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Property & IRDAI Licensed Insurance Agent in Indore. Expert in Health Gap Analysis. Travel Insurance. Insurance is the subject matter of solicitation.
Note: When looking for policy features, clause and wording always be sure to look for prospectus with identical UIN number as your policy has. some inclusions and exclusions vary even when the policy is same due to version change.
Policy Name:
Policy Name:
Care Supreme
Care Supreme
Insurer Name:
Insurer Name:
Care Health Insurance
Care Health Insurance
Policy Overview (At-A Glance)
Policy Overview (At-A Glance)
Think of the Care Supreme Policy as a customisable safety net. The Base Benefits are the strong, core ropes that catch you during major falls (hospitalisation). The Optional Benefits are like adding extra padding or widening the net specifically where you think you might need it most (e.g., fitness access or women’s care). Finally, the Wellness Discounts act like a maintenance program—the better you look after yourself (by walking daily), the less it costs to keep the net in place.
Policy In-Depth
Policy In-Depth
Sum Insured (in Lakhs: 5/7/10/15/25/50/100
Allowed Policy Term / Tenure: 1 / 2 / 3 (Years)
Base Benefits Of Policy: For clarity refer to Care Supreme Prospectus Section 8 (Schedule of Benefits)
Base Benefits Of Policy: For clarity refer to Care Supreme Prospectus Section 8 (Schedule of Benefits)
Hospitalisation Expenses:
In Patient Care - Up to SI
Day-Care Treatments - All Day Care Treatments
Advance Technology Methods - Up to SI
Pre Hospitalisation Medical Expenses - Up to SI (60 Days Prior to Hospitalisation)
Post Hospitalisation Medical Expenses - Up to SI (180 Days after Discharge)
Ayush Treatment - Up to SI
Domiciliary Treatment - Up To SI
Organ Donor Cover - Up TO SI
Road Ambulance Cover - for SI less than 15 Lac - Up to 10,000 , For SI 15 Lac and above - Up to SI
Cumulative Bonus - 50% of SI per year, Max up to 100% of SI (Shall not reduce in case of claim)
Unlimited Automatic Recharge - Available for unlimited times for both unrelated or related illness.
Unlimited E-Consultations - Available for consultations with General Physicians.
Health Services: Health Portal, Discount Connect
Eligibility & Entry Criteria
Eligibility & Entry Criteria
Individual policy can have multiple persons under one policy number, in this every insured person will have independent sum insured, which will mean it's a multi individual policy.
Family floater is a policy in which sum insured is shared between all the person insured under the policy.
Min. Entry Age(Child): 90 Days
Min. Entry Age(Adult): 18 Year
Max. Entry Age(child): 24 years
Max. Entry Age(Adult): Lifelong
Exit Age Child: 25 years
Exit Age for Adult: Lifelong
Cover Types Available: Individual / Family Floater
Max. Person Allowed in Individual Policy: 6 persons
Max. Person Allowed in Floater Policy: 4 Persons ; upto 2 Adults 2 Child
Medical Test Required(After Age):
Tele-MER / Physical Test:
Hospitalization Covers
Hospitalization Covers
Condition: Hospitalisation for at least 24 hours
Cover: Up to Sum Insured
Room Rent Limit:
Room Rent Limit:
Condition / If Capped : _____% of sum insured or Max ___________ Rs. Per day. Whichever is lower.
Cover: Up -To Sum Insured
Room Category Allowed: Any Room
ICU Limit:
ICU Limit:
Condition / If Capped : _____% of sum insured or Max ___________ Rs. Per day. Whichever is lower.
Cover: Up -To Sum Insured
Room Category Allowed: Not Applicable
Road Ambulance Cover Limit (amount & frequency):
Road Ambulance Cover Limit (amount & frequency):
For SI below 15 Lac - Cover will be up-to 10,000/- per policy year
For SI 15 Lac & above - Cover will be up-to Sum Insured per policy year
Condition: Medical expenses incurred by you towards your in-patient admission at AYUSH Hospitals or health care facilities, which administer treatment related to disciplines of medicine namely Ayurveda, Unani, Sidha and homeopathy.
