At Care Health Insurance Limited, the principal purpose for our existence is to ensure that our customers enjoy quick & hassle-free access to best-in-class healthcare delivery facilities, and we live this objective through our seamless claim process. Our 9400+ network of hospitals make the claim management quick and convenient for you.
Through the seamless procedures at Care Health Insurance, you can enjoy the convenience of making health insurance claims from the comfort of your home. All you are required to do is adhere to a 3-step process and avail cashless treatment or reimbursement of your medical expenses.
You can register your claim online by scanning & uploading the claim documents at the Care Health Insurance ‘Self-Help Portal’ Link- https://www.careinsurance.com/self-help-portal.html or download the Care Health-Customer App to be able to do the same.
As per the product you are insured with, download the re-imbursement claim form & submit online- https://www.careinsurance.com/health-insurance-claim-forms.html or download the Care Health-Customer App to be able to do the same.
Upload a personalized name printed cancelled cheque in name of employee for corporate policy and in name of proposer for individual policy.
In event of employee’s/proposer’s demise – cancelled personalized cheque (name printed) of nominee, ID proof of nominee & legal heir certificate.
You are requested to scan & upload the following documents received from your hospital. Also submit additional documents, if any.
Original discharge summary Original final hospital bill with item wise break-up Original paid receipt against the final hospital bill For Accidental cases 1) MLC/FIR copy (if applicable) 2) Alcohol history (if applicable) Investigation reports (like X-Ray/MRI/CT Scan etc) Attested copy of indoor case papers In case of implant surgery, invoice & stickerFor all claims amounting Rs.1 lakh or above please provide copy of any one of these KYC documents (Aadhaar Card, Passport, Driving Licence Voter ID, etc). Please ensure that the address on KYC documents is matching with the Policy address.
To locate the nearest cashless network visit https://www.careinsurance.com/health-plan-certified-network-hospitals.html or download the Care Health-Customer App by clicking here https://bit.ly/3iI2ZfJ.
Contact hospital insurance help-desk or billing counter with a copy of patient’s medical ID card, e-health card, pre-authorization form along with valid Govt. ID proof.
You can easily access your e-card anytime, anywhere by downloading the Care Health-Customer App.
Submitted documents are shared by the billing counter/TPA desk with us, seeking pre-authorization approval.
In case any information is incomplete/missing; we may contact hospital for the same. Pre-authorization decision will be given by us post review as per policy terms and conditions.Post treatment discharge summary and other related documents are submitted by the hospital/TPA to us for final approval.
We assess the bills basis the sum insured and plan terms & conditions to settle the bill directly with the hospital.
You can intimate, file and submit your claims using our online customer interface ‘Claim Genie’ through the web or mobile phone platform.
To register your claim online just download the Care Health-Customer App by clicking https://bit.ly/3iI2ZfJ.
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We will constantly update you at every stage of claim process through SMS/Whatsapp and email. For reimbursement claims, you will hear from us within 7 days of registration of Claim. For cashless claim we will contact you within 6 hours from the time of claim intimation.
Alternatively you can also check your claim status online on https://www.careinsurance.com and on the Care Health-Customer Mobile App. Click here to download https://bit.ly/3iI2ZfJ.
CIN:U66000DL2007PLC161503 IRDAI Registration Number - 148
assure - critcal illness claim form
Care Reimbursement Claim Form
Group Insurance - Secure- personal accident- claim form
Group Insurance - Care - claim form
List of standard exclusions
What are the lists of Non Payable items?
Click here for list of non-payable items
How do I find a list of Care Health Insurance Limited Network hospitals?
You can view our list of Network hospitals here .
What happens to my Sum Insured after a claim is filed?
Sum Insured is reduced by the amount of claim paid for the rest of policy year.
What are the reasons for deduction in claim amount?
Claim amount can be deducted for any of the following reasons:-
a) Non-Medical expenses such as telephone bills, snacks etc. are non-payable,
b) Treatment details without proper bills or prescription,
c) Sum Insured exhausted,
d) Amount exceeding specified Sub-limits
e) Co Payment applicable,
f) Capping of expenses for any particular treatment or benefit,
g) Original reports/bills not available,
h) Expenses related to any investigations/treatment not related to ailment for which patient is admitted."
How to Track your claim?
Claim status can be tracked online here or contacting customer care at 1800-200-4488. You can also visit our nearest branch or write to us at customerfirst@careinsurance.com.
How does one file a claim for reimbursement?
In case of a reimbursement claim, the insured pays the hospitalization expenses (which is otherwise claimable under his insurance contract) himself and then claims for a reimbursement of those expenses from the Insurer. The Insured should submit all the bills and treatment papers in original to us and intimate regarding the hospitalization as per policy terms & conditions.
For a detailed process – please click on "Process" tab.
How do we avail cashless treatment for planned/emergency hospitalization?
For any emergency hospitalization,the insured should intimate us within 24 hours from the time of hospitalization. For any planned hospitalization, the Insured should seek cashless authorization from us at least 48 hours prior to hospitalization.
Can a request for Authorization of cashless treatment be declined?
"Yes, a request for authorization of cashless treatment may be declined if:- a) Inadequate / vague / wrong information is provided and we are unable to get access to further information. b) The ailment/ disease for which hospitalization is required, is not covered by the scope of the insurance policy. c) The person does not have an adequate sum insured left to cover the hospitalization costs. This only means that cashless access is declined, AND IS IN NO WAY TO BE CONSTRUED AS DENIAL OF TREATMENT. The insured person must obtain the treatment as per his/ her treating doctor's advice, and may subsequently file a claim for reimbursement."
How does one obtain the Authorization letter?
The Authorization form is available at the TPA desk of the hospital. The form can also be downloaded from here. The duly filled form has to besent by the hospital through fax or email to Care Health Insurance Limited; post-review of the same an authorization letter will be sent to the hospital.
What is Cashless Claim?
In a cashless claim, the insured/hospital intimates us regarding the hospitalization and submits a pre-authorization request. On authorization, the claim is directly settled with the network hospital and the insured is not required to pay any charges except for expenses not covered under the policy. Cashless facility can only be availed at a Care Health Insurance Limited network hospital.
What do you mean by Network and Non-network Hospital?
A Hospital, which has an agreement with Care Health Insurance Limited for providing Cashless treatment to its customers, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at network hospitals.
Non-network hospitals are those which will not provide a cashless treatment facility toCare Health Insurance Limited customers. Customers availing treatment at these hospitals will have to pay for the same and later file a claim as per the reimbursement procedure.
What is the maximum number of claims allowed during the policy period?
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.
