Care Health Insurance Claim Settlement Ratio

Considering the recent rise in lifestyle diseases and increasing medical inflation, it is obvious that health insurance plans are becoming a popular financial product. To cater to this rising demand, multiple insurers are now offering customisable, affordable, and comprehensive policies with very few restrictions and exclusions.

However, say you have already been diagnosed with an ailment and are now looking for a health insurance plan; you might face a few hurdles—a limited number of plans available, high premiums to cater to your pre-existing medical condition, room rent restrictions, mandatory co-payment, disease-wise sub-limits, longer waiting periods, and more. Such pricier health insurance plans may discourage you from purchasing health insurance altogether.

This is where a health insurance provider like Care Health Insurance (previously known as Religare Health Insurance and founded in 2012) comes in. Even if you have a pre-existing condition, they won’t ask you to pay extra. Or in other words, they do not impose “loading charges” This ensures that your premiums stay pocket-friendly despite your pre-existing medical condition. While this is an incredible feature extending Care the required edge over its competitors, we wonder about the actual credibility of this insurer.

Let’s focus on the Care Health Insurance Claim Settlement Ratio as the first metric to measure the insurer’s credibility. Then, you can decide whether to purchase a health insurance policy from this standalone provider.

What is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) of a health insurance provider is given by -

(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100

In the case of health insurance providers, a CSR of 90 or above indicates top-notch credibility in the market. On the other hand, if the numbers go above 100 or drop below 80, it’s best to avoid these providers, considering the chances that these insurers might be involved with delayed claim settlements, rejected claims, or partial settlements.

What is the Care Health Insurance Settlement Ratio for 2024?

(If you are looking for the Care Health Insurance Claim Settlement Ratio 2024, you need to consult the data of Care Health for 2022- 2023. However, a single year’s data may not suffice, considering that you need to have an in-depth understanding of the consistency in the insurer's performance. Hence, we have taken the data from the last 3 years, drawn an average of them, and then tallied the average with the industry average.)

Overview of Care Health Insurance

What is the significance of Care Health Insurance Claim Settlement Ratio 2024?

Across the last 3 years, the Claim Settlement Ratio data of Care Health has undergone specific changes. So, what does this data reflect? Here’s an insight -

1. Consistency: The Care Health Insurance Claim Settlement Ratio data has fluctuated over the last 3 years. Unfortunately, the numbers have, at times, dropped below 90. This isn’t a good sign for its policyholders, and now we have to focus on the coming years to ensure that the insurer improves its credibility-consistency.
2. Overall Performance: Unfortunately, Care Health Insurance barely exceeds our recommended threshold of 90 on average and hardly meets the industry average year over year.

Why is the Claim Settlement Ratio important?

When purchasing a health insurance plan, the first step is to finalise a provider. To ensure that you land upon a top-notch provider, you need to measure the brand’s true credibility via a few metrics. The first metric in this respect is the Claim Settlement Ratio (CSR). This gives you an initial idea about the claim settlement track record and history.

However, CSR is only one metric to measure an insurer’s credibility, but it isn’t the ONLY one. Apart from the CSR, you also need to check out the data for the brand’s Incurred Claim Ratio (ICR), complaint volume, and number of network hospitals. This will give you a comprehensive insight into the overall performance proficiency of the health insurer in question.

What is the Claim Settlement Process for Care Health Insurance?

• CASHLESS

STEP 1: Contact Care Health 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.

STEP 2: Submit the required documents (as mentioned below).

STEP 3: The hospital will request the insurer for their pre-authorisation approval.

STEP 4: The insurer approves the treatment, and you can go ahead with a cashless mode of claim settlement, which will be covered by your insurer when you are discharged.

(Please note that if your cashless request is denied, you can still proceed with the treatment. You will need to pay the bill from your pocket initially and can later file for a reimbursement claim settlement. The process for this is mentioned below.)

• REIMBURSEMENT

STEP 1: You can register your claim online by visiting the Care Health Insurance ‘Self-Help Portal’ Link or download the Care Health-Customer App

STEP 2: Complete the claim form and submit it with the required documents (as listed below) online or at the nearest branch.

STEP 3: After cross-verification of your documents and the hospital desk, the insurer will disburse your claim amount to your bank account.

You can also receive guidance on your claim settlement by calling their helpline number - 1800-200-4488 for assistance.

What are the documents required to settle claims for Care Health Insurance?

When planning to file a claim to Care Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy -

• CASHLESS

- Policy number (health insurance card)

- Copy of ID proof

• REIMBURSEMENT

- Original discharge summary

- Original final hospital bill with item-wise break-up

- Original paid receipt against the final hospital bill

- For Accidental cases, MLC/FIR copy (if applicable)

- Alcohol history (if applicable)

- Investigation reports (like X-ray/MRI/CT Scan etc.)

- Attested copy of indoor case papers

- In case of implant surgery, invoice & sticker

- For all claims amounting to ₹1 lakh or above, please provide a copy of any of these KYC documents (Aadhaar Card, Passport, Driving Licence, Voter ID, etc).

Please ensure that the address on the KYC documents matches the Policy address.

Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.

Conclusion

To date, Care Health Insurance holds great credibility across the industry. However, the fluctuations in the Care Health Insurance Claim Settlement Ratio data are a concerning sign that needs to be addressed urgently since the brand’s credibility might take a severe hit. In that case, despite having a solid lineup of health insurance products, the unique perk of “no loading charges,” affordable premiums, and comprehensive policies - competitors will have the edge over Care.