Religare CARE Freedom Health
- Religare Health Insurance is a specialist Health Insurance engaged in the distribution & servicing of Health Insurance Products .
- Religare is promoted by the founders of Fortis Healthcare, which owns or manages 54 healthcare facilities in India, Dubai & Mauritius.
- Religare Health Insurance Company started the operation in the year 2012 and expertise in the spectrum of financial services, and preventive health solutions.
- Religare CARE has been awarded as one of the best medical insurance product in 2015.
CARE FREEDOM SUM INSURED OPTIONS (IN LACS)
It is a health cover for the people above 45 years of age with cashless or reimbursement facility.
IN PATIENT TREATMENT
This policy is a comprehensive package of inpatient treatment that covers hospitalisation expenses up to sum insured.
If the patient is admitted in hospital for a minimum period of 24 consecutive hours the treatment expenses are covered.
Medical expenses for in-patient treatment for:
- Doctors’ fees .
- Professional charges
- Blood, oxygen , Operation Theater Charges.
- Surgeons Fees.
- Diagnostics procedures .
- Medicines, drugs and consumables.
- Operation Theater charges .
- Intensive Care Unit charges.
- Other medical charges.
In this policy the expenditure related to hospitalization post 24 hours are being covered like room rent , ICU charges.
PRE&POST HOSPITALIZATION EXPENSES
Consultations, Diagnostics tests and any Medication required Pre Hospitalization up to 30 days is covered or similar medical expenses required Immediately after being discharged from hospital for up to 60 days will be covered under the same policy.
DAY CARE PROCEDURE
They cover the medical expenses incurred for various surgeries that do not require a minimum of 24 hours of hospitalization under the Day Care Treatment Benefits.
Religare covers 171 listed day care procedures in care freedom.
EMERGENCY AMBULANCE COVER
Religare covers the expenses incurred by the Insured on availing Ambulance services for necessary transportation to the nearest Hospital in case of an Emergency.
It is a treatment taken at home because the insured is not in a condition to be transferred to hospital with the doctors approval or the insured satisfies the insurance company that the beds were not available in the hospital.
As far as it involves medical treatment for a period exceeding 3 consecutive days this feature will be covered.
ANNUAL HEALTH CHECK UP
This policy provides all insured with a Complimentary Annual Health Check-up, at any time during the policy year.
Non medical expenses which are spent on daily basis like consumables, transportation, attendants cost etc all these expenses are met by the company with a lump sum per day for each day of hospitalization.
The Recharge shall be utilized only after the Sum Insured, No Claims Bonus have been completely exhausted in that Policy Year.
The Recharge shall be available only for all future Claims and not in relation to any Illness or Injury for which a Claim has already been admitted for that Insured Person during that Policy Year.
The Recharge will only be applied once for the Insured Person during the Policy Year up to sum insured.
Any unutilized Recharge cannot be carried forward to any subsequent Policy Year.
Religare pays a lump sum amount to the Insured Person if admitted in Hospital for treatment of any One Illness or Injury arising from an Accident during the Policy Period.
Once the Hospitalization exceeds 10 consecutive days, Religare is liable to make payment under this Benefit more than once in a Policy Year.
Religare covers Rs.1,000 per sitting payable up to 24 consecutive months for the dialysis expenses incurred by you.
Religare will not make any payment under this benefit with respect to kidney disease which occurred and was diagnosed as a Chronic Condition prior to the Policy Start Date.
DISEASE WISE SUB LIMIT
OPTIONAL BENEFIT -GOOD HEALTH +
Religare provides up to 8 consultations with their Network Service Providers up to a limit with a Co-payment as per the base plan.
Religare provides discounts at the pharmacies of the Network Service Providers and wellness centers of the Network Service Providers em paneled with them.
OPTIONAL BENEFIT-HOME CARE
Religare covers the expenses for hiring a Qualified Nurse and providing care and convenience to the Insured Person to perform his daily activities, recommended by a Medical Practitioner in writing.
