Care Health Insurance Claim Settlement Ratio

The health insurance claim settlement ratio indicates a company's ability to settle claims against the number of requested claims in a financial year. Every year, the Insurance Regulatory and Development Authority of India (IRDAI) publishes the claim settlement ratio of each health insurance company in its annual report.

Evaluating the claim settlement ratio before buying a health insurance plan is advisable as it reflects the efficiency, reliability, and financial health of an insurer.

This article provides information about the claim settlement ratio of Care Health Insurance.

What is Claim Settlement Ratio?

The claim settlement ratio of a company refers to the claims settled by a company against the total claims filed during that financial year. For example, if the company settled 90 claims out of 100, the CSR would be 90%.

The formula for calculating the CSR is:

(Total Claims Settled) / (Total Reported Claims + Outstanding Claims at the beginning of the Year - Outstanding Claims at the End of the Year).

Care Health Insurance Claim Settlement Ratio

According to IRDAI, Care Health's claim settlement ratio is 92.77% in the first quarter of 2025. The company claims to settle cashless claims within 2 hours. To date, the company has settled over 25 lakh claims, demonstrating its commitment to quick claim settlement and support during medical-financial needs.

What is the Claim Settlement Process of Care Health Insurance?

Care Health Insurance operates transparently and systematically to clear claims. The following is the claim settlement process:

Case 1: Cashless Claim Procedure

• In case of emergency or planned hospitalization, inform the insurer within 24 or 48 hours of hospitalization.
• The policy nominee must fill and submit the pre-authorization request form to the hospital's insurance/TPA desk.
• The hospital will send all documents to Care Health Insurance for verification.
• After reviewing the documents, the claim management team will send an approval letter to the hospital.
• The hospital will proceed with the cashless treatment of the insured member.

Note: If the cashless claim is rejected, the insured member can initiate treatment and file for a reimbursement claim after discharge.

Case 2: Reimbursement Claim Procedure

• In case of emergency or planned hospitalization, inform the insurer within 24 or 48 hours of hospitalization.
• The insured must submit the duly filled reimbursement claim form to the insurer along with required supporting documents such as:
• Original duly completed and signed claim form
• 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 card 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 required by the company to assess the claim
• The company will review the documents.
• If the claim is approved, the company will transfer funds to your registered bank account.

Conclusion

Care Health Insurance has a strong track record of settling over 25 lakh claims and aims for swift cashless settlements within 2 hours. The claim settlement ratio for the first quarter of 2025 is 92.77%. Understanding the claims process and ensuring all documentation is meticulously prepared is crucial. By staying informed and adhering to the outlined procedures, policyholders can navigate the claim settlement process confidently, knowing that Care Health Insurance is committed to supporting them during medical emergencies. Explore Care Health Insurance plans today and download our detailed claims guide to familiarize yourself with the process. Visit our website or speak with a PolicyX.com representative for personalized assistance and secure your family's health today!