Care Health Insurance – Family Health Insurance Plan

Why do I need health insurance?

Everyone is exposed to various health hazards. If you don't have Health Insurance, you end up paying hefty medical bills from your own pocket, in the event of hospitalization due to illness or injury. Effectively, this means that your savings get depleted. Worse still, in case you do not have enough money for treatment at the time, you may have to borrow and incur a debt.

In such circumstances, health insurance comes to your rescue. It is a shield against expenses owing to unforeseen medical exigencies. Health insurance usually covers the cost of hospitalisation and related pre and post hospitalisation expenses, as specified in your policy.

This is why purchasing adequate Health Insurance is a crucial part of your financial planning exercise.

What is the difference between a family floater and critical illness or hospital cash insurance?

An individual or family floater health insurance works on the principle of indemnity. This means that with a family floater, the insurance company will reimburse you only to the extent of what you have spent on medical treatment in a hospital. On the other hand, the critical illness or the hospital cash insurance pays you a pre-defined sum, irrespective of the amount spent on medical treatment. These are called 'benefit-based' policies.

How would I benefit by buying health insurance at a young age?

• Health insurance premiums tend to increase with age; the older you are, the higher your premiums will be.
• If you are insured early, you will be covered for medical conditions that may be diagnosed later in life, provided there is no break in the policy.
• Every year, you receive income tax benefits* under Section 80 D of the Income Tax Act.

Why is it necessary for me to disclose my current health status correctly and accurately when I buy a health insurance policy?

Insurance is a contract of utmost good faith. It always pays to be honest. Declaring the correct and accurate health status at the time of buying health insurance ensures smooth processing of your claims, when they arise. It will also help us service you better.

What is preferable for me – floater insurance or an individual insurance?

The suitability of an individual cover or a floater depends upon your unique situation – your age, number of family members also included in the policy and their ages too, etc. However, as a thumb rule, at a younger age, a floater cover is advisable. As the insured grow older, individual cover may be preferable.

How does a floater cover work?

Unlike an individual policy, which covers a single person, a floater (Family Floater) plan offers insurance coverage to the entire family (husband, wife and children and perhaps even parents) under a single policy. The overall limit on the policy applies to any individual covered. However, once a claim is filed, the overall limit stands reduced by the claim amount, for the year in reference.

Let's simplify this concept with an example. Suppose you insure yourself, your spouse and dependent children with individual insurance plans; each of these has a sum insured of Rs. 1 lakh. Accordingly, you may end up paying a premium ranging between Rs. 1000 - Rs. 2000 for each family member. On the other hand, if you opt for a family floater plan, with a sum insured of Rs. 3 lakhs, the total premium would surely be less than the separate premium payments for individual health insurance plans.

Moreover, separate health plan save a cover of only Rs. 1 lakh each while the family floater offers a cover of Rs. 3 lakh to any of the family members that it covers. However, if one of the family members covered is hospitalised and claims an amount of Rs 2 lakh, the next family member to be hospitalised during the same year will have a cover of only Rs 1 lakh.

What is a 'no claim' bonus?

If you purchase a health insurance policy and do not file a claim during the year for which you are covered, you are eligible for a bonus during the following year, if you renew your policy. The quantum and specifics of this bonus differ from company to company.

In case of Care Health Insurance's CARE, the policy sum insured increases by 10% during every claim-free year, with no change in the premium. So, a policy with a sum insured of Rs 5 lakh, will get an extended cover of Rs 50,000 in the following year, at the same premium. A claim-free second year will see the policyholder enjoying another 10% extra cover on his base sum insured, taking the total to Rs 6 lakh.

A maximum bonus of up to 50% of the base sum insured is permissible under this policy and in case of a claim, the accumulated bonus is reduced by 10%.

How does the automatic recharge facility work?

We will automatically recharge the sum insured (i.e.original policy sum insured ) in case it is exhausted during the policy year. This recharge is allowed only once in a policy year and can be used for future claims by the insured but not against an illness/disease (including its complications) for which a claim has already been made during the on-going policy year.

However, in case of family floater plan, other insured members can use the recharged amount for any illness.

Do I need to undergo a medical check-up while buying a health insurance policy?

You may be required to undergo a medical check-up if you opt to buy a health insurance policy, in case you are above 60 years of age. In most of the cases, the medical tests are done at your home, after taking an appointment from you and you are not required to make any upfront payment for these tests. In case the policy is issued, you will not be charged anything. However, if the policy is declined or cancelled, the medical charges will be deducted from your refundable premium amount. For further details, please refer to the prospectus or call 1800-102-6655 / 1800-102-4488

How do I cancel my health insurance policy?

We offer you a free look period during which you can review your policy terms and conditions at leisure. In case you are not satisfied with these, you can request us to cancel your policy during this period. You will be charged the pro-rated premium for the period during which your policy was in-force, the cost of the pre-policy health check-up, if any, and the stamp duty. The balance premium will be refunded to you.

You can also request us to cancel your policy at any time during the policy period. You will be refunded the premium amount as per the short scale grid. The grid is available in your Policy Terms and Conditions. However, in case you have lodged any claim with us before the cancellation, you will not be entitled to any refund of premium when the policy is cancelled.

What is co-payment?

Health Insurance companies initiate co-payment once the insured member turns a certain age. 'Co-pay' is that part of your claim amount, which you have to bear. It could be in percentage terms or an absolute amount. For example, in case of a co-pay of 20% and a claim of Rs. 10,000, the insurer will pay you Rs. 8,000 (80% of Rs10,000) and you will bear the remaining 20% (Rs. 2,000). Care Health Insurance policies with sum insured of 2,3 and 4 lakh have no co-payment clause. For policies with a sum insured of over Rs4 lakh, there is also no co-payment clause, if the insured has enrolled with us before the age of 61.

What are the documents required for portability?

To apply for CARE under portability, you will need the following documents:

• CARE proposal form
• Portability form
• Copy of expiring health insurance policy
• Copy of renewal notice