6 crore, and the variant decides your room category, whether ICU is capped, whether disease sub-limits apply and whether maternity or overseas treatment exist at all. Care 8 and Care 9 in particular carry sub-limits that the mainstream variants do not. Ask your advisor which variant is on the quote before comparing it with anything.
Is there a co-payment for older buyers?
Not automatically, and this is worth stating plainly because it is easy to assume otherwise. The plan carries no co-payment by default at any age. What exists is an optional cover, available to buyers whose own age or whose eldest member's age is 61 or over, letting you take on a 20% co-payment in exchange for a lower premium. It is a choice you make, not a condition the insurer imposes. Two other options bring co-payments with them: Smart Select adds 20% for treatment outside its hospital list, and Everyday Care applies a flat 20% to its own out-patient claims.
How long do pre-existing conditions wait?
36 months of continuous coverage, and this can be cut to 24 months through the Reduction in PED Wait Period optional cover. Worth flagging: the current Care brochure states four years for this, which contradicts both the prospectus and the Customer Information Sheet carrying the same UIN, and would exceed what the regulations allow. The policy wording governs, and it says 36 months.
Are consumables covered?
No. Gloves, syringes, PPE and the rest of the non-payable items are not in the Care plan. The route to them is the separate Care Shield add-on policy, which bundles cover for the 68 listed items with protection for your bonus on small claims and an inflation-linked increase in the sum insured. It can only be bought alongside a Care Health retail policy, not on its own.
Is maternity included?
Only at the top of the range. The plan pays up to ₹1 lakh at ₹50 lakh to ₹75 lakh of cover and up to ₹2 lakh above that, and the wording restricts it to floater cover and to insured people aged 18 or over, after a 24-month waiting period from the first policy. On every variant below ₹50 lakh there is no maternity benefit and no add-on to create one.
How does the restoration work?
The full sum insured comes back once in a policy year after a claim exhausts it, and it is usable for the same illness as well as a different one – which is the more generous of the two arrangements you see in the market. If you want it to refill more than once, the Unlimited Automatic Recharge optional cover does that, and the brochure confirms it applies to the same person and the same illness.
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.