Care Health Claim Settlement Ratio
  • Explore the CSR of Care Health
  • How to calculate CSR
  • Care Claim settlement process
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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.

Health Insurance Companies

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

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 Plan

Care health insurance offers a total of 13 health insurance plans. Check below to know more about the other care health insurance plans offered by the company.

A comprehensive family floater plan that decides your policy premium based on the living cost of the city you reside in.

Unique Benefits

  • Covers IVF treatment
  • Compassionate travel coverage
  • Unlimited e-consultation

Care Classic (Pros)

  • Zone-Based Health Insurance
  • Family Floater Plan
  • Affordable Plan
  • High Sum Insured
  • Value Added Services

Care Classic (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Classic (Other Benefits)

  • Unlimited e-consultations
  • Annual Health Check-up
  • Wellness Services
  • OPD care
  • ENT Consultations

Care Classic (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - 65 Years
  • SI - 5 L to 15 L
  • Waiting Period - 30 Days

Comprehensive health plan for people above 60 to make their second inning stress-free from health-related financial worries.

Unique Benefits

  • No pre-policy Medical Checkup
  • Lifelong Renewability
  • Automatic SI Recharge

Care Senior Citizen (Pros)

  • No pre-policy check-up
  • Annual Health Check-up
  • 540+ Day Care Treatments
  • EMI premium options
  • Discounts Available

Care Senior Citizen (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Senior Citizen (Other Benefits)

  • Organ Donor Cover
  • Second Opinion Available
  • Affordable Premiums
  • Covid-19 Treatment
  • Ambulance Cover

Care Senior Citizen (Eligibility Criteria)

  • Entry Age - 61 Years
  • Max Entry Age - No age limit
  • SI - 3 L to 10 L
  • Waiting Period - 30 Days

Get medical coverage for pre-existing diseases like BP, diabetes without any waiting period by bearing a co-pay of 20-30%.

Unique Benefits

  • No pre-policy checkup needed
  • Dialysis cover available
  • Annual Health Checkup

Care Freedom (Pros)

  • Cashless Healthcare
  • No pre-policy check-ups
  • SI Recharge
  • Lifelong Renewability
  • 15-day free-look period

Care Freedom (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Freedom (Other Benefits)

  • 2 Plan variants
  • Consumable Allowance
  • Annual Health Check-up
  • Long Term Discounts
  • Dialysis Cover

Care Freedom (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - Lifelong
  • SI - 3 to 10 L
  • Waiting Period - 30 Days

A super top-up health insurance plan to provide extra medical cover on the basis of policy deductible principle.

Unique Benefits

  • Covers modern treatment
  • Flexible options of deductible
  • No pre-policy medical test

Care Enhance (Pros)

  • Annual Health Check-up
  • Family floater option
  • Pre & Post Hospitalization
  • Inpatient care
  • Day Care Treatments

Care Enhance (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Enhance (Other Benefits)

  • High Sum Insured
  • Organ Donor Expenses
  • Expert Opinion Cover
  • Cashless Treatment
  • Long Term Policy

Care Enhance (Eligibility Criteria)

  • Entry Age - 5 Years
  • Max Entry Age - No age limit
  • SI - 1 L to 55 L
  • Waiting Period - 30 Days

A maternity health insurance plan with child cover. This plan protects individuals and families during medical emergencies.

Unique Benefits

  • 100% increase in SI as NCB
  • Newborn Cover
  • 541 day care treatments covered

Care Joy (Pros)

  • 2 Plan Variants
  • Maternity Plan
  • New Born Baby Cover
  • Day Care Treatment
  • Modern Treatment Cover

Care Joy (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Joy (Other Benefits)

  • Long term discount
  • Congenital Disease Cover
  • 100% increase in SI
  • Ambulance Cover
  • Lifelong Renewability

Care Joy (Eligibility Criteria)

  • Entry Age - 1 Day
  • Max Entry Age - 65 Years
  • SI - 3 L/5 L
  • Waiting Period - 30 Days

Enjoy the advantage of 1 crore cover and multiple benefits at lower monthly premiums with this affordable individual & family floater plan.

Unique Benefits

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

Care Advantage (Pros)

  • Automatic Recharge
  • High SI
  • 50% No Claim Bonus
  • Ambulance Cover
  • Optional Cover Available

Care Advantage (Cons)

  • 20% Co-pay
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Advantage (Other Benefits)

  • 5 L Air Ambulance Cover
  • Reduction in PED Waiting period
  • Co-pay Waiver
  • Annual Health Check-up
  • Room rent modification

Care Advantage (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - Lifelong
  • SI - 25 L to 6 Cr
  • Waiting Period - 30 Days

A standard comprehensive plan mandated by IRDAI that offers coverage for both Ayurvedic or Allopathic treatments.

Unique Benefits

  • AYUSH Treatment
  • Pre and Post hospitalization
  • 5% cumulative bonus

Care Arogya Sanjeevani (Pros)

  • Affordable Premium
  • Lifelong Renewability
  • Tax Benefits
  • Ambulance Expenses Cover
  • Cataract Treatment Cover

Care Arogya Sanjeevani (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Arogya Sanjeevani (Other Benefits)

  • Modern Treatments Available
  • 50% Cumulative Bonus
  • 30 Days Pre Hospitalization
  • 60 Days Post Hospitalization
  • COVID-19 Cover

Care Arogya Sanjeevani (Eligibility Criteria)

  • Entry Age - 5 Years
  • Max Entry Age - 65 Years
  • SI - 5 L
  • Waiting Period - 30 Days

Offers lifelong coverage against cancer and the cost of its treatment with several other benefits.

