Care Health Insurance Claim Settlement Ratio

Health Insurance claim settlement ratio is used to determine the company’s ability of settling claims against the number of requested claims in a financial year.. Every year the Insurance Regulatory and Development Authority of India (IRDAI) publishes the claim settlement ratio of every health insurance company in its annual report.

Evaluating the claim settlement ratio before buying a health insurance plan is a good idea as it reflects the efficiency, reliability, and financial health of an insurer.

In this article, we will tell you everything about the claim settlement ratio of Care Health Insurance.

What is Claim Settlement Ratio?

The claim Settlement Ratio of a company refers to the claims settled by a company against the total claims filed during that financial year. For example, if the company settled 90 claims out of 100, the the CSR of the company would be 90%.

The simple formula of calculating the CSR is

(Total Claims Settled)/(Total Reported Claims + Outstanding Claims at the beginning of Year-Outstanding Claims at the End of Year).

Care Health Insurance Claim Settlement Ratio

As per IRDAI, Care Health Claim Settlement Ratio is 100%. The company claims to settle the cashless claims within the time frame of 2 hrs. Until now, the company has settled up to 25 Lakhs+ claims. The figure shocases that the company understands the importance of quick claim settlement and ensures to support you at the time of medical-financial need.

What is the Claim Settlement Process of Care Health Insurance?

Care Health Insurance works in a very transparent and systematic manner to clear claims. Following is the clain settlemet process of Care Health Insurance.

Case 1: Cashless Claim Procedure

In the case of an emergency or planned hospitalization, intimate the insurer within 24 hours or 48 hours of hospitalization.
The nominee of the policy has to fill and submit the pre-authorisation request form to the hospital’s insurance/TPA desk.
The hospital will then send all the documents to the company i.e. Care Heath Insurance for verification.
After reviewing all your documents, the claim management team will send an approval letter to the hospital.
The hospital will proceed with the cashless treatment of the insured member.

Note: If the cashless claim is rejected, the insured member can initiate the treatment and file for a reimbursement claim after discharge.

Case 2: Reimbursement Claim Procedure

In the case of an emergency or planned hospitalization, intimate the insurer within 24 or 48 hours of the hospitalization.
The insured has to submit the duly filled reimbursement claim form to the insurer along with the required supporting documents such as:
- Original duly completed and signed claim form
- Valid photo-id proof
- Medical practitioner’s referral letter advising hospitalization
- Medical practitioner’s prescription advising drugs/diagnostic tests/consultation
- Original bills, receipts, and discharge card from the hospital/medical practitioner
- Original bills from pharmacy/chemists
- Original pathological/diagnostic tests reports/radiology reports and payment receipts
- Indoor case papers
- First Information Report, final police report, if applicable
- Post mortem report, if conducted
- Any other document as required by the company to assess the claim
The company will check and review the documents.
If the claim is approved, the company will transfer funds to your registered bank account.

Care Health Insurance Network Hospital List

Care Health Insurance Network Hospitals are present in 31 states nationwide. With a wide network of hospitals, Care Health Insurance ensures that you are medically secured, irrespective of the city you reside in.

Delhi

Mumbai

Bengaluru

Chennai

Kolkata

Hyderabad

Pune

Ahmedabad

Jaipur

Lucknow

Know More About Network Hospital

Explore other Care Health Insurance

To cater to the different medical needs of an individual & their family, Care Health Insurance offers several Health Plans ranging from senior citizen plans to specialized plans for autistic children, to health insurance for cardiac patients, and many more.Take a look below to Care Health Insurance plans explore more:

Individual and Family Health Insurance

Arogya Sanjeevani Plan

Arogya Sanjeevani was first introduced by IRDAI (Insurance Regulatory and Development Authority of India) in the year 2020 to provide a standard and a...

