What is the Care Health Insurance Claim Settlement Process?

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.

 

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Care Health Insurance Claim Process

At Care Health Insurance Limited (formerly known as Religare Health Insurance Company Limited), the team is committed to ensure that our customers enjoy quick & hassle-free access to best-in-class healthcare facilities and offer an easy claim process. With a huge network of hospitals and seamless claim management that offers nothing but convenience to the customers, the company is committed to deliver the best service. This very dedication is reflected in their exceptional Claim Settlement Ratio that stands at over 90%*. Through their seamless claim process, you can rest assured when a medical emergency strikes, while they take care of the rest. All you have to do is follow some easy steps, intimate the insurer on time and avail cashless treatment or reimbursement of your medical costs. Not just this, the company ensure that you get all the Care Health Insurance claim status (Religare claim status) details without having to follow any complicated procedures.

 

What is a Claim Form? How to Fill the Care Insurance Claim Form?

 

When making a Care Health Insurance claim, it is important to make a note of the basics and keep all the necessary documents handy. Amongst these is the Care Insurance claim form (commonly known as religare health insurance claim form). This form is a standard document provided by the insurer to ensure that you can share all the details regarding the claim before the claim settlement process begins.

Filling your health insurance claim form (religare claim form) is not a very complicated process. You must follow just a few steps to get it done.

 

Step 1 – Obtain itemized bills

You need to attach the original itemized bills to the claim form. You must ask your doctor to share itemized bills that has the details of the services offered by the doctor and the cost for each of the services. It is important to ensure that all the medications provided in the treatment are listed in the bills.

 

 

Step 2 – Obtain the claim form

You will have to download the claim form from your insurer’s website or contact the insurance company to get your claim form. The claim form also offers additional instructions and rest of the details.

 

 

Step 3 – Keep copies ready for future reference

It is important to make adequate copies of the complete set of documents and claim form. This helps eliminate errors or flaws, if any and help you refill the health insurance claim, if misplaced.

 

 

Step 4 – Review and submit

It is crucial to review your claim before you submit the final copy. Go through the paperwork, all the documents, and the claim form. Check with the insurer if anything additional is required. Once you have all the required details in order, submit the claim to your insurer and keep a check for any response from the insurance company.

 

*as on FY 2020-2021

How to Claim at Finserv MARKETS

Filing claims was never so simple. Just follow these steps and you’re done!

  • 1

    Visit Finserv MARKETS

  • 2

    Click on the ‘Register a claim’ button

  • 3

    Upload the necessary documents

  • 4

    Your insurer will assess the claim

  • 5

    Check claim status online

What are Cashless Claims

Wonder how you’d deal with an emergency hospitalization if you’d be low on cash? Such uncertain exigencies can strike anytime and put a strain on your monthly budget and savings, causing you to spend your hard-earned life savings on hefty hospital bills. But with Care Insurance cashless claim settlement you need not worry about this untimely trouble. Under a cashless facility, the insurance company directly settles the medical expenses with the hospital without you having to pay the bills first. Care Health Insurance plan are designed in this exact same way. With a cashless treatment facility available at its wide network of 8350+ hospitals, all you need to focus on getting the right medical care!

 

Here’s how you can file a cashless claim:

 

  1. Seek medical care at your nearest network hospital
  2. Intimate the insurer within 24 hours in case of an emergency hospitalisation and 48 hours prior for a planned one.
  3. Request and submit the pre-authorization form available at hospital’s TPA/insurance desk
  4. Your request may be approved, sent with query or rejected by the claim management team      
      
    Approval - On approval your claim is settled.

    Query Raised - In case a query is raised, the insured or hospital is to respond to the same

    Rejection - Upon rejection, you may initiate the treatment and file for reimbursement claim

Document Required for Filing a Cashless Claim

  • Pre-authorization form
  • Valid ID proof along with photograph
  • Documents such as voter ID, Aadhar car, 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

What are Reimbursement Claims

Unlike cashless claims, in case of reimbursement claims you have to take care of the medical bills initially. These expenses are them reimbursed by the insurance company. Reimbursement claims take place when you seek treatment and medical care at a non-network hospital, which is usually a scenario during critical conditions. It is important to retain all the documents and medical bills, which must be submitted by filing the claim.

Here’s how you can file a reimbursement claim:

  1. Get your treatment done at the nearest hospital
  2. Inform the insurer within 24 hours in case of an emergency hospitalisation and 48 hours prior for a planned one.
  3. Submit the claim form, original medical bills and receipts along with documents required while filing a claim.
  4. Your request may be approved, sent with query or rejected by the claim management team

            On approval your claim is settled.
 

