Care Health Insurance

• Promoter Synergies: promoted by the founders of Fortis Healthcare and SRL Diagnostics bringing experiences in the field of wellness and healthcare.
• Wide Network: promises quality treatment at 4100+ leading network hospitals across the country.
• Settlements: has a good claim-settlement record, which is quite reassuring for potential customers.
• No-Claim Bonus: for specific products, the no-claim bonus scheme can go up to a whopping 150%.
• Incurred Claim Settlement Ratio: The incurred claim settlement ratio of Care Health Insurance for F.Y. 2018 - 19 is 55%.
• No. of members - The plan covers maximum 6 members of your family with up to 2 children and 4 adults.
• Lifelong Renewal - The plans offered are lifelong renewable hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
• Pre & Post hospitalization cover - The health insurance plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
• Health Check-ups – Offers free health check-up for insured.
• Pre-existing diseases - Pre-existing diseases are covered after 4 years of waiting period

There are two ways to make claim under a health insurance policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Care Health Insurance has a well-defined claim processing system.

Cashless Service: seeking Pre-Authorization

• Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
• Send the completed form via email or fax.
• Approved letter will be sent by the claim management team.
• Remember that the claim management team could send an inquiry to the hospital or you before authorization.
• In case the authorization is rejected, initiate the treatment and file for reimbursement claim.
• Reimbursement Claim: Claim Submission

Complete the necessary form and submit along with required documents, as per the policy terms and conditions.

Necessary documents include discharge summary, prescriptions, bills etc.

Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.

In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform Care within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Care’s toll free number 1800-102-4499, or fax 1800-200-6677.

Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.