Cover: Up to Sum Insured
Pre-Hospitalisation Medical Expenses: For clarity refer to Care Supreme Prospectus Section 3.1.1.iv.1
Pre-Hospitalisation Medical Expenses: For clarity refer to Care Supreme Prospectus Section 3.1.1.iv.1
Condition: Pre- Hospitalisation Medical Expenses covered for 60 days Prior to hospitalisation
Cover: Covered up to sum insured
Post-Hospitalisation Medical Expenses: For clarity refer to Care Supreme Prospectus Section 3.1.1.iv.2
Post-Hospitalisation Medical Expenses: For clarity refer to Care Supreme Prospectus Section 3.1.1.iv.2
Condition: Post- Hospitalisation Medical Expenses covered for 180 days after discharge
Cover: Covered up to sum insured
Out Patient
Out Patient
Condition:
Cover:
Condition: Hospitalisation involving less than 24 hrs
Cover: All day care procedures Covered
Condition: Medical Expenses incurred during your treatment at home, as long as it involves medical treatment for period exceeding 3 consecutive days. This will be applicable if patients condition dose not allow him/her to move to hospital or in case when hospital room may not be available when patient needs the most.
Cover: Covered up to sum insured
Condition: Company will pay you up to SI for medical expense that are incurred by you towards your organ donor, while undergoing the organ transplant surgery, if the donation confirms to the transplantation of Human Organs Act (1994) amended and other applicable laws and rules.
Cover: Covered up to sum insured
Advanced Technology Methods
Advanced Technology Methods
Condition:
Cover: Covered up to sum insured
Freelook & Waiting Periods
Freelook & Waiting Periods
Free Look Period - 15 Days
Free Look Period - 15 Days
Definition: Period in which you can cancel your policy have get back your premium (Terms & Conditions Apply)
Condition: You can cancel the policy if you are not satisfied with the terms.
Note: You cannot exercise the Free Look option if a claim has already been made. If policy is re-newed or ported. Applicable only for new individual policies.
Refund:
You get a full refund of the premium minus:
Pro-rata risk premium for the days covered.
Stamp duty charges.
Expenses incurred by the insurer for any medical check-ups.
Initial Waiting Period - 30 Days
Initial Waiting Period - 30 Days
Definition: A mandatory cooling-off period starting from the first day of the policy during which no claims for illnesses are admissible.
Waiting Period:30 Days from the policy issue date.
Condition: This waiting period applies only to the first year of the policy. It does not apply during renewals, provided there is no break in the policy.
Note: If you increase your Sum Insured at renewal, the 30-day wait applies only to the "fresh" increased portion of the cover.
List of Diseases:
Covered: Only Accidental Injuries requiring hospitalization are covered from Day 1.
Not Covered: Any illness, sickness, or disease diagnosed or treated within these 30 days (e.g., Dengue, Malaria, Heart Attack, Typhoid, Viral Fever).
Do's & Don'ts
Do: Understand that this is a "Safety Period" for the insurer to prevent people from buying a policy only when they feel they are about to fall sick.
Do: Ensure your policy start date is well before any planned travel or season changes (like Monsoon) to cross this 30-day window.
Don't: Apply for a claim for a fever or infection that started on Day 28, even if you got hospitalized on Day 31. The "first occurrence of symptoms" must be after Day 30.
Don't: Worry about accidents. If a person meets with a road accident 2 hours after the policy is issued, Care Supreme covers it
Accidental Hospitalisation
Accidental Hospitalisation
Accidental hospitalisation is covered from Day 1.
PED Waiting Period - 36 Months (3 Years)
PED Waiting Period - 36 Months (3 Years)
Definition: PED is any condition, ailment, injury, or disease diagnosed by a physician within 48 months prior to the first policy issued by the insurer.
Waiting Period: 36 Months (3 Years). If you declare a disease at the time of purchase, you must wait 36 months before a claim related to it is payable.
Condition: The disease must be disclosed in the proposal form. Non-disclosure can lead to claim rejection or policy cancellation.
Do's & Don'ts
Do: Declare every minor or major past illness (even if cured) like BP, Diabetes, or past surgeries.
