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Introduction

Before we start comparing these two policies we have to set out some ground rules.

Both products are marketed by different insurance companies. Care Plus Complete is sold by Care and Health Insurance Gold is sold by Edelweiss. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.

Second, we know that both products are reasonably comprehensive. They do the basics quite well, but they won’t have all the bells and whistles (Think extensive coverage for international, dental, maternity and other such matters). So if you are looking for something else entirely, then both these policies may not cut it.

And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?

That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.


Let’s start with Care Plus Complete. The product comes from Care’s stable:

Care Health Insurance (formerly Religare Health Insurance) was founded in 2012. And in that time, they’ve managed to corner a large part of the Indian Insurance market.

What’s more impressive?

Care Health Insurance has a remarkable claim settlement ratio of 90% and a network of more than 16,000+ hospitals.


Health Insurance Gold meanwhile comes from Edelweiss’s stable:

Edelweiss Health Insurance company was founded in 2017 when they were hived off the homegrown Edelweiss Financial Services Limited. The company provides an array of products across multiple categories and they boast a claim settlement ratio of almost 92% with more than 6,200 network hospitals.

The only problem is - They’re still trying to find a firm foothold in the market.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
16,000+
6,200+
Claim settlement ratio

(avg. of last 3 years)

90%
92%
Co-payment

No

No

Room rent

Single Private room

Single Private room

Disease sub-limit

No

No

Pre existing diseases waiting

3 years

3 years

Pre/Post hospitalization

60/90 days

60/90 days

No claim bonus

50% per year

(up to 200%)

50% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(unlimited no. of times

for any illness)

100% restoration

(once for different illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹50,000 after 4 years)

Out Patient Department

Up to ₹1,500

(cap of ₹350 on each consultation)

Day care

Feature Comparison

coPay

Co payment

With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Care Plus Complete doesn’t impose a co-payment clause. And neither does Health Insurance Gold.

roomRent

Room rent

If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Care Plus Complete lets you stay in a single private room and Health Insurance Gold also lets you stay in a single private room. Nothing fancy.

diseaseSublimit

Sub limits

Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, neither Care Plus Complete imposes disease-wise sub-limits nor does Health Insurance Gold

ped

Waiting periods for pre-existing diseases

If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Care Plus Complete imposes a 3 year waiting period on pre-existing diseases and Health Insurance Gold will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases

prePost

Pre and post Hospitalization expenses

Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Care Plus Complete covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Health Insurance Gold covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits

ncb

No claim bonus

Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. And in this case, Care Plus Complete offers a no-claim bonus of 50% and Health Insurance Gold similarly extends a 50% no-claim bonus.

domiciliary

Domiciliary

Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Care Plus Complete offers domiciliary cover. And Health Insurance Gold also coves domiciliary expenses.

ayush

Ayush treatments

Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Care Plus Complete covers Ayush procedures and Health Insurance Gold also extends coverage for Ayush treatments.

maternity

Maternity benefits

If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, however, Care Plus Complete doesn’t offer protection for maternity-related hospitalizations whereas Health Insurance Gold offers maternity cover.

opd

Out Patient Department (OPD)

Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Care Plus Complete offers OPD cover whereas Health Insurance Gold doesn’t offer OPD protection.

Final Conclusion

After considering all the features on hand, we believe that Health Insurance Gold is a better alternative to Care Plus Complete for most use cases that we’ve evaluated so far.

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