Unique Features

High sum insured
540+ procedures covered
Organ donation cover

Arogya Sanjeevani Plan (Pros)

AYUSH treatment
Affordable premium
Lifelong renewability
Tax benefit

Arogya Sanjeevani Plan (Cons)

Change of gender treatment
Obesity treatment unavailable
Hazardous activity not covered

Arogya Sanjeevani Plan (Other Benefits)

Modern treatments available
50% cumulative bonus
30 days pre-hospitalisation

Arogya Sanjeevani Plan (Eligibility Criteria)

Entry age- 5 years
Max entry age- 65 years
SI- 5 L
Waiting period- 30 days

Individual and Family Health Insurance

Care Operation Insurance

Care Operation Insurance Plan is designed specifically to offer you surgical operations coverage. A wide range of sum insured options are available ra...

Unique Features

Unlimited E-consultations
Automatic Restoration
Wellness Benefits

Care Operation Insurance (Pros)

Health services
Air Ambulance cover
Chemotherapy cover

Care Operation Insurance (Cons)

Illegal activities
Alcohol abuse
Obesity treatments

Care Operation Insurance (Other Benefits)

Dialysis cover
Second opinion
Organ donor cover

Care Operation Insurance (Eligibility Criteria)

Min entry age: 5 Years
Max entry age: 50 Years
Initial Waiting Period: 30 Days
Sum Insured: Up to 2 Cr

Individual and Family Health Insurance

Care Advantage Plan

Care Advantage Health Insurance is an ideal 1 Crore option so that a policyholder's family is adequately covered. Care Advantage health insurance offe...

Unique Features

High sum insured
540+ procedures covered
Organ donation cover

Care Advantage Plan (Pros)

No bonus claim up to 50%
Automatic SI recharge
Organ donor cover
Automatic recharge
High SI

Care Advantage Plan (Cons)

20% co-pay
Obesity treatment unavailable
Hazardous activity not covered

Care Advantage Plan (Other Benefits)

Ambulance cover available
Optional cover available
Co-pay waiver
Room rent modification

Care Advantage Plan (Eligibility Criteria)

Entry age- 91 days
Max entry age- Lifelong
SI- 25 L to 6 Cr
Waiting Period- 30 days

Critical Illness Health Insurance

Cancer Mediclaim Policy

Worried about cancer in your bloodline? Care Cancer Mediclaim has got you covered. Cancer can be defined as distress, hopelessness and loss. There cou...

Unique Features

Wide SI options
Lifelong renewability
Cancer-related global coverage

Cancer Mediclaim Policy (Pros)

Annual health checkup
Chemo and radiotherapy cover
Air ambulance cover
Chemo and radio therapy
Organ donor cover

Cancer Mediclaim Policy (Cons)

Change of gender treatment
Obesity treatment unavailable
HIV/AIDS not covered
Cosmetic surgery unavailable

Cancer Mediclaim Policy (Other Benefits)

International second opinion
Doctor on call
Air ambulance cover
OPD cover

Cancer Mediclaim Policy (Eligibility Criteria)

Entry age- 5 years
Max entry age- 50 years
SI- 10 L to 2 Cr
Waiting Period- 30 days

Accident Health Insurance

Care Secure Personal Accident

Care Secure personal accident policy covers accidental death, permanent and temporary partial/total disability, recovering treatment costs, accidental...

Unique Features

PTD & PPD cover
Cover for child education
100% accidental death payout

Care Secure Personal Accident (Pros)

Accidental death
Accidental total disablement
Permanent total disablement

Care Secure Personal Accident (Cons)

Illegal activities
Alcohol abuse
Obesity treatment

Care Secure Personal Accident (Other Benefits)

Accidental hospitalisation
Tax benefits
Loyalty benefit

Care Secure Personal Accident (Eligibility Criteria)

Min entry age: 18 Years
Max entry age: 70 Years
Initial Waiting Period: 30 Days
Sum Insured: Up to 50 L

Individual and Family Health Insurance

Care Supreme Plan

Care Supreme is an extensive coverage health insurance plan that safeguards you and your family members without worrying about your future healthcare ...