Do: Opt for the "Instant Cover" rider if you have Diabetes/BP to reduce this wait to 30 days.
Don't: Hide any medical history. The insurer checks past records during the first claim.
Don't: Expect coverage for a PED-related complication (e.g., Kidney failure due to long-term Diabetes) before 36 months.
Named Ailments Wait Period - 24 Months (2 years)
Named Ailments Wait Period - 24 Months (2 years)
Definition: These are a pre-defined list of slow-developing or "planned" surgeries and ailments that are excluded for a specific duration from the policy inception date, regardless of whether the insured had them before or not.
Waiting Period: The 24-month waiting period for Named Ailments is calculated from the inception date of the very first policy, provided the policy has been continuously renewed without any break. This benefit remains valid even if the policy is ported from another insurer, as per IRDAI guidelines.
Condition: Even if these diseases are not pre-existing and occur for the first time after buying the policy, they will still not be covered until the 24-month period is completed.
List of Diseases:
Eyes: Cataract and Glaucoma.
Internal Growths: Stones in the Urinary/Biliary system (Kidney/Gallbladder stones), Benign Prostatic Hypertrophy (BPH).
Female Reproductive: Hysterectomy (removal of uterus), Myomectomy, Fibroids, Endometriosis.
Body Structure: All types of Hernia, Hydrocele, Piles (Fissures/Fistula), Varicose Veins.
Joints/Spine: Osteoarthritis, Gout, Rheumatism, Spinal Disc disorders (unless caused by an accident), Joint Replacement surgeries (unless caused by an accident).
Respiratory: Sinusitis, Deviated Nasal Septum, Tonsillitis, Adenoids.
Do's & Don'ts
Do: Plan any elective surgeries for these conditions only after the policy has crossed the 2-year mark.
Do: Keep track of the first diagnosis date if you feel symptoms of these ailments early on.
Don't: Try to "convert" a chronic joint pain into an "accidental injury" to bypass the 2-year wait; insurers audit the MRI and medical history strictly.
Don't: Forget that if you had these diseases before buying (PED), the 36-month wait will apply instead of 24 months.
Optional / Add-On Benefits
Optional / Add-On Benefits
Smart Select: For listed Smart Select hospital - Up to SI, Other than listed - Up to SI with additional 20% co-Payment
Room Rent Modification: Twin Sharing Room / Single Private Room
PED Wait Period Modification: PED wait Period shall be modified to 1/2/3 Years
Named Ailment Wait Period Modification: Waite period shall be modified to 1 year
Instant Cover: No PED wait period for Diabetes (Sugar), Hypertension (BP), Hyperlipidemia , Asthma. If insured person has these pre existing diseases at the time of issuance of first policy with us.
Deductible: 10k, 25k, 50k, 1Lac, 2 Lacs, 5 Lacs, 10 Lacs.
Co-Payment(%): 5/10/20/30/50
New Born Cover: New born babies are allowed to get coverage from the day 1, all wait period will be applicable mandatorily.
Plus Benefit: Additional 20% SI, Maximum upto 10 lacs from day 1.
Cumulative Bonus Super: Up to 100% of base SI per Year, Max up to 500% of base SI, Note: Shall not reduce in case of claim
Annual Health check up: Once for all insured every policy year.
Be-Fit Benefit" Unlimited Visits to fitness centers can be availed by insured member aged above 12 years.
Wellness benefits: will provide specific discount on renewal if 10k steps are recorded for specified days.
Air Ambulance Cover: up to 5 lac per years
Women Care(Mammography, Cervical Cancer Screening, PCOS/PCOD Test): Up to 10/25/50 k per year only cashless
Mental Health Well Being: Up to 10/25/50 k per year only cashless
Claim Shield: Non payable Items covered up to sum insured
Zonal pricing
Zonal pricing
Zonal pricing is a strategic way for the insurer to offer lower premiums to residents of cities where medical costs are relatively lower. Zones (Zone 1 / 2 / 3 / 4 ) are used only to decide premium. You pay lower premium if you live in a lower-cost city (Zone 2 or 3)
According to Care Supreme Prospectus zones are defined as follows:
Zone 1: Delhi NCR, Surat, Mathura, Aligarh;
Zone 2: Mumbai(MMR), Rest of Gujarat;
Zone 3: Pune, Indore Nashik, Telangana;
Zone 4: Rest Of India
Note:
Cities above means adjoining cities also.
