Care Health Insurance Claim Process
Claims are the financial compensation provided by the insurance company to the policyholder, to cover the financial loss incurred due to any medical situation. Filing a claim can be a tedious task, especially at the time of any medical emergency. So, Care Health Insurance Company has designed an easy and efficient process for filing a claim. The company has a dedicated team to assist the customer at every step of making the claim. The Claim Settlement Ratio of the company is 100% (for 3 months) which translates that they go above and beyond to provide a seamless claim settlement process. Here is a comprehensive look at the Care Health Insurance Claim.
Health Insurance Companies: Policy and Claim Process
Types of Care Health Insurance Claims
Cashless Claims: The policyholder can get treatment at a network hospital without worrying about the payment. Care Health Insurance company will later settle the hospital bill directly.
Reimbursement Claims: If the policyholder chooses a non-network hospital for treatment, they pay the expenses initially and then get the compensation after submitting the valid documents.
How To Claim Care Health Insurance
Both cashless and reimbursement claims are processed differently and documents asked for each are also handled differently. In the claim process, the policyholder has to inform the company first, then submit the documents and after successful verification, the claims are settled. Now let us examine each type of procedure separately.
Care Health Insurance Cashless Claim Process
Cashless claims are the fastest way of filing a claim and they are settled directly between the insurer and the network hospital. Following are steps to file a cashless claim:
Step 1: Visit the network hospital and contact the TPA desk of the hospital. Ask for a pre-authorization form.
Step 2: With the assistance of the TPA, fill in all the details in the pre-authorization form, attach all the necessary documents as suggested by the TPA and submit the details via email.
Step 3: The company will verify all the submitted details and it may ask for additional documents if necessary.
Step 4: Once all the documents are submitted, the company will verify them and then settle the claims directly with the hospital.
Note:
- The company could coordinate with the hospital administration for claim verification.
- You can get the pre-authorization form at the TPA desk of the hospital.
Care Health Insurance Reimbursement Process
Reimbursement claims give the opportunity to the policyholder to choose the hospital where he wants to receive the treatment. Here are the steps required to process these claims:
Step 1: Submit the claim along with the claim from the TPA desk or mail it to the company.
Step 2: After verification, the hospital il notify the insured, through a text message or an email. The company can even send a claim approval letter.
Step 3: The claim amount will be sent directly to the policyholder's bank account.
Claims Process For Accidents
In any emergency situation such as an accident, inform the company within 24 hours of hospitalization. You can inform the company by calling on their toll-free number or by emailing them. Here are a few important points to process these claims:
Step 1: Inform the company and contact the hospital TPA.
Step 2: Download the claim form and fill in all the details and submit it to the TPA or the company.
Step 3: Care Health Insurance Company will settle the claim after verification of the document.
Documents Required For Accident Claims
For submitting the accident claims following documents are required:
- Police Report or FIR
- Medical Certificate from the doctor/hospital
- Discharged summary from hospital/doctor
- Medical report
- Medical documents from the hospital/doctor
- Post-mortem report
- Death Certificate (For Accidental Death)
Documents Required For Cashless And Reimbursement Claims
Here is the list of documents required for filing the claim:
- Claim Form (Duly filled and Signed)
- Doctor's Prescription
- Diagnostic Tests and Medical Reports
- Original Biils
- Police Report or FIR
- Post- Mortem Report
- Death Certificate
- Health Policy Details (Policy Number, name of the policyholder, nature of illness)
Tips To Avoid Claim Rejection
Sometimes the claims get rejected, and there may be many reasons behind this. Here are a few tips that may help you avoid rejection of claims:
- Be honest about the pre-existing disease when buying the policy.
- Follow the specific time frame for planning and emergency hospitalization. This means notifying planned hospitalization 48 hours before and emergency hospitalization within 24 hours.
- Collect all the important documents and submit them as soon as the claims are filed.
- Check for the waiting period of some specific diseases, to avoid any confusion while filing a claim.
- Read all the policy documents thoroughly, including inclusion and exclusions to avoid any discrepancy in filing the claim.
Choose Care Health Insurance Plan for
Care Health Insurance (Formerly Known As Religare Health Insurance) Network Hospital List
Care Health Insurance promises a wide Network of cashless Hospitals across India. A well connected network of over 20800+ cashless hospitals, Care Health Insurance ensures that you are medically secured, irrespective of the city you
reside in
Explore Care Health Insurance
PolicyX.com is a Recognised Care Partner View Certificate
