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A super top-up health insurance policy, Care Enhance covers you for illnesses whose treatment expenses tower above your expectations and are too critical to ignore. Enhance 1 and Enhance 2 are the two variants of this policy. Their coverage benefits differ as well as their sum insured and deductible options. For Enhance 1, you have a choice of the sum insured between Rs. 1 lakh and Rs. 30 lakh, while for Enhance 2, you have a choice between Rs. 45 lakh, Rs. 30 lakh, and Rs. 55 lakh. Until 50 years of age, there is no requirement for a pre-policy medical checkup if the deductible and sum insured combined do not exceed Rs. 40 lakh. Additionally, you can receive selected medical treatment worldwide with Enhance anywhere. Thousands of leading hospitals across India are covered under the policy, so treating patients cashlessly is hassle-free. In-patient care, daycare expenses, pre-hospitalization, and post-hospitalization expenses are some of the coverage benefits you can take advantage of if covered by the policy. Additionally, the policy provides floater coverage as well as tax benefits based on Section 80D of the Income Tax Act, 1961.
1. Payments are made without cash - It's no longer necessary to pay off hospital bills and then follow up for reimbursement with Cashless Facility. It's now just a matter of getting started. You can be admitted to any of our Network Hospitals and focus solely on your recovery. You can leave the bill payment arrangements to us, except for non-medical expenses.
2. The deduction - You are responsible for paying the deductible under this policy. An aggregate deductible would apply to a policy year. All Claims must exceed the Deductible before we are liable.
3. Loading underwriting - The premium shall be loaded according to the underwriter's assessment of the extra risk associated with medical conditions. Based on the specified table, the total premium is calculated. The extra premium will be communicated to You before the Policy is issued for Your consent. Renewals of the policy shall also be subject to such extra premiums.
4. Term of the policy - One, two, or three years can be the term of the policy.
5. Benefits of taxation - A health insurance policy is certainly a step in the right direction, and it comes with two benefits. Besides ensuring that you and your family have access to good medical care at all times, it also allows you to receive a tax benefit on your premiums, under Section 80D of the Income Tax Act, 1961.
6. Period of free look - If the terms and conditions are not acceptable to you, you may return the Policy within 15 days (30 days if distance marketing). New individual health insurance policies are eligible for the Free Look Period, not renewals or ports/migrations. After deducting proportionate risk premium for the period on cover, medical examination expenses, and stamp duty charges, it will refund the premium received if no claim has been made.
7. Premium - The premium charged under the Policy is determined by the member's age, Sum Insured and Deductible, the type of coverage chosen (individual or floater), the number of members in the policy, tenure, and health status.
8. Hospitalization at home - In spite of an illness/injury (which would normally require hospitalization), hospitalization may not be possible because your state of health prevents you from being moved to a hospital, or a room may not be available. If your stay at home involves medical treatment for a period exceeding 3 consecutive days and you have actually merited hospitalization, the Domiciliary Hospitalisation Benefit will reimburse your medical expenses. A claim made under this Benefit will not be reimbursed for any Medical Expenses incurred under Pre-hospitalization Medical Expenses or Post-hospitalization Medical Expenses. Medical expenses incurred for the treatment of any of the following diseases will not be covered by this benefit:
i. In the case of asthma
ii. Acute bronchitis
iii. Nephrotic Syndrome and Chronic Nephritis
iv. Diarrhoea and all dysenteries, including gastroenteritis
v. Types of Diabetes Mellitus and Insipidus
vi. The epilepsy syndrome
vii. Having hypertension
viii. Cold, flu, or cough
ix. Psychosomatic or psychiatric disorders
x. An unknown cause of pyrexia
9. Care in an inpatient facility - Hospitalization of at least 24 hours If you are admitted to a hospital for inpatient treatment due to an illness or injury, which should be medically necessary, for a minimum of 24 consecutive hours, we will pay for the medical expenses incurred by you at the hospital through Cashless or Reimbursement Facility up to the maximum amount insured. Hospitalization includes room charges, nursing costs, intensive care unit charges, surgeon's fees, doctor's fees, anesthesia, blood, oxygen, operating room charges, etc.
