Care Health Insurance Ultimate Care
Claim Settlement Ratio 96.99% Network Hospitals 10000+
Claim Settlement Ratio 96.99% Network Hospitals 10000+
Care Health Insurance Ultimate Care
Care Ultimate Care is a comprehensive health insurance plan designed to help you manage the financial impact of hospitalization and major medical expenses. Instead of offering only basic hospital cover, the plan combines regular health insurance benefits with features that can help build or extend your coverage over the years.
It covers important expenses such as hospitalization, day-care treatment, advanced technology treatments, AYUSH treatment, domiciliary hospitalization, ambulance services and organ donor expenses. The plan also comes with benefits such as Cumulative Bonus, Unlimited Automatic Recharge, Loyalty Boost, MediVouchers and health services.
For people looking for additional protection, Care Ultimate Care also offers optional benefits such as Infinity Bonus, MoneyBack, Tenure Multiplier, Instant Cover, Claim Shield, PED Waiting Period Modification and wellness benefits. This gives policyholders the flexibility to choose benefits based on their healthcare needs rather than paying for features they may not require.
Eligibility Criteria of Ultimate Care
Thinking about who can be covered under Care Ultimate Care? The plan is designed for both individuals and families, with coverage available for adults from 18 years and children from 91 days. You can also choose the Sum Insured and policy term based on your healthcare and family requirements.
| Eligibility Parameter | Details |
| Adult Entry Age | 18 years and above; lifelong entry, subject to policy terms |
| Child Entry Age | From 91 days up to 24 years |
| Policy Type | Individual or Family Floater |
| Individual Coverage | Up to 6 members |
| Family Floater Coverage | Up to 2 adults and 2 children |
| Eligible Relationships | Self, spouse, children, parents, parents-in-law and grandparents, subject to applicable insurable-interest conditions |
| Sum Insured Options | ₹5 lakh, ₹7 lakh, ₹10 lakh, ₹15 lakh, ₹20 lakh, ₹25 lakh, ₹50 lakh and ₹1 crore |
| Policy Term | Up to 5 years |
Care Health Ultimate Care Optional Benefits
Care Ultimate Care allows you to add extra protection through optional benefits. These can be useful when your healthcare needs go beyond standard hospitalization coverage.
- Infinity Bonus: Adds 100% of the Base Sum Insured every Policy Year, irrespective of claims, with unlimited accumulation as long as the policy continues and the conditions are met.
- MoneyBack: After every block of 5 consecutive claim-free Policy Years, the first policy year's base premium can be refunded, subject to the terms of this benefit.
- Tenure Multiplier: For multi-year policies, this benefit allows the annual Sum Insured to be combined for a single eligible claim during the policy tenure, subject to the applicable conditions.
- Instant Cover: Provides quicker coverage for certain accepted pre-existing conditions such as Diabetes, Hypertension, Hyperlipidemia, Asthma, Obesity, and Hypothyroidism and specified Coronary Artery Disease, with coverage beginning from Day 31 for eligible conditions.
- Claim Shield: Covers specified expenses that are normally non-payable under the policy, subject to the applicable limits and claim conditions.
- PED Waiting Period Modification: This option can reduce the standard PED waiting period to 1 year or 2 years, depending on the option selected and underwriting approval.
- Annual Health Check-Up: Provides a health check-up for all insured persons once every Policy Year, subject to the applicable conditions.
- Physical Consultation with General Physicians: Provides up to 4 consultations per insured person in a Policy Year, subject to the specified consultation limit.
- Physical Consultation with Specialist Doctors: Provides up to 4 specialist consultations per insured person in a Policy Year, subject to the applicable limit.
What Are the Exclusions Under Care Ultimate Care?
Care Ultimate Care does not cover every medical expense. Some important exclusions include treatment for pre-existing diseases during their waiting period, specified ailments during their applicable waiting period, investigation-only admissions, rest cure or custodial care, certain cosmetic procedures, hazardous sports-related injuries, substance abuse, unproven treatments, infertility-related treatment and maternity expenses unless specifically covered.
Certain dental procedures, spectacles, contact lenses, external congenital conditions and non-medical expenses may also be excluded unless an applicable benefit provides coverage.
The exact exclusions can vary depending on the policy and optional benefits selected, so the final policy wording and Policy Schedule should always be checked before making a claim.
Waiting Period for Care Health Ultimate Care
Not every medical condition is covered from the very first day of the policy. Care Ultimate Care has different waiting periods depending on the type of illness or treatment, so it is important to understand them before you buy the plan.