But they will not cover the expenses for more than 7 consecutive days arising from any One Illness or an Injury and for the first day of hiring the Qualified Nurse subject to a maximum of 45 days in a Policy Year per Insured Person.
HEALTH CHECK +
Religare Benefits you with the Annual Health Check – up upgraded to either Diabetes Health Check – up or Cardiac Health Check – up.
The customers avail the following set of tests under the upgraded annual health check-up:-
If the age of the eldest member is 71 years or above at entry, then there will be a co-payment of 30%per claim by 10% increase of final amount payable and liability shall be restricted to the balance amount, subject to the availability of the Sum Insured.
But if the insured doesn’t want the increase in the co-payment from 20% to 30%,they should pay an extra premium In this regard.
Any regular Medication, Past Surgery, or any Medical condition or Past Accidental Injury will qualify as
Pre -existing Disease or condition and the same will have a Waiting Period.
PED waiting is 2 years in CARE FREEDOM Plan.
- Any claim for or arising out of following critical illness or surgical procedure will not be covered for 2 years.
- Any treatment related to Arthritis, Osteoarthritis and Osteoporosis, Gout, Rheumatism, Spinal Disorders(unless caused by accident), Joint Replacement Surgery(unless caused by accident), Arthroscopic Knee Surgeries/ACL Reconstruction/Meniscal and Ligament Repair
- Surgical treatments for Benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to Adenoidectomy, Mastoidectomy, Tonsillectomy and Tympanoplasty), Nasal Septum Deviation, Sinusitis and related disorders
- Benign Prostatic Hypertrophy
- Dilatation and Curettage
- Fissure / Fistula in anus, Hemorrhoids / Piles, Pilonidal Sinus, Gastric and Duodenal Ulcers
- Surgery of Genito-urinary system unless necessitated by malignancy
- All types of Hernia & Hydrocele
- Hysterectomy for menorrhagia or Fibromyoma or prolapse of uterus unless necessitated by malignancy
- Internal tumours, skin tumours, cysts, nodules, polyps including breast lumps (each of any kind) unless malignant
- Kidney Stone / Ureteric Stone / Lithotripsy / Gall Bladder Stone
- Myomectomy for fibroids.
- Varicose veins and varicose ulcers.
- End stage liver disease.
- Procedures for Retinal disorders.
- Cerebrovascular accident.
- Renal Failure / End Stage Renal Disease.
- Myocardial Infarction.
- Heart Failure; Arrhythmia / Heart blocks.
- All types of Cancer.
- Any condition directly or indirectly caused by or associated with any sexually transmitted disease, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
- Any treatment arising from or traceable to pregnancy (including voluntary termination), miscarriage
- (unless due to an accident), childbirth, maternity (including caesarian section), abortion or
- complications of any of these. This exclusion will not apply to ectopic pregnancy.
- Any treatment arising from or traceable to any fertility, sterilization, birth control procedures, contraceptive supplies or services including complications arising due to supplying services or Assisted Reproductive Technology
- Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline for which he is licensed or any kind of self-medication.
- Charges incurred in connection with cost of routine eye and ear examinations, dentures, artificial teeth and all other similar external appliances and / or devices whether for diagnosis or treatment.
- Unproven/Experimental or investigation treatments which are not consistent with or incidental to the diagnosis and treatment of the positive
- Existence or presence of any Illness for which confinement is required at a Hospital. Any Illness or treatment which is a result or a consequence of undergoing such experimental or unproven treatment.
- Expenses incurred on High Intensity Focused Ultra Sound, Balloon Sinuplasty, Enhanced External Counter Pulsation Therapy and related therapies. Deep Brain Simulation, Hyperbaric Oxygen Therapy, Robotic Surgery, Holmium Laser Enucleation of Prostate, KTP Laser surgeries, Femto laser surgeries and such other similar therapies.
