Care Health Insurance  Claim Settlement 

The process for raising a Care Health Insurance claim is fairly simple. If you are a policyholder, you can raise cashless claims or reimbursement claims, depending on where you get your medical treatment. Cashless claims are where the insurer directly settles the bills with the hospital.

You can avail this facility only at network hospitals.

On the other hand, in non-network hospitals, you can file only reimbursement claims. Here, you need to first pay the costs out of pocket, and then request a reimbursement from your insurance provider. Read this article for more details on the process of filing a claim on your Care Health Insurance policy.

The Care Insurance claim form (commonly known as Religare health insurance claim form), is a standard document. Here, you can share all the details regarding the treatment before the Care Health Insurance claim settlement process begins. You can follow these steps and begin the claim settlement process. 

• Step 1: Obtain itemised bills

To file a claim with any health insurance provider, including Care Health Insurance, you need to attach the original itemised bills to the claim form. These bills contain the details of the services offered by the doctor and the cost for each of the services. 

You can ask your doctor to share itemised bills. It is important to ensure that all the information of your treatment, including medications, is accurately listed in the bills.

• Step 2: Obtain the claim form

Once you have the itemised bills, you will have to download the claim form. You do this either from the website or by contacting customer support. The claim form also has additional instructions and the details regarding the claim process. You can go through this to have a better understanding of how the Care Health Insurance claim settlement process works.

• Step 3: Keep copies ready for future reference

Having an extra copy of the original documents is smart, especially when it comes to formalities like the claim process. This is because it helps ensure that in case of misplacement or error, you can redo the whole process easily. 

• Step 4: Review and submit

Any inaccuracy or discrepancy in your claim form can lead to rejection. This is why it is crucial to review the documents before you submit the final copy. Go through the paperwork, all the documents, and the claim form. 

You can check with customer support if anything additional is required. Once you have all the required details in order, submit the claim request and keep an eye out for a response or query.

1. Visit Bajaj Markets

2. Click on the ‘Register a claim’

3. Upload the necessary documents

4. Wait for your request to be assessed 

5. Check claim status online

6. Resolve the query, if any

cashless insurance are offered by a majority of insurance providers, including Care Health Insurance. This claim facility can be extremely beneficial as it allows you to get the treatment you need without worrying about the payment. As such, it is a great feature in case of an emergency. 

Care Insurance claim settlement process under this facility is quick and easy to avail. Once you submit the request for the cashless facility and it is approved, you can go to the nearest care health network hospital and get the treatment you need. Your bills will be directly settled with the hospital and you will not have to pay the expense unless it exceeds the sum insured. 

With the cashless treatment facility available at a wide network of 8,350+ hospitals, all you need to focus on is getting the right medical care!

Here’s how you can file a cashless claim:

• Inform the insurer about your treatment (If it is planned, ensure that the intimation is sent 48 hours prior and within 24 hours in case of an emergency).

• Visit the TPA/insurance desk to request and submit the pre-authorisation form 

• Your request may be approved, rejected, or sent with query 

  1. Approval: On approval, your request is approved and you can enjoy the cashless feature on offer.

  2. If a query is raised: You or hospital will need to respond to the same.

  3. Rejection: Upon rejection, you can initiate or continue the treatment and file for reimbursement claim afterwards.

• Pre-authorisation form

• Valid ID proof along with photograph

• Documents such as voter ID, Aadhar card, PAN card

• Duly filled claim form with your signature

• Doctor’s prescription for diagnostic tests, consultation and medicines

• Original medical bills

• Doctor’s prescription recommending hospitalization

• Case papers

• Policy details including your name, policy number, address and illness details

• Ambulance receipt

• FIR, if applicable

Unlike cashless claims, in case of reimbursement claims you have to take care of the medical bills initially. These expenses are then reimbursed. You can make a reimbursement claim if your treatment was done at a hospital not listed in their network. 

It is important to keep track of all the documents and medical bills, as will be needed to file the reimbursement claim.

Here’s how you can file a reimbursement claim:

• Inform the insurer about your treatment (If it is planned ensure that the intimation is sent 48 hours prior and within 24 hours in case of an emergency).

• Submit the claim form with the required documents at the earliest.

• You may receive the approval, rejection, or query from the insurer

  On approval your claim will be settled and the amount will be transferred

  If a query is raised, you will have to respond to reach a resolution

  Upon rejection, the insurer will communicate the reason for rejection

• Valid ID proof

• Complete KYC if the claim amount exceeds more than 1 LAC (ID, address, photographs)

• Duly filled claim form with your signature

• Doctor’s prescription for diagnostic tests, consultation and medicines

• Discharge summary

• Final bill, break up bill with payment receipt.

• All investigation reports including x-ray /MRI/CT image.

• Original medical bills

• Doctor’s prescription recommending hospitalisation

• Case papers

• Policy details including your name, policy number, address and illness details

• Ambulance receipt

• FIR, if applicable

Despite taking care of all your documents and details, here are some reasons why your health insurance claims may get rejected:

• Claim for expense or treatment that falls under exclusion

In case you file a claim for an expense or treatment that is not covered in your policy, your claim may get rejected

• Incorrect Details

In case any discrepancies, misinformation, or inaccuracy in the details provided for the claim, your claim will be rejected

• Delay in intimation

In case you fail to inform about your medical emergency or planned hospitalisation, your insurer may not be able to assess the situation completely, resulting in rejection

• Invalid policy

In case you file a claim after your policy is lapsed, your claim would be denied

• Waiting period

In case you file a claim for the expenses of the treatment of a disease having a certain waiting period that has not been completed, your claim will be denied.

There are certain key points that you must be careful about when beginning the Care Health Insurance claim settlement process. These steps would help in a hassle-free and quick claim settlement.

• Keep a check on the documents required

Apart from the pre-authorisation form, hospital bills and medical reports, there are some other documents that you need to keep handy. Here’s a list of commonly required documents:

• Your valid ID proofs

• Bills of any medicines or equipment used

• Policy document

• Cancelled cheque                           

This is not an exhaustive list and you may need to furnish additional documents based on your claim, policy, and treatment/care availed. You can check the document requirement by contacting the customer support.

• Read the list of exclusions carefully

Every health insurance policy has some scenarios listed that are not covered by the insurance company. These are referred to as exclusions. In case the claims are filed for scenarios that are listed in the exclusions, they will not be approved. Hence, it is imperative that you check the exclusions before making a claim.

• Ensure your claim is admissible to the sum insured limit

When you buy health insurance, the insurer is liable cover the expenses only up to the sum insured amount. In case your claim amount exceeds the available sum insured limit, you would have to take care of the excess. So, you should check the sum insured limit of the health insurance policy.

• Go through the list of network hospitals

A cashless claim settlement is possible only at the insurance company’s network hospital. So, in case you wish to take the advantage of the cashless claims, it is important to check the list of hospitals that the insurer has a tie-up with before seeking treatment.

• Check the validity of your insurance policy

It is important to check the validity of your health insurance policy when filing a claim as your claim may not get settled if the policy has lapsed.

An important thing to keep in mind is that the document requirement may vary depending on your insurer, among other factors. To proceed with you Care Health Insurance claim settlement process, you will need to submit the following documents:

• ID proof

• Medical reports and tests

• Prescription for hospital recommendation

• Original copy of bills and receipts, including chemist bills

• Case papers

• Discharge card

• Signed claim form with accurate details

• Post-mortem report, if applicable

• FIR, if required

In some cases, you may need to submit documents apart from the ones mentioned above. You can confirm the documents needed by contacting the customer support before submitting the claim form.

Read More: Claim Settlement Ratio in health insurance