- Initial Waiting Period: A 30-day waiting period generally applies to illness-related hospitalization from the policy start date. Eligible accidental hospitalization is not covered by this initial illness waiting period.
- Specific Disease Waiting Period: A 24-month waiting period applies to specify named ailments and procedures listed in the policy wording.
- Pre-Existing Disease Waiting Period: The standard waiting period for pre-existing diseases is 36 months. Coverage for eligible treatment related to an accepted PED begins after completion of the applicable waiting period.
Care Health Ultimate Care Claim Process
Care Ultimate Care provides both cashless and reimbursement claim facilities. For planned hospitalization, the insurer generally needs to be informed at least 48 hours before admission, while emergency hospitalization should be intimated within 24 hours.
| Claim Process | Cashless Claim | Reimbursement Claim |
| Hospital | Visit a Care network hospital | Treatment can be taken at an eligible hospital |
| Intimation | Inform Care before planned admission or within 24 hours in an emergency | Follow the applicable claim-intimation timeline |
| At admission | Provide policy/e-health card details and identification | Take treatment and keep the original bills and records |
| Pre-authorization | Hospital submits the pre-authorization request to Care | Not applicable |
| Assessment | Care checks coverage, treatment and claim admissibility | Care checks the submitted documents and policy coverage |
| Settlement | Approved eligible expenses are settled directly with the network hospital | Approved admissible expenses are reimbursed to the policyholder |
| Your payment | Non-payable expenses, deductibles and co-payment, where applicable, are paid by the customer | The customer initially pays the hospital and bears non-admissible expenses |
Care also provides digital support for claim-related services, making it easier to submit information and track the claim status.
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Care Health Ultimate Care Coverage and Key Benefits
Care Ultimate Care covers eligible expenses when you need to stay in a hospital for more than 24 hours. Depending on the treatment, this can include hospital room charges, ICU expenses, doctor fees, medicines, diagnostics and other admissible medical costs.
Many procedures can now be completed without a full-day hospital stay. Ultimate Care covers eligible day-care procedures that require less than 24 hours of hospitalization because of modern medical technology.
The plan covers eligible treatments that use specified advanced medical technology methods, subject to the policy conditions.
Medical expenses often start before admission and continue even after discharge. Care Ultimate Care covers eligible expenses for up to 60 days before hospitalization and 90 days after discharge, when they are related to an admissible hospitalization claim.
Eligible inpatient treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered, subject to the applicable conditions.
There are situations where hospitalization may not be possible and treatment has to continue at home. Eligible domiciliary hospitalization is covered when the policy conditions are satisfied and the required treatment duration is met.
When an organ transplant is covered under the policy, eligible expenses for the donor's surgery to remove the organ can also be covered, subject to the policy terms and applicable government requirements.
Eligible ambulance expenses are covered for transportation to a hospital, shifting between hospitals for better treatment or returning home after discharge, subject to the applicable policy limits.
For every claim-free Policy Year, the plan adds 50% of the Base Sum Insured as a Cumulative Bonus. The bonus can build up to a maximum of 100% of the Base Sum Insured.
If your available Sum Insured gets used up, the plan can automatically recharge the cover for subsequent eligible claims. This benefit can be used multiple times during the policy year, including for related or unrelated illnesses, subject to the applicable conditions.
After 7 consecutive claim-free years, the plan provides an additional Sum Insured equal to the Sum Insured available in the first policy year. This benefit is available once during the lifetime of the policy.
At the first renewal, policyholders can receive two pharmacy vouchers of ₹250 each, subject to the applicable conditions.
Care Ultimate Care also provides access to health-related services through Care's digital and network services. These can include online health support, consultations, diagnostics, maternity-related services and other discounts available under the plan.
The plan encourages policyholders to maintain healthier habits through its wellness program. Eligible activities can help you earn rewards and may provide a renewal premium discount of up to 30%, subject to the applicable conditions.
Eligibility Criteria of Ultimate Care
Thinking about who can be covered under Care Ultimate Care? The plan is designed for both individuals and families, with coverage available for adults from 18 years and children from 91 days. You can also choose the Sum Insured and policy term based on your healthcare and family requirements.
| Eligibility Parameter | Details |
| Adult Entry Age | 18 years and above; lifelong entry, subject to policy terms |
| Child Entry Age | From 91 days up to 24 years |
| Policy Type | Individual or Family Floater |
| Individual Coverage | Up to 6 members |
| Family Floater Coverage | Up to 2 adults and 2 children |
| Eligible Relationships | Self, spouse, children, parents, parents-in-law and grandparents, subject to applicable insurable-interest conditions |
| Sum Insured Options | ₹5 lakh, ₹7 lakh, ₹10 lakh, ₹15 lakh, ₹20 lakh, ₹25 lakh, ₹50 lakh and ₹1 crore |
| Policy Term | Up to 5 years |
Care Health Ultimate Care Optional Benefits
Care Ultimate Care allows you to add extra protection through optional benefits. These can be useful when your healthcare needs go beyond standard hospitalization coverage.
