Policy Library

RAG-indexed policy documents with AI-highlighted clauses and coverage notes

Policy Documents

3 documents indexed

Care Health Insurance — Comprehensive Plan 2024

Insurer: Care Health Insurance � v2024.2 � Updated Jan 2026

AI Analysis Note

This policy has 3 clauses flagged as high-risk for denial: Dengue sub-limit (4.2b), Room entitlement (6.1), and Non-disclosure (10.1). Recommend auto-checking these on every claim ingestion.

Section 2.3Page 4

Waiting Period Rules

Retail policies: 2-year minimum waiting period for pre-existing conditions. Corporate plans: no waiting period.

Section 3.1Page 5

Cashless Settlement

Cashless facility available at 10,000+ network hospitals. Pre-authorization mandatory within 4 hours of admission.

Section 4.2(b)Page 7

Dengue Sub-limit

Dengue fever treatment capped at ₹3,00,000 per policy year. Excess billing to be borne by the insured.

Section 5.1Page 11

Surgical Procedures

All listed surgical procedures covered as per Schedule II. Non-listed procedures require prior approval.

Section 6.1Page 12

Room Entitlement

General ward: ₹3,000/day. Single AC room: ₹5,000/day. ICU/ICCU: actuals as per policy variant.

Section 7.1Page 14

Diagnostic Tests

Diagnostic tests must be prescribed by attending physician. Protocol limits apply per disease category.

Section 10.1Page 21

Non-Disclosure Policy

Material non-disclosure of pre-existing conditions at policy inception may result in claim rejection and policy termination.