Care Health Insurance Claim Settlement Ratio

Claim Settlement Ratio in the medical insurance sector allows the customers to understand how the Health Insurer will handle their claim. A consistent health claim settlement ratio is a good indicator of a company’s ability to settle the claims received.

Care Health Insurance Company secures an impressive claim settlement ratio of 92.23% in 2019 and 89.69% in 2018. Simply put, the company received a total of 700,596 claims as of March 2019 and settled 92.3 percent of them. So, their claim settlement pattern is consistent, which makes it one of the trusted health insurance companies among the Indian Insurance customers.

Care Health Insurance (Formerly known as Religare Health Insurance) at a Glance:

Features Specifications
Hospital Network 7400+
Incurred Claim Ratio ( 2018-2019) 55%
Claim Settlement Ratio 95%
Waiting Period specified for Pre-existing disease(s) 4 years
Policy Renewability Lifetime renewal
Total Claim Paid  7lakh+

Care Health Insurance Claim Settlement Ratio

The ideal claim settlement ratio of health insurance providers should range between 80% and 90%. The claim settlement ratio of Care Health Insurance Company for 2019 and 2018 was 92.93 % and 89.69% respectively.

So, the insurers’ health claim ratio reflects their efficiency, reliability, sound financial health, and great value products. This claim ratio is determined by using this formula:

Health claim settlement ratio= Total claims settled/ total reported claims- pending claims at the start of the year- pending claims at the end of the fiscal year

Claim Process of Care Health Insurance

Care Health Insurance Company ensures smooth claim settlement for all its health insurance plans including family floater plans, senior citizen plans, coronavirus health plans, Arogya Sanjeevani policy, and even critical illness plans.

The policyholder can avail cashless hospitalization in more than 7900 network hospitals across 500 cities in India. Moreover, easy online payment is also possible. Mentioned below is the process for both cashless claims and reimbursement claims.

Claim Process for Cashless Treatment

Care health insurance cashless claims can be settled without the hassle of submitting all the medical bills and discharge summary. If you have availed treatment in a network hospital then you can file a cashless claim request with the insurer by following the steps illustrated below:

  • Claim Intimation: You can inform our customer care team within 48-hours of a planned hospitalization and 24-hours of emergency hospitalization
  • Initiate Pre-authorization Process: Now submit the pre-authorization form at the hospital’s insurance desk
  • Processing a request for Pre-authorization: In-house medical insurance team will review the documents and then accept or reject your health insurance claim

Claim Process for Reimbursement Treatment

If you have availed treatment in a non-network hospital then you can file a reimbursement claim request with the insurer by following the steps given below:

  • Claim Intimation: Inform the support team within 24-hours of an emergency hospitalization and 48-hours of a planned hospitalization
  • Initiate Claim Process: The health insurance claim form needs to be submitted along with all the details and the required documents
  • Claim Processing: All the documents will be reviewed and the claim rejection and approval intimation will be provided. If the claim is rejected a valid reason will be provided

Documents Required for Care Health Insurance Claims

There is an option to download the medical insurance claim forms from the insurer’s website. However, you need to submit the following documents along with the duly filled claim form-

  • Duly filled and signed claim form (original copy)
  • Photo ID proof 
  • Doctor’s prescription recommending hospitalization
  • Letter from the doctor mentioning the list of medical tests, consultations, and medications
  • Receipts and bills ( original copies)
  • Chemist bills (original copies) 
  • All the medical tests and reports with receipts ( original copies)
  • Indoor case papers
  • Discharge card from the doctor/ hospital
  • Police FIR Report (if applicable)
  • Original post-mortem report ( if applicable)

For any additional details you can speak to our health insurance experts and make an informed purchase.

Written By: PolicyBazaar - Updated: 15 April 2021

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