Care Health Insurance
Claim Settlement Ratio 96.99% Network Hospitals 10000+
Claim Settlement Ratio 96.99% Network Hospitals 10000+
Care Supreme Shine
Care Supreme Senior
Care Health Insurance
Care Health Insurance is a specialized health insurer offering a range of insurance solutions for individuals, families, senior citizens and customers with specific healthcare needs. Its product portfolio includes health insurance, top-up plans, personal accident, maternity, critical illness, international travel and group health insurance, along with wellness services.
For FY 2025–26, Care Health Insurance recorded a 96.99% claim settlement ratio, based on publicly disclosed industry data, while its has 10000+ cashless network hospitals. These figures can be updated periodically, so the latest insurer or regulatory disclosure should be checked before buying the policy.
Major Exclusions in Care Health Insurance
Care Health Insurance covers a wide range of medical expenses, but certain treatments, conditions and situations may not be covered. The exact exclusions depend on the selected Care health insurance plan and its policy terms. Some common exclusions include:
- Cosmetic and Aesthetic Treatments: Procedures done mainly to improve appearance, such as cosmetic surgery, are generally not covered unless medically necessary or specifically covered under the policy.
- Pre-Existing Diseases During the Waiting Period: Pre-existing diseases are not necessarily permanently excluded, but claims related to them are generally not payable until the applicable waiting period is completed.
- Maternity and Infertility Treatment: Pregnancy, childbirth and infertility treatments such as IVF may not be covered under a standard plan unless the selected policy specifically provides the benefit or an applicable add-on is chosen.
- Self-Inflicted Injuries: Medical expenses arising from intentional self-harm, attempted suicide or similar situations are generally excluded.
- Dental and Vision Care: Routine dental treatments and certain corrective vision procedures are generally not covered unless they qualify under the policy’s specific coverage conditions.
- Diagnostic-Only Hospitalization: Hospitalization undertaken only for investigation, evaluation or diagnostic tests, without active treatment of an illness or injury, may not be payable.
- Alcohol, Tobacco and Substance Abuse: Treatment or injuries directly related to excessive consumption or misuse of alcohol, tobacco or narcotic substances may be excluded, subject to the policy wording.
- Adventure and Hazardous Activities: Injuries resulting from high-risk or adventure activities may not be covered unless the policy specifically provides such coverage.
- War, Riots and Nuclear Events: Medical expenses arising from war, riots, nuclear events or similar perils may be excluded from health insurance coverage.
- Non-Medical Hospitalization Expenses: Certain consumables and other non-medical items may not be payable under a standard policy unless an applicable benefit, such as a consumables or Claim Shield cover, includes them.
Claim Process of Care Health Insurance
Care Health Insurance provides cashless and reimbursement claim facilities. The insurer also provides digital claim support through its Care Health Customer App and Claim Genie, allowing policyholders to intimate claims, upload documents and track claim status.
| Claim Stage | Cashless Claim | Reimbursement Claim |
| 1. Hospital & Intimation | Choose a Care network hospital. For planned hospitalization, generally intimate Care at least 48 hours before admission. For emergencies, intimate within 24 hours of hospitalization. | Take treatment at an eligible hospital and inform Care according to the applicable policy timeline. |
| 2. At the Hospital | Approach the hospital's insurance desk/TPA counter with the e-health card, pre-authorization form and valid ID. | Take treatment and pay the hospital expenses initially. |
| 3. Pre-Authorization | The hospital submits the pre-authorization request and treatment details to Care for approval. | Not applicable. |
| 4. Claim Documents | The hospital submits the required medical and billing documents. | Submit the claim form, discharge summary, original bills, receipts, prescriptions, investigation reports, payment proof and other required documents. |
| 5. Claim Assessment | Care assesses the claim according to the Sum Insured, treatment, medical necessity and policy terms. | Care reviews the submitted documents and assesses the claim according to policy coverage and applicable conditions. |
| 6. Settlement | Once approved, eligible expenses are settled directly with the network hospital. | The admissible amount is reimbursed to the policyholder after claim approval. |
| 7. Customer's Share | Deductibles, co-payments, exclusions, non-payable expenses and expenses beyond policy limits are paid by the policyholder. | The policyholder bears non-admissible expenses, deductibles, co-payments and amounts outside the policy coverage. |
Care's official claim guidance allows customers to locate network hospitals, submit pre-authorization information and track claims through its digital services. The exact documentation and timelines should be checked against the individual policy wording.
Care Health Insurance Waiting Period
There is no single waiting period applicable to every Care Health Insurance policy. The waiting period depends on the product, plan, optional covers and the medical condition involved.
Many Care health insurance plans generally have a 30-day initial waiting period for illnesses, except eligible accident-related treatment. A 24-month waiting period commonly applies to listed or named ailments and procedures, while pre-existing diseases are often subject to a 36-month waiting period. However, some plans have different conditions. For example, Care Supreme Senior has a four-year waiting period for pre-existing diseases.
Some Care plans and optional benefits may also allow waiting-period reductions for specific conditions. Therefore, the policy wording and schedule should always be checked before assuming that a particular disease or treatment is immediately covered.
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Popular Care Health Insurance Plans
Ultimate Care is designed for customers looking for enhanced health coverage and long-term benefits. It offers a 100% annual increase in the Sum Insured, up to 500% of the annual Sum Insured, even when claims are made. It also provides unlimited automatic recharge for eligible unrelated illnesses, annual health check-ups, claim-related protection and unlimited e-consultation. A Premium Payback feature is available after every five consecutive claim-free years, subject to the policy terms.