10. Providing daycare services - Hospitalisation lasting less than 24 hours, Some surgeries do not require or need not necessarily require a 24-hour stay in the hospital. There may be a reason for this, or the surgery may have been minor or of intermediate complexity. Whenever possible, will pay for such daycare treatments through Cashless or Reimbursement Facilities, up to the sum insured.
11. Methods of advanced technology - If you take part in the following advance payment, you will be indemnified for all expenses incurred under in-patient care and/or daycare treatment technologies.
12. Medical expenses prior to hospitalization - The procedures that lead to you being admitted to the hospital, such as investigative tests, consultation fees, and medication, can be quite expensive. It covers the medically necessary expenses (Up to the Sum Insured) incurred by You during the period of 60 days prior to Your admissible hospitalization, providing that it shall not be liable to pay for any Pre-hospitalization Medical Expenses that have not been incurred during the Policy Year.
13. Medical expenses after hospitalization - As soon as you are discharged, the expenses don't end. Follow-up visits to your doctor may be necessary. A physician, medication, and sometimes even further tests are needed to confirm the diagnosis. It also covers the medically necessary expenses (up to the sum insured) incurred by You for a period of 180 days immediately after your discharge from the hospital. The claim documents must be submitted within 30 days.
1. Treatments offered by Ayush - The recovery process can be accelerated & aided by a combination of conventional medical treatment and AYUSH therapies. Therefore, it will pay You up to the Sum Insured for medical expenses incurred by You towards Your in-patient admission at any AYUSH Hospital or healthcare facility. To the extent covered under this benefit, treatments related to Ayurveda, Unani, Siddha, and Homeopathy will be superseded.
2. Coverage for organ donors - As much as it cares for you, we care about those who help you. As a result, it will not only cover your medical needs but also reimburse you for any medical expenses incurred by you in relation to your organ donor, as long as the donation conforms to the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and regulations. For the donor, 'Pre Hospitalisation Medical Expenses' and 'Post Hospitalisation Medical Expenses' are not payable.
3. Coverage for dialysis - Your dialysis expenses will be reimbursed for up to 24 consecutive months by Rs. 1,000 per sitting. This benefit will not apply to kidney disease diagnosed as a Chronic Condition before the Policy Start Date.
4. Cover for ambulances - Getting you the medical attention you need as soon as possible is one of our utmost concerns. To that end, it will reimburse you for ambulance expenses incurred by you, up to a specified amount/limit per Policy Year. An emergency service provider. As part of this cover, it will also pay for the necessary transportation from one hospital to another Provided medically necessary, a hospital can provide advanced/better equipped medical support and aid for your health condition.
5. Bonuses cumulative - Every year that you enjoy uninterrupted good health, your bonus increases! Just a way of letting you know we're with you. There are good times and bad times. If the policy is renewed without a break, the sum insured (excluding cumulative bonus) will increase by 50%.
6. Recharge without limit - There is always room for A refill! When you need the sum insured most, it is reinstated. It reinstates the entire sum insured if you ever exhaust/run out of your health coverage because of claims made The base sum is insured immediately, for an unlimited number of times during the policy year. Recharges that are not utilized cannot be carried forward to a subsequent policy year. The recharge amount can be used for the same illness as well as for different illnesses. Only claims admissible under Benefit: Hospitalisation Expenses will be eligible for the Recharge Under Unlimited Automatic Recharge, the Sum insured is available only for Benefits under 'Hospitalisation Expenses' and 'Benefits'. The policy includes 'Road Ambulance Cover'.
7. Coverage that is instant - The inclusion of this will waive off the applicable PED waiting period on Diabetes/ Hypertension/ Hyperlipidemia/ Asthma at the time of issuance of the first policy with it, regardless of anything to the contrary in the Policy.
8. Inclusion of wellness - Insured Persons who are covered as adults (over 18 years of age) in the Policy can avail of the following, provided this benefit opts for a Discount on renewal Premium. Through tracking apps, devices, etc., 10,000 steps can be recorded in one Healthy Day.