Delhi NCR, Mumbai(MMR) is as defined by Government.
Zonal Co-Payment: If the Zonal Co-pay is not in the "Entire Contract," it does not exist. No specific condition/explanation is mentioned in prospectus of Care Supreme pertaining to Zonal Co-Pay. Therefor, no copayment can be applied if you get treatment in higher zone.
A. Cashless Claim (Network Hospital)
A. Cashless Claim (Network Hospital)
Admission: Present the Care Health ID card and Aadhaar/PAN at the hospital insurance desk.
Pre-Auth: The hospital sends a "Pre-Authorization Form" to Care Health (within 24 hours for emergency, 48 hours prior for planned).
Audit: Care Health reviews the medical records.
Approval: Insurer sends a "Letter of Approval."
Discharge: You pay only the non-medical items (e.g., masks, gloves) unless you have the Claim Shield rider.
B. Reimbursement Claim (Non-Network Hospital)
B. Reimbursement Claim (Non-Network Hospital)
Intimation: Notify Care Health within 24 hours of admission (Call 1800-102-4488 or email).
Payment: You pay the full bill at the hospital.
Submission: Send all original documents to Care Health within 15 days of discharge.
Verification: The company may send an investigator to the hospital to verify the case.
Settlement: Money is credited to your bank via NEFT within 30 days of receiving the last "complete" document.
List of Documents Required:
List of Documents Required:
Claim Form: Part A (filled by you) and Part B (filled by the hospital).
Discharge Summary: Must mention the history and line of treatment.
Final Bill & Receipts: Itemized bill with original payment receipts.
Test Reports: All X-rays, Blood reports, Scans with doctor’s prescription.
KYC: Cancelled cheque (with name printed) and ID proof.
Exclusions in Policy
Exclusions in Policy
Permanent Exclusions in Health Insurance Policy
Permanent Exclusions in Health Insurance Policy
Investigation & Evaluation: Admission primarily for diagnostics, observation, or evaluation with no active treatment.
Rest Cure, Rehabilitation, & Respite Care: Admissions for bed rest, custodial care, or nursing without active medical treatment.
Obesity / Weight Control: Surgery or treatment for obesity/weight loss (unless critical criteria met under specific policy riders).
Change of Gender Treatments: Any treatment to change bodily characteristics to those of the opposite sex.
Cosmetic / Plastic Surgery: Surgery to change appearance (unless for reconstruction following an accident/cancer/burns).
Hazardous or Adventure Sports: Injuries from professional or semi-professional participation in activities like skydiving, scuba diving, mountaineering, racing, etc.
Breach of Law: Treatment arising from the Insured committing or attempting to commit a breach of law with criminal intent.
Excluded Providers: Treatment from Medical Practitioners or Hospitals specifically excluded by the insurer (listed on the insurer website).
Alcohol, Drugs & Substance Abuse: Treatment for alcoholism, drug or substance abuse, or conditions attributable to them.
Dietary Supplements: Vitamins, minerals, and tonics unless prescribed as part of a hospitalization claim.
Refractive Error: Correction of eyesight (Laser/Lasik) for refractive error less than 7.5 diopters.
Unproven Treatments: Treatments considered experimental or unproven.
Sterility and Infertility: IVF, contraception, sterilization, assisted reproduction, and related treatments.
Maternity: Pregnancy, childbirth, abortion, miscarriage, and complications (unless a specific Maternity Benefit is purchased).
Specific Exclusions in Health Insurance Policy
Specific Exclusions in Health Insurance Policy
War & Nuclear Perils: Damage caused by war, invasion, nuclear energy, or radiation.
Suicide / Self-inflicted Injury: Intentional self-injury or attempted suicide.
External Congenital Anomalies: Visible congenital defects.