Unique Benefits

  • Annual Health Checkup
  • Chemo and radiotherapy cover
  • Air Ambulance Cover

Care Cancer Mediclaim (Pros)

  • Chemo & Radio Therapy
  • Organ Donor Cover
  • Annual Health Check-up
  • Covers all major cancer
  • Lifelong Renewability

Care Cancer Mediclaim (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Cancer Mediclaim (Other Benefits)

  • International Second Opinion
  • Doctor On Call
  • Air Ambulance Cover
  • Quick Recovery Counseling
  • OPD Cover

Care Cancer Mediclaim (Eligibility Criteria)

  • Entry Age - 5 Years
  • Max Entry Age - 50 Years
  • SI - 10 L to 2 Cr
  • Waiting Period - 30 Days

Offers coverage against 32 critical illnesses that are pre-defined under the policy such as catastrophic burns, coma, etc.

Unique Benefits

  • Psychiatric Counselling
  • Dialysis Cover
  • Organ Donor Cover

Care Critical illness (Pros)

  • Dialyses Cover
  • Organ Donor Cover
  • Psychiatric Counseling
  • 32 Critical Illness Covered
  • Day Care Treatment

Care Critical illness (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Critical illness (Other Benefits)

  • Ambulance Cover
  • Annual Health Check-up
  • Global Cover
  • OPD Cover
  • Doctor On Call

Care Critical illness (Eligibility Criteria)

  • Entry Age - 61 Years
  • Max Entry Age - No age limit
  • SI - 3 L to 10 L
  • Waiting Period - 30 Days

Care for 45+

A comprehensive plan that takes care of your medical needs in your late 40s.

Unique Features

  • Organ Donor
  • Emergency Ambulance
  • Annual Health Checkup

Individuals with pre-existing cardiac diseases can get coverage against medical treatments by paying 20-30% of co-payment for every claim.

Unique Benefits

  • Cardiac Health Checkup
  • Second medical Opinion
  • Automatic SI Restoration

Care Heart (Pros)

  • Lifelong Cover
  • Domiciliary Hospitalization
  • Cardiac Check-up
  • Ambulance Expenses
  • No claim bonus

Care Heart (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Heart (Other Benefits)

  • OPD Care
  • Home Care
  • International 2nd Opinion
  • Automatic Recharge
  • High SI

Care Heart (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age limit
  • SI - 3 to 10 L
  • Waiting Period - 30 Days

A flexible health plan that covers advanced technology methods, unlimited e-consultations and personal accidents.

Unique Benefits

  • 200% increase in cumulative bonus
  • Rewards for being fit
  • Dental and Ophthalmic cover

Care Plus (Pros)

  • Unlimited Recharge Benefit
  • High Sum Insured
  • Cover up to 6 family members
  • Up to 200% No Claim Bonus
  • 10% renewal discount

Care Plus (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Plus (Other Benefits)

  • 5% Digital Discounts
  • Annual health check-up
  • Unlimited e-consultations
  • Health Services Available
  • Air Ambulance Cover

Care Plus (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - Lifelong
  • SI - 3 L to 25 L
  • Waiting Period - 30 Days

A unique healthcare plan offering extensive coverage to individuals and families under a single plan with affordable premiums.

Unique Features

  • Unlimited E-consultations
  • Unlimited Automatic Restoration
  • Avail Up to 30% Discounts

Care Supreme Plan (Pros)

  • Day Care Treatments
  • No Sub-Limits
  • Emergency Ambulance
  • No-Claim Bonus
  • Organ Donor Cover

Care Supreme Plan (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Supreme Plan (Other Benefits)

  • Unlimited Recharge
  • 30% Renewal Discount
  • Unlimited E - Consultation
  • Wellness Benefits
  • Nutrition and Fitness Coaching

Care Supreme Plan (Eligibility Criteria)

  • Entry Age - 90 Days
  • Max Entry Age - No age limit
  • SI - 5 L to 15 L
  • Waiting Period - 30 Days

Health Insurer Claim Settlement Ratio

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I had a hassle free policy issuance from policy X and I am completely satisfied with process and especially I thank Amit on assisting and staying in touch with me throughtout the process and he...

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I ported my previous health insurance to Care and so far I got my claims settled easily. Last year also, I was admitted due to an accidental injury which was later covered by Care health insura...

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April 8, 2024

I’m expecting this year and I’m so happy to know that my husband had bought the Care Joy maternity health policy in advance. I’m hopeful that the company will cover my deliver...

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The user experience of PolicyX is so seamless and effective that I compared many health plans and chose the Care Supreme health insurance for my family which is a really good investment in my 2...

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Arjun Singh

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From seamless transportation to the hospital to hospitalisation for COVID, Care Senior Citizen plan helped me in all. Thank you PolicyX for recommending the plan

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April 8, 2024

A family friend asked us to consult with PolicyX for family health plan, we are very happy to take the decision and bought Care Supreme for family

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Naval Goel

Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.