Care Supreme is a comprehensive health insurance plan that focuses on higher coverage through its Cumulative Bonus Super and unlimited automatic recharge. The plan provides no sub-limits on several hospitalization and treatment benefits, along with AYUSH and advanced technology coverage. It also offers wellness-based renewal discounts and unlimited e-consultations.
Care Advantage is designed for customers looking for high Sum Insured options and broader protection. The plan offers coverage up to ₹6 crore, along with features such as global coverage, automatic recharge, no zone-based co-payment, annual health check-ups, organ donor cover, unlimited e-consultation and a No Claim Bonus.
Care Supreme Shine is positioned as a comprehensive health plan with coverage up to ₹1 crore. It includes benefits such as hospitalization, day-care treatment, advanced technology procedures, AYUSH treatment, organ donor expenses, unlimited e-consultations and wellness benefits. The plan also provides no zone-based co-payment and renewal discounts based on eligible wellness activities.
Care Supreme Senior is designed specifically for senior citizens. The plan has no upper age limit for purchase and includes features such as annual health check-ups, unlimited e-consultation, cumulative bonus, advanced treatment, AYUSH treatment, home care and unlimited automatic recharge. The standard pre-existing disease waiting period is four years, subject to the policy terms.
The right plan depends on factors such as age, family structure, existing medical conditions, required Sum Insured, preferred benefits and budget. It is better to compare the actual policy wording rather than choosing a plan only by its advertised features.
Major Exclusions in Care Health Insurance
Care Health Insurance covers a wide range of medical expenses, but certain treatments, conditions and situations may not be covered. The exact exclusions depend on the selected Care health insurance plan and its policy terms. Some common exclusions include:
- Cosmetic and Aesthetic Treatments: Procedures done mainly to improve appearance, such as cosmetic surgery, are generally not covered unless medically necessary or specifically covered under the policy.
- Pre-Existing Diseases During the Waiting Period: Pre-existing diseases are not necessarily permanently excluded, but claims related to them are generally not payable until the applicable waiting period is completed.
- Maternity and Infertility Treatment: Pregnancy, childbirth and infertility treatments such as IVF may not be covered under a standard plan unless the selected policy specifically provides the benefit or an applicable add-on is chosen.
- Self-Inflicted Injuries: Medical expenses arising from intentional self-harm, attempted suicide or similar situations are generally excluded.
- Dental and Vision Care: Routine dental treatments and certain corrective vision procedures are generally not covered unless they qualify under the policy’s specific coverage conditions.
- Diagnostic-Only Hospitalization: Hospitalization undertaken only for investigation, evaluation or diagnostic tests, without active treatment of an illness or injury, may not be payable.
- Alcohol, Tobacco and Substance Abuse: Treatment or injuries directly related to excessive consumption or misuse of alcohol, tobacco or narcotic substances may be excluded, subject to the policy wording.
- Adventure and Hazardous Activities: Injuries resulting from high-risk or adventure activities may not be covered unless the policy specifically provides such coverage.
- War, Riots and Nuclear Events: Medical expenses arising from war, riots, nuclear events or similar perils may be excluded from health insurance coverage.
- Non-Medical Hospitalization Expenses: Certain consumables and other non-medical items may not be payable under a standard policy unless an applicable benefit, such as a consumables or Claim Shield cover, includes them.
Claim Process of Care Health Insurance
Care Health Insurance provides cashless and reimbursement claim facilities. The insurer also provides digital claim support through its Care Health Customer App and Claim Genie, allowing policyholders to intimate claims, upload documents and track claim status.
| Claim Stage | Cashless Claim | Reimbursement Claim |
| 1. Hospital & Intimation | Choose a Care network hospital. For planned hospitalization, generally intimate Care at least 48 hours before admission. For emergencies, intimate within 24 hours of hospitalization. | Take treatment at an eligible hospital and inform Care according to the applicable policy timeline. |
| 2. At the Hospital | Approach the hospital's insurance desk/TPA counter with the e-health card, pre-authorization form and valid ID. | Take treatment and pay the hospital expenses initially. |
| 3. Pre-Authorization | The hospital submits the pre-authorization request and treatment details to Care for approval. | Not applicable. |
| 4. Claim Documents | The hospital submits the required medical and billing documents. | Submit the claim form, discharge summary, original bills, receipts, prescriptions, investigation reports, payment proof and other required documents. |
| 5. Claim Assessment | Care assesses the claim according to the Sum Insured, treatment, medical necessity and policy terms. | Care reviews the submitted documents and assesses the claim according to policy coverage and applicable conditions. |
| 6. Settlement | Once approved, eligible expenses are settled directly with the network hospital. | The admissible amount is reimbursed to the policyholder after claim approval. |
| 7. Customer's Share | Deductibles, co-payments, exclusions, non-payable expenses and expenses beyond policy limits are paid by the policyholder. | The policyholder bears non-admissible expenses, deductibles, co-payments and amounts outside the policy coverage. |
Care's official claim guidance allows customers to locate network hospitals, submit pre-authorization information and track claims through its digital services. The exact documentation and timelines should be checked against the individual policy wording.
Care Health Insurance Waiting Period
There is no single waiting period applicable to every Care Health Insurance policy. The waiting period depends on the product, plan, optional covers and the medical condition involved.
Many Care health insurance plans generally have a 30-day initial waiting period for illnesses, except eligible accident-related treatment. A 24-month waiting period commonly applies to listed or named ailments and procedures, while pre-existing diseases are often subject to a 36-month waiting period. However, some plans have different conditions. For example, Care Supreme Senior has a four-year waiting period for pre-existing diseases.
Some Care plans and optional benefits may also allow waiting-period reductions for specific conditions. Therefore, the policy wording and schedule should always be checked before assuming that a particular disease or treatment is immediately covered.
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