            In case a query is raised, the insured is to respond to the same
 

            Upon rejection, the insurer should communicate with reason for  rejection

Document Required for Filing a Reimbursement Claim

  • 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 report s including x-ray /MRI/CT image.
  • 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

 

Why Your Care Health Insurance Claims May Get Rejected

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

Claim for an excluded incident

In case you file a claim for an incident that is excluded from your policy, your claim may get rejected

Incorrect Details

In case any details are misinterpreted, and information provided during the claim is wrong, the claim stands rejected

Delay in intimation

In case you fail to inform the insurance company regarding the medical emergency or planned hospitalisation, your insurer may not be able to assess the situation completely, resulting in claim denial

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 which is still not completed, your claim could be denied.

What to Keep in Mind while Filing a Care Health Insurance Claim

There are certain key points that you must be careful about when filing health insurance claims. These steps would help in a hassle-free and quick claim settlement.

Keep a check on the documents required

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

  • Your valid ID proofs
  • Bills of any medicines or equipment used
  • Policy document
  • Cancelled cheque                           
  • Other documents required by the insured

Read the list of exclusions carefully

Every health insurance policy has some scenarios listed that are not taken care of by the insurance company. These are referred to as exclusions. In case the claims are filed for scenarios that are listed in the exclusions, the claims are not approved. Hence, it is imperative to check the exclusions before making a claim so that the claim amount is covered by the insurance plan.

Ensure your claim is admissible to the sum insured limit

When you buy your health insurance, your claims are acceptable up to the available sum insured limit of your health insurance plan. In case your claim 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

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 is lapsed. 

Read More: Claim Settlement Ratio.

We are Here to Help You

 

At Finserv MARKETS

 

At Finserv MARKETS, we are committed to serve you better. Here’s how you can connect with us, should you need any help with Care Health Insurance!

 

Here’s how you can seek help with Finserv MARKETS:

 

  • You can call us on 020-66399444. Our executive will be at your service from Mon to Sat - 10 am to 6 pm
  • You can write to us at: insuranceconnect@bajajfinservmarkets.in
  • You can also login to our Customer Portal - https://www.bajajfinservmarkets.in/cust/#/
  • We like to be connected! Download our Finserv MARKETS App, so can easily manage your account and track your applications - anytime, anywhere!

 

At Care Health Insurance Limited

 

Care Health Insurance, with its prompt and easy service, is committed to meeting your needs consistently. Their online, self-help portal lets you get a resolution to your issues in a jiffy.

 

Here’s all you have to do:

 

  • Logon to carehealthinsurance.com/self-help-portal.html in case you wish to update basic details
  • You can contact them at 1800-102-6655, 1800-200-4488 (Toll Free)
  • You may also write to them at customerfirst@carehealthinsurance.com

Best Health Insurance Plans Available at Bajaj MARKETS

Manage all Your Queries Here

  • ✔️Where do I find the list of Care Health Insurance Limited (formerly known as Religare Health Insurance Company Limited) network hospitals?

    Accessing the list of network hospitals is very. You can do it through any of the following ways:

    ·         Visit https://www.careinsurance.com/health-plan-network-hospitals.html

    ·         Call at 1800-200-4488 to enquire about a specific hospital

  • ✔️What is the meaning of a Cashless Claim?

    In case of a cashless claim, the policyholder or hospital has to intimate the insurance company regarding the hospitalization and submit the respective pre-authorization request. After this, the claim is directly settled with the network hospital and the you are not required to pay any amount (except the costs not covered under the policy). It is important to note that you can avail cashless hospitalization at a Care Health Insurance Limited (formerly known as Religare Health Insurance Company Limited) network hospital only.     

  • ✔️What is a network hospital?

    A network hospital is the one that has an agreement with Care Health Insurance Limited (formerly known as Religare Health Insurance Company Limited), for providing cashless treatment to its policyholders. You can avail the cashless facility at network hospitals only.

  • ✔️How can I file a reimbursement claim?

    In case of a reimbursement claim, you have to pay the complete hospitalization expenses yourself and then claims for a reimbursement of the hospital bill from the insurance company. You are required to submit all the original medical bills and treatment and discharge papers and intimate the insurer.

  • ✔️How many claims am I allowed file during a policy period?

    You can make multiple claims during a policy period as there is no upper limit on the number of claims. That being said, the total cumulative claim amount should be within the Policy Sum Insured limit.

Health Insurance Claim Settlement Reviews

Health Insurance Claim Settlement Reviews

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Easy Claim Process

The claim process of health insurance plans on Finserv MARKETS is very easy and hassle-free. Happy to buy the policy from this platform.

Reliable Platform

Plans on Finserv MARKETS are super reliable and so is the platform. The plans are very cost-effective and helpful when it comes to claim settlement.

Great Customer Service

The health insurance plans on Finserv MARKETS come with great customer service. The executive helped solve my claim related query very politely.