Care Health Insurance Claim Settlement

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Care health insurance's claims handling procedure is just as good as its services. It is completely hassle-free and has a simple process which can be completed online. The insurance prides itself on its high Care health claim settlement ratio statistics through a quick and easy claim procedure, which is supported by a sizable number of network hospitals on the database of healthcare facilities. When it concerns Care claim settlement, there are two options: Cashless and Reimbursement.

The Claim Process for Cashless Treatment for  Care Health Insurance Claim Settlement

The Care health insurance claim settlement comes in with the cashless treatment benefit, which assures you of not having to pay your medical bills,  and some other expenses when you admit to one of the network hospitals during stressful times under the company's database. Care health insurance will pay all your insured expenses once you submit the claim and let the company know about your admission. 

You have access to almost over 19,000 network hospitals under their partnership, where you can avail of cashless treatment. The high Care health claim ratio assures you have a stressless treatment process. The entire procedure of the Care health insurance claim settlement can be done in two ways, planned and emergency. The only recurring difference between the two is the time slot you have to avail yourself while informing the company about the admission. You have to let the company know within 24 hours of emergency hospitalisation, and within 48 hours if it is a planned hospitalisation. Here is the process of cashless Care health insurance claim settlement:

  1. Locate a Care network hospital in the city where you wish to receive cashless care Care health insurance claim settlement.
  2. Carry the cashless care card or the insurance number and member ID while attending a network hospital.
  3. The member ID card or policy number should be presented to the hospital's insurance desk.
  4. Fill out the hospital's pre-authorization form completely and accurately.
  5. The pre-authorization request will be delivered to Care health insurance company when the insurer has been informed and the form has been filled out.
  6. The team at Care health insurance notifies the policyholder and the hospital of the acceptance or denial after inspecting and assessing the claim information received.
  7. While the policyholder is responsible for paying the bills in the event of rejection, the Care will cover the medical costs immediately in the event of acceptance.

The Cashless Claim Procedure After Admission

The procedure of the cashless claim after your admission to the network hospital is fairly simple. Once you have submitted all the necessary documents to the hospital authority for the  Care health insurance claim settlement, the hospital will forward it to the company of the TPA in charge. If your claim is approved and reviewed, then you can Caret receiving treatment immediately. The hospital authority or the TPA may suggest changing the cashless insured sum if required. You will have to submit additional documents in case of the change of sum insured. 

The TPA in charge of the hospital authority will forward your discharge certificate and the invoice to the company for the  Care health insurance claim settlement. The company will make the complete payment for the claim under what you are insured for, excluding some expenditures prohibited by law. 

List of Documents Required for Care Health Cashless Claim:

The required documents for the cashless claim are as follows:

  1. The doctor's evaluation, prescription
  2. Your coverage and insurance details
  3. Your name, address, and contact information for the hospital records
  4. The name and contact of the treating doctor
  5. The date of the day you were admitted to the hospital and the day you may be discharged

The hospital may require additional information if they deem it fit.

How to Check  Care Health Insurance Policy Claim Status?

A variety of health insurance plans from Care health insurance company assist its clients in covering their hospital-related medical costs. The firm conducts the majority of its claim procedures online, with the claim settlement ratio of Care health insurance being around 95.2%. On the website of the insurer, you may check the status of a claim under the Care health insurance policy, submit a claim notification, monitor a claim, and more. By following the short instructions listed below, one may easily check the status of their care Health Insurance Claim Settlement and policy online: 

The Online Process for  Care Health Insurance Claim Settlement

  • Self-help through the website or mobile application – 

You may visit the self-help portal to update your contact information, including your address, email address, and mobile number. Additionally, you may submit online requests for policy documentation and check the progress of your claim requests. Additionally, you may utilise their mobile app on iOS & Google Play Store.

  • By submitting a request through the customer portal-

Visit the Care health insurance customer support portal and you will reach their login page. Submit your request by entering your policy number and captcha. Moreover, you can also check the status of your policy claim online.

Here is how to check the status of a Care health insurance claim on your own:

  1. Visit the Care Insurance Company's official website.
  2. Select the “Contact Us” option on the home page.
  3. It will take you to the insurer's website's "Contact Us" section.
  4. There are several alternatives on this page; choose "Claim Filing and Tracking" and then "Know Your Policy."
  5. Enter the "Policy Number" and the "Captcha code" on the screen that appears, and then click "Next."
  6. On the screen that appears next, verify the status of your Care health insurance settlement ratio.

Here is how to use Claim Genie to check the status of a Care health insurance policy claim online:

  1. Go to the Care Insurance Company's official website.
  2. Select the "ClaimGenie" option from the drop-down menu labelled "Already a Customer" on the main page.
  3. You will be sent to a new page where you must enter your "Care health insurance policy number."
  4. When it's finished, you need to enter the captcha code.
  5. Click the ‘Next’ button now.
  6. One can check the status of their claim on this website after it loads.

Through the customer support portal:

  1. Visit the Care Insurance Company's customer service at the website.
  2. On this screen, pick the "Claim Filing and Tracking" option under the heading "Useful Links."
  3. You must input the provided "Captcha" and your "Care health insurance policy number" on this page before pressing the ‘Next’ button.
  4. One can also check the progress of their claim by clicking on ‘Track Your Request’.

