Care Health Insurance Claim Process/Form/Reimbursement 2026

Quick Overview

Care Health Insurance allows you to file both cashless and reimbursement claims. You must inform the insurer regarding all cashless claims through email, the website, or the Claim Genie app. If it's a planned hospitalization, notify the insurer within 48-71 hours before admission. For emergencies, you must inform them within 24 hours of getting admitted or before your discharge.

Alternatively, you must file a reimbursement claim if you’re choosing a non-network hospital. This requires you to pay bills yourself, collect relevant documents, and submit them to the Care health officials within 15 days after discharge.

Have you bought your health insurance policy from Care? If yes, then the most important thing for you to understand is the claim settlement process of the insurer. Irrespective of a medical emergency or planned treatment, you must know how to file claims, submit documents, or contact the insurer.

This guide helps you understand:

How to file a claim
What the cashless and reimbursement processes look like
Documents required for claim settlement

Quick Note

For hospitalization, day care, and pre-hospitalization expenses, the claim must be filed within 15 days from the date of discharge from the hospital. Post-hospitalization expenses must be filed within 15 days from discharge.

How to Claim Care Health Insurance?

Cashless Claim Process

The cashless claim process at Care health insurance is simple and includes the following steps:

Go to a network hospital and contact the insurance/ third party administrator (TPA) desk.
Share your policy/health card details and patient information.
The hospital helps initiate a pre-authorization request (this is the “permission” request sent to the insurer/TPA).
Care/TPA reviews the request against your policy coverage, waiting periods, exclusions, or room eligibility.
Once approved, Care directly settles admissible expenses with the hospital (you pay only the non-payables like excluded items, co-pay, sub-limits, etc.).

An Important Timeline!

IRDAI has directed insurers to:

Decide on cashless authorization within 1 hour of receiving the request.
Provide final discharge authorization within 3 hours of receiving the discharge request (and you shouldn’t be made to wait for discharge).

If there’s a delay beyond 3 hours, the additional amount charged by the hospital due to that delay should be borne by the insurer.

Reimbursement Process

If you have chosen a non-network hospital, follow these steps for reimbursement at Care Health Insurance:

Inform your insurer as early as possible about your hospitalization at the non-network hospital.
Receive treatment at the hospital.
Pay the bill upfront during discharge and collect related documents, such as bills, discharge summary, or pharmacy receipts.
Fill out the claim settlement form and attach the required documents.
Submit the claim as per Care’s process (online or physical), which depends on the option you choose.
Care’s claim management team will review your documents and send their approval as per the policy’s terms and conditions.
The insurer pays an admissible claim amount to your bank account.

Alternatively, you can also use the Claim Genie app available on Android and iOS, where you can file and track claims by submitting your policy number, customer ID, and date of birth.

CTA

Documents Required to File a Care Health Insurance Claim

Here is a list of documents required to file a reimbursement-based or cashless health insurance claim at Care.

For Cashless Claims

Duly filled and signed claim form
Doctor's prescription and referral letter
Diagnostic tests and medical reports
Original bills, receipts, and discharge papers from the hospitalization
Original bills from pharmacy/chemists
Police FIR, in case of an accident
Policy copy including policyholder name, contact number, nature of the illness, address, and other required information

Note: Post-mortem reports and death certificates are required only in cases of accidental death.

For Reimbursement Claims

Original discharge summary
Original final hospital bill with item wise break-up
Original paid receipt against the final hospital bill
MLC/FIR copy (if applicable); Alcohol history (if applicable in the case of accidents)
Investigation reports (like X-Ray/MRI/CT Scan, etc.)
Attested copy of indoor case papers
In case of implant surgery, invoice & sticker
A copy of any one of the KYC documents (Aadhaar Card, Passport, Driving Licence Voter ID, etc.) for all claims amounting ₹1 lakh or above.

Did you know? As per IRDAI Guidelines, if your claims are not settled within 45 days after submitting documents, your insurance company must pay a 2% interest above the bank rate from the date the last required document was received.

Quick Tips

Always keep digital and hard copies of all medical documents before submitting originals to Care.
Maintain proper document organization to ensure a smooth and faster Care health insurance claim/form/reimbursement process.
During pre-authorization, request the hospital to send complete clinical notes because missing them often leads to insurer queries.
Ensure your name is consistent everywhere: the policyholder, insured member, and patient names must match across claim forms, bills, and medical records.

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Ditto’s Take on Care Health Insurance Claim Process/Form/Reimbursement

Since Care Health Insurance is one of Ditto’s trusted partner insurers, we make the claim process simple for you. If you brought your health insurance plan through us, get in touch with our team for claim assistance.

Care’s average claim settlement ratio from 2022 to 2025 is 93%, which also reflects that your claims will be settled in time without delays.

Alternatively, if you’re submitting the claim yourself, and it is rejected, talk to the insurer and ask if you can submit it again. Collect missing papers and reapply. If that still doesn’t work, reach out to the Ombudsman for further assistance.

Frequently Asked Questions

How can I track the status of my health insurance claim?

You can visit the official website of Care health insurance and click on the ‘claims’ section. Then, enter your policy number and access all details instantly. Alternatively, you can also use the Claims Genie app to track your cashless or reimbursement claims.

How can I process a care health insurance claim?

Contact the hospital insurance help-desk or bill counter with a copy of your medical ID card, e-health card, pre-authorization form, and a valid Govt. ID proof. You can also access your e-card anytime or anywhere by downloading the Care Health-Customer App.

How is Care Health insurance claim settlement?

Care health insurance has an excellent claim settlement ratio of 93%, which falls within the suggested benchmark of 90+%. It also has 11,400+ network hospitals, which makes it a reliable insurer for buying insurance.

Can I use the cashless facility in any hospital?

Yes, the Cashless Anywhere initiative allows you to request cashless treatment even at non-network hospitals. However, cashless approval is not automatic and depends on Care Health’s evaluation and the hospital authority’s willingness to accept the terms. Remember, cashless claims are not allowed at excluded hospitals. In a genuine emergency, it may be allowed only until stabilization, not for full treatment.

How long does a reimbursement claim take to process?

Care’s claim processing page specifies that reimbursement claims should be filed within 15 days from discharge (as per their stated process). Any delay in the process may happen due to missing information or incorrect forms. Timely and complete submission is the only way to ensure repayment.

Last updated on: 4 Jan, 2026