1. Diseases that preexist - The treatment of pre-existing diseases (PEDs) and their direct complications shall be excluded from coverage for 48 months after the inception of the first policy. If the sum insured is enhanced, the exclusion will apply afresh. It would reduce the waiting period for the same to the extent of prior coverage if the insured person is continuously covered without any breaks as defined under the portability norms of the current IRDAI (Health Insurance) Regulations. Pre-existing diseases are covered under the policy only if they are declared at the time of application and accepted by the insurer.
2. Waiting period for named ailments - If the first policy is issued after the date of inception of the first policy with the Company, expenses related to the listed Conditions, surgeries/treatments will be excluded until the expiration of 24 months of continuous coverage. Accident-related claims are not excluded from this exclusion. If the sum insured is enhanced, the exclusion will apply afresh. The longer of the two waiting periods shall apply if any of the specified diseases/procedures fall under the pre-existing disease waiting period. Contracts contracted after the policy or declarations and acceptances without a specific exclusion are subject to the waiting period for listed conditions. As defined under the applicable norms on portability stipulated by IRDAI, if the insured person has continuously been covered without a break, then the waiting period will be reduced accordingly.
3. Waiting period of 30 days - Within 30 days of the policy commencement date, medical expenses related to any illness shall be excluded, except for claims resulting from an accident. Insured Persons with continuous coverage for more than twelve months are not subject to this exclusion. If a higher sum insured is granted subsequently, the referred waiting period applies to the enhanced sum insured.
4. Evaluation & Investigation - Expenses associated with admissions primarily for diagnostics and evaluation are excluded. Diagnostic expenses that are not related or incidental to the current diagnosis and treatment are excluded.
5. Rehabilitation, rest, and respite care - The costs associated with any admission are primarily for bed rest and not for treatment. Additionally, this includes:
a. Personal care such as bathing, dressing, and moving assistance at home or in a nursing facility Nursing assistants and non-skilled individuals can assist nurses.
b. The provision of physical, social, emotional, and spiritual support to people who are terminally ill.
6. Weight loss/obesity - Costs associated with obesity surgery that does not meet all the conditions below:
a. On the doctor's advice, surgery will be performed.
b. Clinical protocols should support the surgery/procedure.
c. Members must be 18 years or older
d. A measure of body mass index (BMI)
i. Equal to or greater than 40
ii. After the failure of less invasive methods of weight loss, have a body mass index greater than 35, as well as any of the following severe comorbidities:
7. Surgery for cosmetic or plastic reasons - Treatments to change appearance except for reconstructive surgery following an accident, burn(s), or cancer or as part of the medically necessary treatment to remove a direct and immediate health risk. In order for this to be considered a medical necessity, the attending physician must certify it as such.
8. Sports that are hazardous or adventurous - As a professional, you may be required to pay for any treatment you require as a result of participating in hazardous or adventure sports, such as para jumping, and rock climbing.
Depending on the policy, the deductible options range from Rs. 1 lakh to Rs. 10 lakh, and the Care Enhance 2 policy offers deductible options of Rs. 5 lakh, Rs. 10 lakh, Rs. 15 lakh, and Rs. 20 lakh.
Yes, of course. When you enroll in a Care Enhance policy at the age of 61 or over, you will have to pay 20% of the claim amount and the rest will be covered by the insurer.
Purchasing a Care Enhance policy on an individual basis requires a minimum entry age of 18 years for adults and 5 years to 24 years for children. On the other hand, if purchased on a floater basis, then the minimum entry age for adults is 18 years, and for children, it is 1 day to 24 years with at least one member aged 18 or older.
The Care Enhance policy has a 30-day waiting period. For some specific illnesses, the waiting period is 2 years, while for pre-existing illnesses, it is 4 years.
As part of Care Enhance 1, you will be covered by a single private room with air conditioning. As opposed to Enhance 2, you'll be covered for a single private room with AC, and you can upgrade to the next level if you wish.
Policyhub IMF Private Limited | CIN: U66000DL2021PTC383135 | Registered Office - Plot No TA-72-A UGF Back Side Block TA Uttam Nagar New Delhi 110059.
Policyhub is now registered as an Insurance Marketing Firm |Serial No. 544, Irdai Registration No. IMF187297800720220545, Valid till 10-07-2025, License category- Insurance Marketing Firm (Life & General)
*Discount is provided by insurers And approved by IRDAI on payment of multi year premiums
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