Care Health Insurance Company’s Claim Settlement Ratio 2025

In assessing health insurance companies, metrics such as the Care Health Insurance Company's Claim Settlement Ratio are also considered. However, reliability involves more than just statistics. Because life is unpredictable, unexpected medical crises can happen, and having a reliable insurance partner can make all the difference. In addition to providing coverage, the ideal insurer offers assurance during difficult times.

It is essential to comprehend Care Health Insurance Company's Claim Settlement ratio because of this. We'll examine its notable characteristics and unique selling points in the highly competitive insurance market in more detail in this article. Having a comprehensive understanding of claim settlement efficiency can help you make well-informed decisions for your financial and health well-being, whether you're comparing options or exploring new plans.

What Is The Claim Settlement Ratio And How Is It Calculated?

The claim settlement ratio is one of the metrics to take into account when assessing the dependability of a health insurance company. This ratio provides information about an insurer's efficiency by showing the proportion of claims that are successfully settled in proportion to the total number of claims received during a specific fiscal year.

It is very easy to calculate:

Claim Settlement Ratio = (Number of claims settled) ÷ (Number of claims received + Outstanding claims at the start of the year) × 100

It's important to understand that this figure doesn't provide the complete picture, even though insurers often cite it as a sign of credibility. Although a high ratio seems welcoming, the processing of claims is also influenced by other factors.

We'll examine Care Health Insurance Company's Claim Settlement Ratio in more detail in the following section, along with other important details that can help you make an informed choice.

Care Health Insurance Company’s Key Features and Benefits

One of India's standalone health insurance companies is Care Health Insurance, formerly Religare Health Insurance Company Limited. A wide range of products, including health insurance policy, top-up coverage, maternity insurance, critical illness plans, personal accident insurance, and international travel insurance, are offered by the organisation, which serves both individuals and corporations. For corporate clients, it also offers group health and group personal accident insurance.

Mr. Anuj Gulati serves as the company's CEO and MD. It was founded in 2012 and has its headquarters in Gurugram, Haryana.

Key Performance Indicators

Here’s an overview of the various aspects:

These figures highlight Care Health Insurance Company’s efficiency in handling claims and customer service. While numbers paint a picture of reliability, it’s always beneficial to assess additional factors before choosing a health insurance provider.

Source: Care Health Insurance Company’s website and Public Disclosure for the financial year 2023-2024

Care Health Insurance Company’s Benefits:

When unforeseen medical expenses arise, health insurance serves as a safety net. What's the biggest advantage? You won't have to take money out of your hard-earned savings because it drastically lessens the burden of medical bills. A decent health insurance plan covers a wide range of medical needs, from hospital stays to necessary treatments, and provides important benefits like:

1. Inpatient Hospitalisation Coverage
   Health insurance relieves the financial burden when a hospital stay is inevitable. If a patient stays in the hospital for at least 24 hours straight, most policies will cover inpatient care. A significant amount of the cost, sometimes even the whole amount, is covered once this condition is fulfilled. This covers hospital-related costs such as room rent, nursing fees, diagnostic testing, and surgery.
    
2. Pre- and Post-Hospitalisation Coverage
   The cost of medical care doesn't start and stop with just hospitalisation. Costs incurred prior to and following hospitalisation are covered by health insurance for a predetermined period of days. Pre-hospitalisation costs are covered only if they are directly related to the medical condition for which the inpatient claim has been approved. Similarly, post-hospitalisation expenses must be directly linked to the treated condition and fall under the approved inpatient hospitalisation category.
    
3. Coverage For Daycare Treatments
   Several procedures no longer necessitate an overnight hospital stay because of medical improvements. These daycare treatments are covered by your health coverage, so you don't have to worry about paying for quick but necessary procedures like chemotherapy, gallbladder removal, hernia treatments, etc.
    
4. Domiciliary Treatment Coverage
   Hospitalisation isn't always an option, either because there aren't enough hospital beds or because of a serious medical condition that makes mobility impossible. Health insurance coverage takes over in these situations to pay for domiciliary treatments, guaranteeing that you can get the care you need in the convenience of your own home without worrying about finances.
    
5. Early Detection Via Preventive Health Screening
   Health insurance understands that prevention is always superior to treatment. Regular health examinations are covered by many plans, which aid in the early detection of possible health issues. Periodic tests can identify problems early on, enabling prompt treatment and improved long-term health.
    
6. No Claim Bonus
   Many health insurance plans include a No Claim Bonus (NCB) as an expression of appreciation for not filing any claims during a policy year. This bonus gives you rewards for staying healthy and avoiding needless medical bills by either raising your sum insured or lowering your premium at renewal.
    
