• Care Joy Maternity & Newborn Cover with Health Insurance

    Health Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    Care Health Insurance is a standalone health insurance service provider in India. The company focuses on health insurance for people with different kinds of requirements. Care Joy Maternity & Newborn Cover is a policy that combines the benefits of both maternity cover and health insurance in a single plan. While maternity benefit is the primary focus of this cover, it also provides a range of other benefits against hospitalisation.

    Eligibility for Care Joy Maternity & Newborn Cover

    Customers who wish to subscribe to Care Joy Maternity & Newborn Cover must have the following eligibility criteria. Some of the eligibility criteria for this policy can be given as follows.

    • Adults who wish to enroll in this policy must be at least 18 years old.
    • Dependent children can be covered from day 1 up to 24 years of age.
    • The maximum entry age for this cover is 45 years.
    • Once enrolled, lifelong renewability is available with this policy cover.
    • This policy can be availed as a family floater cover, and it offers coverage for up to 6 members in a family.

    Features of Care Joy Maternity & Newborn Cover

    Some of the key features of this policy can be listed as follows.

    • This policy is available in two different plans - Joy Today and Joy Tomorrow - based on the types of benefits offered.
    • There are two different sum insured options available under this policy cover - Rs.3 lakh and Rs.5 lakh.
    • All pre-existing diseases have a waiting period of 48 months.
    • There is an initial waiting period of 30 days for all kinds of illnesses. However, this waiting period does not apply for accidental hospitalisation.
    • Pre-hospitalisation medical expenses are covered for up to 30 days before the date of hospitalisation.
    • Post-hospitalisation medical expenses are covered for up to 60 days after discharge from a hospital.
    • Maternity cover is available only up to 45 years of age.
    • Maternity waiting period under ‘Joy Today’ plan is 9 months. For ‘Joy Tomorrow’ plan, the waiting period is 24 months.
    • For conditions such as arthritis, cataract, benign prostatic hypertrophy, hernia, hydrocele, etc., a waiting period of 24 months is applicable.
    • A mandatory copayment of 20% of the sum insured is required if the eldest member enrolled in this policy cover is over 61 years of age at the time of entry.
    • Policy term for this cover is flexible, and it ranges from 1 year to 3 years.
    • There is a grace period of 30 days from the date of expiry to renew this policy cover.

    Benefits of Care Joy Maternity & Newborn Cover

    The benefits offered by Care Joy Maternity & Newborn Cover can be given in the following table.

    In patient care Up to the sum insured limit
    Day care treatment Available
    Ambulance cover Up to Rs.1,000 per hospitalisation
    Maternity cover (pre-natal and post-natal expenses included) Up to Rs.35,000 for sum insured Rs.3 lakh Up to Rs.50,000 for sum insured Rs.5 lakh
    Coverage for newborn baby Up to Rs.30,000 for sum insured Rs.3 lakh Up to Rs.50,000 for sum insured Rs.5 lakh
    Newborn birth defects Lump sum payment of Rs.50,000 (only under Joy Tomorrow plan)

    Exclusions of Care Joy Maternity & Newborn Cover

    There are multiple exclusions for which Care is not liable to compensate the insured. Some of the key exclusions under this cover can be listed as follows.

    • Any expenses related to self-inflicted injuries or attempted suicide
    • Treatment for sexually transmitted diseases, venereal diseases, HIV, AIDS, etc.
    • Expenses related to drug or alcohol misuse
    • Treatment for fertility or birth control procedures
    • Non-allopathic treatment and treatment taken from anyone who is not a medical practitioner
    • Cost of spectacles, dentures, artificial teeth, or other similar external appliances
    • Expenses related to unproven or experimental treatments
    • Congenital diseases, birth defects, and anomalies
    • Any kinds of cosmetic or aesthetic treatments
    • Treatment related to mental illness, psychological disorders, or stress
    • Circumcision unless necessitated by a medical treatment
    • Any kinds of preventive care including vaccination and inoculation
    • Artificial life support where the treatment does not result in recovery of health
    • Hospitalisation primarily for diagnostic purposes
    • Injuries caused while breaching the law with criminal intent
    • Injuries or illnesses caused due to war or warlike activities
    • Injuries or illnesses caused by nuclear weapons, chemical weapons, biological weapons, or radioactivity
    • Expenses related to personal comfort and convenience items
    • Any treatment for substance abuse issues

    Claim Procedure

    Following the occurrence of an event that may give rise to a claim, the company must be notified immediately. For planned hospitalisation, the company must be notified at least 48 hours prior to admission in a hospital. In case of emergency hospitalisation, the company can be notified 24 hours after hospitalisation. Both cashless treatment and reimbursement claims are available with Care.

    Cashless treatment: Pre-authorisation form can be obtained from the hospital’s help desk. The completed form must be sent to the company through fax. The company’s claim management team will verify the claim form and approve the request for cashless treatment. Even if the cashless treatment request is rejected at the time of hospitalisation, the insured can still apply for reimbursement claims.

    Reimbursement claim: To apply for reimbursement claims, the insured must submit the list of documents required for the claim. These documents may include medical bills, hospital bills, diagnostic reports, physician’s certificate, surgeon’s certificate, etc. Once the documents are submitted, Care will initiate the claim proceedings and verify the submitted documents. Once the verification process is over, the company will provide the settlement amount.

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