The Offline Process for  Care Health Insurance Claim Settlement

If you are unable to check the progress of your Care health insurance claim settlement online, you may use their WhatsApp number-8860402452 or send them an email at As an alternative, you can verify the progress of your Care health claim ratio by going to the Care health insurance branch that is closest to you and giving the customer service agent the appropriate information, such as your policy ID, intimation number, card number, etc.  

The Claim Process for Reimbursement Treatment for  Care Health Insurance Claim Settlement

Non-network hospitals allow you to submit a reimbursement claim for Care health insurance claim settlement. The steps involved in filing a refund claim are as follows:

The Care health insurance company must be notified 48 hours before any anticipated hospitalisation. Within 24 hours after being admitted to the hospital, the notification should be provided in the event of an emergency. According to the terms and circumstances of the plan, a reimbursement claim form must be filled out along with the pertinent papers. The claim management staff of Care health insurance sends the policyholder a letter of approval to confirm the approval after investigating the supporting documentation and claim form information. Following this, the money is repaid within 15 days. In the event of a rejection, the insured person must answer the insurer's question, failing which the insured will be informed of the reasoning for the rejection.

List of Documents Required for  Care Health Reimbursement Claim

These are the documents required for your Care health claim settlement ratio:

  1. Initial investigation reports
  2. Summary of the final hospital discharge
  3. An FIR or post-mortem report, if possible
  4. Along with the prescription, pharmacy bills
  5. Authentic invoices, receipts, and a discharge report indoor case files and a properly completed claim form
  6. Original healthcare bills and documentation of a valid picture ID
  7. Report from the treating physician and the original consultation notes
  8. The type of surgery done, the surgeon's invoice, and the receipt
  9. Test results are accompanied by a report from the treating physician or surgeon

Please note that the Care health insurance may ask for additional documents.

Incurred Claim Ratio (ICR) of  Care Health Insurance

The Incurred Claim Ratio (ICR) is a very efficient method for assessing an insurer's viability and dependability. ICR displays the speed at which claims are processed as well as the insurance company's productivity in terms of income. For the fiscal years 2020–21, Care health insurance's ICR is 55.15%. An ICR number between 50% and 90% is often seen as satisfactory, indicating that Care health insurance has a sufficient quantity of assets on hand and is successfully managing claim processes.

Care Health Insurance Claim Settlement Ratio (CSR)

The percentage of claims that are settled to all claims that are allowed by the insurance company in a given fiscal year is known as the Care health claim settlement ratio. For instance, if an insurance company's CSR is 90%, it indicates that 90 out of every 100 claims have been resolved. The claim settlement ratio for Care health insurance is 100% for the fiscal year 2021. This effectively guarantees the greatest defence for potential clients against a medical claim. Keep in mind that the claim settlement ratio fluctuates.

Care Health Insurance Claim Settlement FAQs

  • 1. How long is the time limit for settling a claim in ManipalCigna?

    In general, the firm responds to claims within 7 working days of receiving the last 'required' document. However, in some circumstances, the deadlines are extended. These should take no longer than 30 days.

  • 2. What are the causes for the claim amount being reduced?

    The amount of the claim can be reduced for any of the following reasons:

    1. Non-Medical costs such as phone bills, refreshments, and so forth are not reimbursable
    2. Absence of valid documents or prescriptions
    3. Exhaustion of the insured sum
    4. Exceeding the defined sub-limits
    5. If a co-payment is required
    6. Cost limits for any given treatment or benefit
    7. Authentic reports/bills are no longer available
    8. Expenses for any studies or therapy that are unrelated to the condition for which the patient is hospitalisedease or accident that happens during a policy year.

    This information is only illustrative and may differ depending on your coverage plan.

  • 3. Will my ManipalCigna claim be approved if I fail to submit it on time?

    In some cases, yes. Generally, the completed claim form and paperwork must be submitted to the firm within the specified timeframes. If the deadline is missed, but the policyholder can demonstrate that the lag was legitimate and unavoidable, accompanied with evidence, the claim will be approved.

  • 4. Is there any inquiry that takes place after the ManipalCigna claim is filed?

    For cashless claims, the hospital resolves all queries, so there isn’t any further enquiry. However, for reimbursement claims, the insurer can choose to enquire about the claim if there is any suspicion regarding the legitimacy of the claim. So, to avoid all confusion, you need to submit all relevant documents and claim only if the same is legitimate. 

  • 5. What are the most prevalent reasons for ManipalCigna claim rejection?

    The following are the most prevalent reasons for claim rejection:

    1. If the claim is raised within the waiting period for the policy.
    2. If there is an exclusion for pre-existing illness and a claim is raised for the same.
    3. If there has been a non-disclosure or misrepresentation of material facts regarding any pre-existing ailment, diagnosis, or treatment for the same.
    4. If you violate the terms and conditions of the policy as defined in the policy document.
    5. If all documents are not provided on time, or there has been a delay in the claim intimation.
    6. If there has been a sub-limit or an exclusion for any particular ailment.

    In fact, there could be multiple reasons for the rejection of a claim. But if you follow the process to the tee and submit all relevant documents, your claim will be cleared on time without delay.

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