7. Cashless Services: Instant Access
   The cashless treatment facility is one of the primary perks of health insurance. It spares you from having to pay up front for medical services at network hospitals. The insurance company pays the hospital directly rather than you paying out of pocket and then requesting reimbursement. When time and money are of the essence during medical situations, this feature is extremely beneficial. Only any extra costs not covered by your policy will need to be paid for.
    
8. Tax Benefits For Additional Savings
   In addition to providing medical protection, health insurance policies lower your tax liability. Under Section 80D of the Income Tax Act, you can claim deductions on the premiums you pay for your health insurance policy, subject to certain terms and conditions. Additional benefits are provided if the coverage includes dependent parents or senior citizens, and the deduction amount varies depending on the insured individuals.

Health insurance acts as a dependable financial safety net against unforeseen medical costs, covering everything from hospitalisation and preventive care to tax benefits and additional protection options. But it's crucial to keep in mind that different insurers have different policies; terms, conditions, and coverage details might vary greatly. Therefore, always carefully read the policy documents to learn what is covered. Furthermore, tax benefits are subject to current tax legislation and are susceptible to change over time.

What Is The Care Health Insurance Company's Claim Settlement Ratio?

The claim settlement ratio of Care Health Insurance Company as of March 2024 is 90.50%. (Source: Public Disclosure, FY: 2023-24).

What Is The Claim Process Of Care Health Insurance?

There are two ways that Care Health Insurance Company accepts claims-

Cashless Claim

If you are treated in a hospital which is covered in the network of the insurer, you can select this option. The insurance company is affiliated with a network of hospitals to simplify the procedure for you. If you choose a hospital from the insurer’s list of approved cashless facilities, your medical expenses will be settled directly with the hospital. You would only need to pay for costs that are not covered by your health insurance policy.

Step-by-Step Guide to Filing a Cashless Claim

Making a cashless claim reduces financial stress during hospitalisation by promising that your insurance company will pay for your medical bills directly. Take these essential steps to ensure a seamless process:

1. Verify Hospital Eligibility
   Make sure the hospital you have selected accepts cashless claims and is included in your insurer's network of hospitals before being admitted. Also, look for any exclusions that can have an impact on your claim.
    
2. Identify Policy Terms And Potential Out-of-Pocket Expenses
   Examine the terms, conditions, and limitations of your health insurance coverage to determine what costs you may be liable for out of your own pocket.
    
3. Compile Necessary Documents
   Have all necessary documents on hand, including:
4. 1. A copy of your insurance policy
   2. Health card or cashless card
   3. PAN and Aadhaar of the proposer and a passport-size photo
   4. Patient identification and policy details
       
5. Gather Documents
   To file a cashless claim, gather the policy copy, the proposer's PAN and Aadhaar, patient identification, medical reports, or a doctor's prescription, among other necessary documents.
    
6. Make A Cashless Claim Request
   1. For planned hospitalisations, submit the request 3-4 days in advance.
   2. For emergency hospitalisations, notify the insurer within 24 hours of admission.
       
7. Fill Out The Pre-Authorisation Form
   Collaborate with the hospital's insurance desk to provide your insurer with the required documentation. Typically, this consists of:
8. 1. KYC documents (PAN, Aadhaar)
   2. Health card
   3. Details of the patient's ID
   4. Policy information like the policy number and the policyholder’s name.
   5. The insured person's name and address for whom the claim is being filed.
   6. Details of the illness/injury and the necessary treatment or surgery.
   7. Name and address of the treating medical practitioner.
   8. Expected date of hospital admission.
   1. Medical history (both related and unrelated to the current condition): Any inconsistencies from the disclosures made at policy inception may result in claim rejection.

If the pre-authorisation process takes longer than anticipated, be ready to give the hospital a deposit in advance.

7. Respond And Stay Updated Quickly
   Track the progress of your claim and promptly address any questions from the insurance company to prevent needless delays.
    
8. Verify Bills And Finalise Discharge
   Prior to your discharge, make sure you pick up the necessary paperwork from the hospital's insurance desk. Examine the discharge summary and final bill carefully to see which costs were covered and which weren't.
    
9. Pay Off Any Outstanding Expenses
   Be prepared to cover any out-of-pocket costs before you leave the hospital.
   Need assistance? Ask your insurer for clarification if you are unclear at any point, or get advice from a financial professional.

Reimbursement Claims

You will be responsible for paying the hospital bill and other medical costs up front if you receive treatment at a non-network hospital. In accordance with the terms and circumstances of your policy, your insurer will reimburse the applicable amount if you later file a reimbursement claim.