- Infinity Bonus: Adds 100% of the Base Sum Insured every Policy Year, irrespective of claims, with unlimited accumulation as long as the policy continues and the conditions are met.
- MoneyBack: After every block of 5 consecutive claim-free Policy Years, the first policy year's base premium can be refunded, subject to the terms of this benefit.
- Tenure Multiplier: For multi-year policies, this benefit allows the annual Sum Insured to be combined for a single eligible claim during the policy tenure, subject to the applicable conditions.
- Instant Cover: Provides quicker coverage for certain accepted pre-existing conditions such as Diabetes, Hypertension, Hyperlipidemia, Asthma, Obesity, and Hypothyroidism and specified Coronary Artery Disease, with coverage beginning from Day 31 for eligible conditions.
- Claim Shield: Covers specified expenses that are normally non-payable under the policy, subject to the applicable limits and claim conditions.
- PED Waiting Period Modification: This option can reduce the standard PED waiting period to 1 year or 2 years, depending on the option selected and underwriting approval.
- Annual Health Check-Up: Provides a health check-up for all insured persons once every Policy Year, subject to the applicable conditions.
- Physical Consultation with General Physicians: Provides up to 4 consultations per insured person in a Policy Year, subject to the specified consultation limit.
- Physical Consultation with Specialist Doctors: Provides up to 4 specialist consultations per insured person in a Policy Year, subject to the applicable limit.
What Are the Exclusions Under Care Ultimate Care?
Care Ultimate Care does not cover every medical expense. Some important exclusions include treatment for pre-existing diseases during their waiting period, specified ailments during their applicable waiting period, investigation-only admissions, rest cure or custodial care, certain cosmetic procedures, hazardous sports-related injuries, substance abuse, unproven treatments, infertility-related treatment and maternity expenses unless specifically covered.
Certain dental procedures, spectacles, contact lenses, external congenital conditions and non-medical expenses may also be excluded unless an applicable benefit provides coverage.
The exact exclusions can vary depending on the policy and optional benefits selected, so the final policy wording and Policy Schedule should always be checked before making a claim.
Waiting Period for Care Health Ultimate Care
Not every medical condition is covered from the very first day of the policy. Care Ultimate Care has different waiting periods depending on the type of illness or treatment, so it is important to understand them before you buy the plan.
- Initial Waiting Period: A 30-day waiting period generally applies to illness-related hospitalization from the policy start date. Eligible accidental hospitalization is not covered by this initial illness waiting period.
- Specific Disease Waiting Period: A 24-month waiting period applies to specify named ailments and procedures listed in the policy wording.
- Pre-Existing Disease Waiting Period: The standard waiting period for pre-existing diseases is 36 months. Coverage for eligible treatment related to an accepted PED begins after completion of the applicable waiting period.
Care Health Ultimate Care Claim Process
Care Ultimate Care provides both cashless and reimbursement claim facilities. For planned hospitalization, the insurer generally needs to be informed at least 48 hours before admission, while emergency hospitalization should be intimated within 24 hours.
| Claim Process | Cashless Claim | Reimbursement Claim |
| Hospital | Visit a Care network hospital | Treatment can be taken at an eligible hospital |
| Intimation | Inform Care before planned admission or within 24 hours in an emergency | Follow the applicable claim-intimation timeline |
| At admission | Provide policy/e-health card details and identification | Take treatment and keep the original bills and records |
| Pre-authorization | Hospital submits the pre-authorization request to Care | Not applicable |
| Assessment | Care checks coverage, treatment and claim admissibility | Care checks the submitted documents and policy coverage |
| Settlement | Approved eligible expenses are settled directly with the network hospital | Approved admissible expenses are reimbursed to the policyholder |
| Your payment | Non-payable expenses, deductibles and co-payment, where applicable, are paid by the customer | The customer initially pays the hospital and bears non-admissible expenses |
Care also provides digital support for claim-related services, making it easier to submit information and track the claim status.
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