Dental & Routine Eye Care: Dental treatment (unless requiring hospitalization due to accident) and routine eye exams/contact lenses/spectacles.
Non-Medical Items: Expenses for items like gloves, masks, hygiene products, etc. (unless "Claim Shield" or similar rider covers them).
Alopecia / Wigs: Treatment for baldness, wigs, or toupees.
Circumcision: Unless medically necessary for treatment of a disease or accident.
Treatment & Dieases
Treatment & Dieases
Standard Waiting Periods (New Policy):
Initial Waiting Period: 30 Days.
Named Ailment Waiting Period: 24 Months.
Pre-Existing Disease (PED) Waiting Period (Section 4.1.a): 36 Months (Reduced from the older 48-month standard in recent product filings).
1. Major Medical Conditions
1. Major Medical Conditions
(Stroke, CABG, Cancer, Organ Transplant, Renal Failure, Multiple Sclerosis, Benign Brain Tumor, Parkinson's, Alzheimer's, etc.)
(Stroke, CABG, Cancer, Organ Transplant, Renal Failure, Multiple Sclerosis, Benign Brain Tumor, Parkinson's, Alzheimer's, etc.)
Standard Initial Waiting Period: 30 Days (Clause 4.1).
If declared as PED (Clause 4.3): 36 Months (3 years).
Portability: Full credit for the time served with the previous insurer is provided.
Reduction Add-on: The "Modification of PED Wait Period" rider allows you to reduce the 36-month wait to 1 Year (12 months) or 2 Years (24 months).
2. Lifestyle Conditions
2. Lifestyle Conditions
(Diabetes, Hypertension, Hyperlipidemia, and Asthma)
(Diabetes, Hypertension, Hyperlipidemia, and Asthma)
Standard Initial Waiting Period: 30 Days.
If declared as PED (Clause 4.3): 36 Months.
Add-on Benefit ("Instant Cover"): This rider specifically covers Hypertension, Diabetes, Hyperlipidemia, and Asthma after an initial wait of only 30 Days, even if they are pre-existing.
Note: Epilepsy is not included in the "Instant Cover" rider; it follows the standard 36-month PED wait.
3. Specific Ailments (Named Ailments)
3. Specific Ailments (Named Ailments)
(Cataract, Hysterectomy, Stones (Calculi), Hernia, Piles, Fistula, Varicose Veins, Benign Prostatic Hypertrophy)
(Cataract, Hysterectomy, Stones (Calculi), Hernia, Piles, Fistula, Varicose Veins, Benign Prostatic Hypertrophy)
Waiting Period (Clause 4.2): 24 Months (2 years).
If declared as PED: The 36-month PED wait usually overrides the 24-month specific ailment wait.
Critical Exception: The 24-month wait is waived if any of these conditions are necessitated due to Malignancy (Cancer). In such cases, only the 30-day initial wait applies.
4. Joint Replacement
4. Joint Replacement
Waiting Period (Clause 4.2): 24 Months.
Accident Exception: If a joint replacement is required due to an Accident, the waiting period is 0 days (covered from Day 1).
If declared as PED: 36 Months.
5. Mental Health, Dental, and Sleep Apnea
5. Mental Health, Dental, and Sleep Apnea
Psychiatric/Mental Health: Covered under "In-patient Care" up to the Sum Insured after the 30-day initial wait (provided it is not a PED).
Dental Treatment: Generally Excluded unless it arises from an Accidental Injury that requires at least 24 hours of hospitalization.
Sleep Apnea: Typically listed under Permanent Exclusions (traceable to Obesity/Lifestyle/Respiratory arrest during sleep) unless specifically mentioned as covered in the policy certificate for a particular medical necessity.
6. Cataract Details
6. Cataract Details
Waiting Period: 24 Months.
Monetary Limit: There is no sub-limit specified in the Care Supreme prospectus for Cataract. It is covered up to the Sum Insured.
Lens & Room Rent: Since there is no room rent cap (for SI ≥ 5L), all associated medical expenses (surgeon fees, OT, lens cost) are paid in full without proportionate deductions.
