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Care Health Insurance Claim

A quick and simple claim process is one of the top priorities for policy-seekers while scouting for the best health insurance plan and provider in the market. Aiming to settle cashless claims within 2 hours (approximately), Care Health Insurance functions to offer the maximum convenience to its customers by designing an easy to understand claim process for its health policies. Let’s find out more details for the same.

Claim Process of Care Health Insurance

Care Health Insurance has kept its door open both online and offline for the benefit of its customers. Here, both the processes are described in detail.

Cashless Claim Procedure

If you feel comfortable with the online procedure, here are the steps for that. Just remember, to avail of the cashless facility, you need to receive medical treatments from a network hospital or healthcare center of the company.

  • As soon as the incident happens, you need to inform the insurer within 24 hours of the occurrence. In case of planned hospitalization, you need to intimate the insurer 48 hours before the hospitalization. You can contact the company for filing a claim using their telephone number, 1800-102-4488, or else can directly write to them, via email, at customerfirst@careinsurance.com.
  • Then, you need to get the pre-authorization form that is available at the hospital’s insurance or TPA desk. You can also download that online by visiting the official website of the company.
  • Fill up the form with proper details and submit the duly filled and signed form to the hospital’s insurance or TPA desk. The hospital will fill up the balance details.
  • The hospital needs to fax the completed form to this number, 1800-200-6677.
  • The in-house medical team will assess and verify the submitted documents and the form thoroughly. If no discrepancy is found, the pre-authorization form is approved by the insurer. You and the hospital will be notified about the same.
  • If the company needs any more documents, the hospital as well as you will be informed about the same.
  • If Care Health Insurance is satisfied and your claim is fair enough, it will directly pay to the hospital. If your claim is not still approved, you will be notified and you may file for a reimbursement claim.

Reimbursement Claim

For availing of a reimbursement claim procedure, you can get admitted to any hospital of your choice. It is not mandatory to receive medical treatments from a network hospital or healthcare center of the company. Here is the step-by-step guide on this process.

  • For emergency hospitalization, inform the insurer within 24 hours of the incident and for planned hospitalization, the company is needed to be notified 48 hours prior to it. During the claim intimation, you need to provide the company with the following information.
    1. Policy Holder’s Name.
    2. Claimant’s Name & Customer ID.
    3. Hospital details.
    4. Diagnosis and Treatment details.
    5. Approximate claim amount.
    6. Date of admission
  • After receiving the information, a unique claim reference ID will be given to you on behalf of the company for future reference.
  • After that, download the claim form from the official website of the company and submit the duly filled and signed form along with the required documents. Do not provide any false information.
  •  An in-house medical team will be appointed on behalf of the company to assess and evaluate your claim. If no discrepancy is found, your claim amount will be approved and you will be notified about the same.
  • If any further documentation is required, the same will be communicated to you.
  • If any discrepancy is found, your claim will not be approved and will be intimated the same by the insurer stating the valid reasons.
  • But, if you or your representative have some documents to validate or substantiate the claim, you can contact the insurer. In that case, your claim file will be reopened and reassessed.

Required Documents To Submit Claim Application

The required documents for reimbursement claim are as follows:

  • Duly completed, filled, and signed claim form, in original
  • 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 cards 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

How To Download Claim Forms For Care Health Insurance?

You can download the claim form on your own, online just by following the below mentioned easy steps.

  • Go to the official website of Care Health Insurance.
  • On the right side of the homepage, there will be the Already A Customer tab. Click on that.
  • Select the ClaimGenie option.
  • Scroll down a little and on the right side of the landing page, there will be the Claim Forms option. Click on that.
  • There will be many options for the claim forms. Select the one according to your convenience.
  • You can either download it directly in PDF format or can send it as an email.

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