Unique Features

Unlimited E-consultations
Automatic Restoration
Wellness Benefits

Care Supreme Plan (Pros)

Modern treatments
Renewal discounts
Unlimited e-consultation

Care Supreme Plan (Cons)

Illegal activities
alcohol abuse
obesity treatments

Care Supreme Plan (Other Benefits)

Ambulance cover
Doctor on chat
Maternity care

Care Supreme Plan (Eligibility Criteria)

Min entry age: 18 Years
Max entry age: No age limit
Initial Waiting Period: 30 Days
Sum Insured: Up to 1 Cr

Individual and Family Health Insurance

Care Freedom

Free yourself from the worries of healthcare. As the name suggests, Care Freedom is the plan that allows you to be worry-free in every situation. Thi...

Unique Features

Additional health checkups
Dialysis cover
No pre-medical check-up

Care Freedom (Pros)

No pre-policy checkup needed
Dialysis cover available
Annual health checkup

Care Freedom (Cons)

Change of gender treatment
Obesity treatment
HIV/AIDS not covered
Cosmetic surgery unavailable

Care Freedom (Other Benefits)

Cashless healthcare
No pre-policy check up
SI recharge
Lifelong renewability

Care Freedom (Eligibility Criteria)

2 plan variants
Consumable allowance
Annual health check-up
Long term discounts

Critical Illness Health Insurance

Care Critical Mediclaim

Critical Mediclaim Care health insurance policy gives you protection against 32 defined critical illnesses based on an indemnity plan. This super-faci...

Unique Features

32 Critical illnesses cover
Dialysis expenses covered
Avail psychiatric counselling

Care Critical Mediclaim (Pros)

Wellness benefits
Organ donor cover
32 CI covered

Care Critical Mediclaim (Cons)

Obesity treatment
alcohol abuse
illegal activities

Care Critical Mediclaim (Other Benefits)

Global coverage
International opinion
Doctor on call

Care Critical Mediclaim (Eligibility Criteria)

Min entry age: 5 Years
Max entry age: 50 Years
Initial Waiting Period: 30 Days
Sum Insured: Up to 2 Cr

Senior Citizen Health Insurance

Care Senior

Care Senior Citizen is specially designed to offer coverage for individuals above 60 years of age. It offers flexibility to choose the sum insured tha...

Unique Features

No pre-policy check-up
Annual rewards available
Reduction in wait period

Care Senior (Pros)

Affordable premiums
Day care treatments
ICU charges

Care Senior (Cons)

Illegal activites
Adventure sports
Alcohol abuse

Care Senior (Other Benefits)

No-claim bonus
Second opinion
Alternative treatments

Care Senior (Eligibility Criteria)

Min entry age: 61 Years
Max entry age: No Limit
Initial Waiting Period: 30 Days
Sum Insured: Up to 10 L

Individual and Family Health Insurance

Care Plan

Single health insurance to cover all family members. Care health insurance plan is a comprehensive medical policy for individuals and families. It is ...

Unique Features

No claim bonus up to 100%
Annual health check-ups
Personal accident cover

Care Plan (Pros)

In-built maternity cover
No upper age limit for enrollment
Coverage for modern treatment
Pre-existing diseases

Care Plan (Cons)

War
Riot
AIDS
Miscarriage
Congenital disease

Care Plan (Other Benefits)

Lifelong renewability
ICU charges
Day care treatment
Ambulance cover
Organ donor cover

Care Plan (Eligibility Criteria)

Min entry age: 91 days
Max entry age: No limit
Initial Waiting Period: 30 Days
Sum Insured: Up to 6 Cr

Women Health Insurance

Care Joy Plan

An ideal combination of hospitalization and maternity care. Care Joy health insurance is designed specifically for expecting mothers and their newborn...

Unique Features

Newborn baby cover
541 Daycare treatments
Modern treatments cover

Care Joy Plan (Pros)

2 Plan variants
New born cover
Maternity cover

Care Joy Plan (Cons)

Illegal activities
Alcohol abuse
Ambulance cover

Care Joy Plan (Other Benefits)

No claim bonus
Renewal
Lifelong renewability

Care Joy Plan (Eligibility Criteria)

Min entry age: 18 Years
Max entry age: 65 Years
Initial Waiting Period: 30 Days
Sum Insured: Up to 5 L

Family

Care Enhance Plan

A top-up plan based on policy deductible principle Care Enhance is a super top-up health insurance plan that provides extra health insurance coverage ...