7. Consumables (Non-Medical Items)
7. Consumables (Non-Medical Items)
Claim Shield (Add-on): Covers 68 non-payable items (gloves, masks, syringes, etc.) that are otherwise excluded from standard hospital bills.
Our Verdict
Our Verdict
We view Care Supreme as a 'pure' medical policy. It doesn't distract you with maternity or OPD gimmicks in the base plan; instead, it provides the most robust hospitalisation protection in the market. The Unlimited Automatic Recharge is the standout feature—it works even for the same illness, which is rare. However, we always advise our clients to check their current health status—if you have a history of Diabetes or BP, the Instant Cover rider is not an option; it's a necessity to avoid the 3-year wait.
Comparisons
Comparisons
Free Health Insurance Gap Analysis Report
Free Health Insurance Gap Analysis Report
At Diversified Solutions, our Health Gap Analysis is a diagnostic "stress test" for your current insurance. Most clients assume they are 100% covered until they face a claim; we ensure that "reality" matches your "policy wording."
What we provide in a Health Gap Analysis:
What we provide in a Health Gap Analysis:
Blind-Spot Detection: We identify "hidden" sub-limits on room rent, ICU charges, and specific surgeries that could lead to massive out-of-pocket expenses.
The UIN Check: We verify the specific Unique Identification Number of your policy to ensure you aren't relying on outdated prospectus terms or older version exclusions.
Restoration Audit: We evaluate if your "Refill" or "Restoration" benefit actually covers the Same Illness (critical for 2025) or if it has a waiting period between claims.
Wait-Period Mapping: We map exactly when your Pre-Existing Diseases (PED) and "Named Ailments" (like cataracts or stones) become payable, so you aren't surprised by a 24-month rejection.
Consumables Review: We check if your policy covers non-medical items (gloves, masks, PPE) which often form 10-15% of modern hospital bills.
How you benefit:
How you benefit:
Claim Certainty: No "hidden surprises" during a medical emergency; you know exactly what will be paid.
Cost Efficiency: Stop paying for duplicate covers or riders you don’t need while filling gaps that actually matter.
Portfolio Sync: We align your corporate (office) policy with your personal plan to ensure seamless double-coverage benefits.
Future Proofing: Ensures your coverage evolves with your life stages (maternity, senior citizen needs, or new health diagnoses).
Important Accuracy & Liability Notice:
While every effort has been made to ensure the accuracy of the information provided, insurance is a complex subject governed by specific legal wordings. Please note:
UIN Verification: Policy features and exclusions can change with version updates. Always refer to the Prospectus with the exact Unique Identification Number (UIN) matching your policy.
Interpretation Disclaimer: The details provided here are based on our professional understanding of the policy clauses. However, in the event of any ambiguity or unintentional error in representation, the Official Policy Wordings issued by the insurer shall prevail.
Verification Advised: We strongly recommend that you read the relevant sections of the provided Prospectus or Policy Kit to confirm specific details before making a purchase. Diversified Solutions shall not be held liable for any decisions made based on unintentional errors or misinterpretations of the policy document.
the UIN (Unique Identification Number) is the DNA of an insurance policy in India. Relying on it is the only way to ensure that the "Prospectus" or "Policy Wordings" you are reading actually matches your policy.
Why the UIN is Critical
Version Control: Insurers frequently update products (e.g., Care Supreme v1 vs. v2). While the marketing name stays the same, the UIN changes with every significant revision. A small change in the UIN (like a version suffix) can mean the difference between having "Unlimited Restoration" and "Restoration with a 45-day gap."
Standardization Compliance: Since the IRDAI’s 2020 and 2024 mandates on standardization, many old policies were revised to include modern benefits (like Modern Treatments or Mental Healthcare). If you look at an old prospectus without matching the UIN, you might miss these mandatory inclusions or updated exclusion wordings.
Legal Validity: In the event of a claim dispute, the Ombudsman or court will refer specifically to the policy wordings associated with the UIN mentioned on the Policy Schedule.
Rider Integration: Often, features like "Consumables Cover" have their own UINs. Checking the base policy UIN ensures you know exactly which riders are compatible and how they interact with the base terms.
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