Step-by-Step Guide to Filing a Reimbursement Claim

Take these crucial actions to make sure of a simple and easy reimbursement process:

1. Check Hospital Eligibility
   Before admission, check if your chosen hospital is not on the list of excluded healthcare providers under your policy.
    
2. Give Your Insurer Timely Notice
   To start the claim procedure, notify your insurance company of the hospitalisation within 24 hours after admission.
    
3. Gather All Original Records
   Prior to discharge, collect and arrange any necessary documentation, such as:
4. 1. Hospital receipts & invoices
   2. Discharge summary & medical reports
   3. MRI/X-ray images & doctor’s prescriptions
   4. Signed claim form (a portion of which has to be filled by the hospital)
   5. Patient’s case sheet & detailed hospital bill

Make sure that every document appropriately includes the patient's name, gender, and age. If there are any mistakes, fix them right away.

4. Prepare Extra Documents
   In addition, you'll need:
5. 1. Health card & policy copy
   2. Proposer’s KYC (PAN, Aadhaar, and passport-sized photo)
   3. Patient’s ID proof
   4. Bank details for reimbursement or an original cancelled cheque that has the policyholder’s name printed on it.
   5. Intra Ocular Lens (IOL) sticker/Invoice (for implantation claims like cataract or knee replacement)

For your personal records, make copies of every document and maintain an organised file.

5. Submit The Documents And Claim Form
   After everything is in order, complete the claim form and send it to your insurer with the necessary documentation. Ask for a receipt of acknowledgement for everything that you submitted.
    
6. Communicate & Respond Promptly
   Following filing, keep a close eye on the progress of your claim and act fast to comply with any further documentation requirements from your insurer.
    
7. Examine The Settlement Details
   Check the claim settlement summary carefully, taking specific note of any deductions the insurer may have made.
   Do not hesitate to get in touch with your insurer or consult your financial counsellor if you need clarification or if you have any questions.

Documents Required For Care Health Insurance Company’s Claims

Filing a health insurance claim with Care Health Insurance Company may seem like a challenging process, but with the right documents in hand, it’s much smoother. Whether you’re opting for a cashless claim or a reimbursement claim, here’s what you’ll need:

Documents for Cashless Claims

If you’re receiving treatment at a network hospital, you’ll need to provide:

1. Health card issued by Care Health Insurance Company
2. KYC documents of the proposer, including the PAN card, Aadhaar card, Recent passport-size photographs, Patient’s identity proof, KYC details of the insured individual
3. Policy number & policyholder’s full name, Insured person’s full name & address (if different from the proposer)
4. Details of the illness or injury and recommended treatment or surgery
5. Contact details and address of the attending doctor
6. Expected hospital admission date
7. Medical history (related and unrelated to the current condition): any discrepancies from previous disclosures may lead to claim rejection

Documents for Reimbursement Claims

If you’ve been treated at a non-network hospital, you’ll first pay the bills out of pocket and then submit a reimbursement claim with the following:

1. Health card or a copy of the insurance policy
2. Proposer’s KYC documents, including:
   1. PAN card
   2. Aadhaar card
   3. Recent passport-size photograph
3. Bank details (any one of the following):
   1. Bank statement with printed bank name, account number, and IFSC code
   2. Passbook showing the latest transaction
   3. Original cancelled cheque with the policyholder’s name printed on it
4. Patient’s identity proof
5. Duly filled & signed claim form
6. All medical documents, test reports, prescriptions, receipts, and films related to treatment
7. Original discharge summary issued by the hospital
8. IOL (Intra Ocular Lens) sticker & invoice (if the claim involves implantation procedures like knee replacement or cataract surgery)

Pro Tip: Since documentation requirements can vary, it's always best to confirm with Care Health Insurance Company for any additional formalities before submitting your claim.

How To Track Your Care Health Insurance Company’s Claim Status?

Staying informed about your Care Health Insurance Company claim status is simple and convenient. You can track your claim through the following methods:

• Website: Track your Care Health Insurance claim status easily at this link by simply entering your policy number.
• Email Enquiry: Drop a message at customerfirst@careinsurance.com with your policy details to receive an update on your claim status.
• Customer Support Call: Connect with a support representative by dialing 1800-102-6655 / 1800-102-4488. Inform them that you’d like to check your claim status, and they’ll guide you through the process.

Final Thoughts

As of March 31, 2024, Care Health Insurance Company has a claim settlement ratio of 90.50%. Whether you're opting for a cashless claim or a reimbursement claim, being well-prepared with the right process and documents ensures a smooth and hassle-free experience. In the ever-evolving world of healthcare, choosing a reliable insurance provider means having a financial safety net that keeps you and your loved ones secure from unexpected medical costs.

FAQs