- Any treatment related to sleep disorder or sleep apnea syndrome, general debility convalescence, cure, rest cure, health hydros, nature cure clinics, sanatorium treatment, Rehabilitation measures, private duty nursing, respite care, long-term nursing care, custodial care or any treatment in an establishment that is not a Hospital.
- Treatment of any genetic disorder or Congenital Anomaly or Illness or defects or anomalies or treatment relating to birth defects.
- Treatment of mental illness, stress or psychological disorders.
- Aesthetic treatment, cosmetic surgery or plastic surgery or related treatment of any description, including any complication arising from these treatments, other than as may be necessitated due to an Injury, cancer or burns.
- Any treatment / surgery for change of sex or gender reassignments including any complication arising from these treatments.
- Circumcision unless necessary for treatment of an Illness or as may be necessitated due to an Accident.
- All preventive care, vaccination, including inoculation and immunizations (except in case of post-bite treatment), vitamins and tonics.
- Non- allopathic treatment.
- Any OPD Treatment.
- Treatment received outside India.
- Charges incurred at Hospital primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury, for which In-patient Care/ Day Care Treatment is required and detainment of all kinds.
- Any implant in the body.
- Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured Person with any criminal intent.
- Act of self-destruction or self-inflicted Injury, attempted suicide or suicide while sane or insane or Illness or Injury attributable to consumption, use, misuse or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
- Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness.
- Personal comfort and convenience items or services including but not limited to T.V. (wherever specifically charged separately), charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), cosmetics, hygiene articles, body or baby care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies.
- Expenses related to any kind of RMO charges, service charge, surcharge, night charges levied by the hospital under whatever head.
- Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion.
- Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile/ fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating disablement or death.
- Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.
- Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.
- In addition to the foregoing, any loss, claim or expense of whatsoever nature directly or indirectly arising out of, contributed to, caused by, resulting from, or in connection with any action taken in controlling, preventing, suppressing, minimizing orin any way relating to the above shall also be excluded.
- Impairment of an Insured Person’s intellectual faculties by abuse of stimulants or depressants
- Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.
- Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
- Multifocal lens implantation for cataract.
- Remicade, Avastin & similar injectable treatment.
- Oral Chemotherapy.
- Any claim related to Hazardous Activities.
- If the Insured Person is suffering from or has been diagnosed with or has been treated for any of the following disorders prior to the first Policy Start Date, then costs of treatment related to or arising from the disorder whether directly or indirectly will be permanently excluded from coverage under the Policy:-
- Chronic Bronchitis.
- Any expenses incurred on prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, walkers, belts, collars, caps, splints, braces, stockings of any kind, diabetic footwear,glucometer/thermometer, crutches, ambulatory devices, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition, cost of cochlear implants & related surgery.
- War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
- Esophageal Stricture or stenosis.
- IUnoperated Varicose Veins.
- Deep Vein Thrombosis (DVT).
- Spondyloarthropathies (Spondylosis/Spondylitis/Spondylolisthesis).
- Residual Poliomyelitis.
- Avascular Necrosis, Idiopathic.
- Unoperated Hyperthyroidism.
- Unoperated Fibroid Uterus.
- Retinal Detachment.
1)ROOM RENT ,ICU CHARGES :-
- Any Hospital – 1% of sum insured or Twin sharing room or Single Private Room Depending on the Sum Insured Opted for Room Rent.
- Up to 2% or No Limits Depending on the sum Insured Opted for ICU .
2)PRE-POST HOSPITALIZATION :- 30 days before and 60 days after the hospitalization expenditure are covered for same illness.
3)EMERGENCY AMBULANCE :-Emergency Ambulance covered up to 1000 Per Hospitalization
4)PRE-EXISTING WAITING PERIOD:- 2 years waiting period for Pre Existing Diseases .
5)CO-PAYMENT:- Co-payment up to 30% per claim, where age of Insured / eldest member is 71 years or above at entry.
6)SPECIFIC DISEASES WAITING PERIOD:- 2 years of waiting period for specific diseases.
7)DAY CARE PROCEDURES:- 171 day care procedures are covered.