Unique Features

Flexible deductible
Modern treatments
No pre-medical check-ups

Care Enhance Plan (Pros)

Covers modern treatment
Flexible options of deducton
No pre-policy medical test
Annual health check-up
Floater option

Care Enhance Plan (Cons)

Change of gender treatments
Obesity treatment unavailable
HIV/AID not covered

Care Enhance Plan (Other Benefits)

High sum insured
Organ donor expenses
Expert opinion cover
Cashless treatment

Care Enhance Plan (Eligibility Criteria)

Entry age- 5 years
Max entry age- No age limit
SI- 1 L to 55 L
Waiting period- 30 days

Family

Care Classic

Get coverage based on your residential zone. Care Classic health insurance is a family floater health plan ideal for married couples, joint families, ...

Unique Features

IVF treatment cover
Free doctor consultation
Discounted premiums

Care Classic (Pros)

Room rent covered
Day care treatment
Advanced technology methods
ICU charges

Care Classic (Cons)

Global coverage
Air ambulance
Vaccination
Daily hospital cash

Care Classic (Other Benefits)

AYUSH treatment
IVF treatment
Cataract
No claim bonus

Care Classic (Eligibility Criteria)

Min. entry age: 18 Years
Max. entry age: 65 Years
Initial Waiting Period: 30 Days
Sum Insured: Up to 15 L

Individual and Family Health Insurance

Care Plus Plan

Care Plus health insurance is a complete healthcare plan that is loaded with features and protects you and your family. Care Plus offers comprehensive...

Unique Features

Comprehensive coverage
No upper age limit
Variants on Sum Insured

Care Plus Plan (Pros)

Ambulance cover
Day care treatments
Domiciliary hospitalization

Care Plus Plan (Cons)

Illegal activities
alcohol abuse
obesity treatment

Care Plus Plan (Other Benefits)

Personal accident cover
Inflation shield
Health services

Care Plus Plan (Eligibility Criteria)

Min entry age: 5 Years
Max entry age: No limit
Initial Waiting Period: 30 Days
Sum Insured: Up to 25 L

Critical Illness Health Insurance

Care Heart Plan

Care Heart is a unique plan launched by Care Health Insurance that provides the flexibility to choose from benefits like Active heart health check-ups...

Unique Features

Coverage for OPD
Home care available
International 2nd opinion

Care Heart Plan (Pros)

Cardiac health check up
Second medical opinion
Automatic SI restoration
Lifelong cover

Care Heart Plan (Cons)

Change of gender treatment
Obesity treatment unavaialable
Hazardous activity not covered
HIV/AIDS not covered

Care Heart Plan (Other Benefits)

OPD care
Home care
International 2nd opinion
Automatic recharge
High SI

Care Heart Plan (Eligibility Criteria)

Entry age- 18 years
Max entry age- No age limit
SI- 3 to 10 L
Waiting period- 30 days

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Care Health Claim Settlement Ratio: FAQs

1. What is the claim settlement ratio of Care Health Insurance Company?

According to IRDAI 2022-23 data, the Care health insurance company’s claim settlement ratio (CSR) is 53.82%.

2. Can I claim against my Care health insurance policy online?

Yes. You can claim your Care health policy online from the company’s website.

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Written By: Naval Goel

Naval Goel is the Founder and CEO of PolicyX.com (IRDA- Approved Insurance Comparison Website). He is a CFA charter holder (USA) and FRM (GARP). He holds an MBA from IIFT, Delhi, and is also an Associate from the Insurance Institute of India. Naval is an avid investor and entrepreneur who has a deep understanding of the Indian equity market and insurance sector. He has been investing for more than 10 years now and is a CFA charter holder.