Claim process in case of Cashless Treatment at Network Hospitals
Step 1 : Claim Intimation
- In case of an emergency hospitalization, call and inform us at 1800-102-4488 within 24 hours of your admission. However, if your hospitalization is planned, kindly intimate us 48 hours prior to your admission by calling on the same number or writing to us at email@example.com
Step 2 : Initiating the process for Pre-Authorization
- A Pre-Authorization form will be available at the hospital's Insurance/TPA desk, or you can alternatively download the same from here.
- Please fill the first section of the form by giving your personal details and hand over signed Pre-Authorization form to hospital's Insurance/TPA desk for them to fill up the balance details.
- Hospital will fax the completed Pre-Authorization form to us at 1800-200-6677.
Step 3 : Processing a request for Pre-Authorization
- Our in-house medical team will review the case and documents submitted by hospital.
- If your request for Pre-Authorization is approved, you and the hospital will be duly informed by us.
- In case of any information deficiency or further information requirement, you and the hospital will be regularly intimated by us to ensure resolution of the same at the earliest.
- If your request for Pre-Authorization is not approved, it only indicates that we are not able to process your request basis the requisite information available with us at this point of time. In such cases, you may claim for reimbursement of your expenses after discharge from the hospital.
Reimbursement of treatment expenses
Step 1 : Claim Intimation
In case of emergency, call and inform us within 24 hours of your admission. However, if your hospitalization is planned, kindly intimate us 48 hours prior to your admission. The following information is to be provided during the claim intimation-
- Policy Holder's Name.
- Claimant's Name & Customer ID.
- Hospital details.
- Diagnosis and Treatment details.
- Approximate claim amount.
- Date of admission
We will provide a reference ID for all future communication pertaining to the claim request.
Step 2 : Initiating the Claim process (Also applicable for Pre/Post Hospitalization claims)
The Claim form can be downloaded from here.
The completed and duly signed claim form has to be sent to us along with the following documents -
- Duly completed and signed Claim form, in original
- 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 as required by the company to assess the claim
The claim form and additional documents are to be sent to us at the following address:
Care Health Insurance Limited(formerly known as Religare Health Insurance Company Limited),
Unit No. 604 - 607, 6th Floor, Tower C, Unitech Cyber Park,
Sector-39, Gurugram-122001 (Haryana).
Step 3 : Claim Processing and Reimbursement
- Our In-house medical team will review the case and documents submitted by you.
- If your request for reimbursement of expenses is approved, you will be duly intimated by us.
- In case of any information deficiency or further information requirements, you will be communicated instantly to ensure resolution of the same at the earliest.
- If your request for claims is declined, you will be communicated the same along with valid reason(s) for rejection. However, if the insured/ insured's representative has further documents to enhance/substantiate his case for
claim, the same can also be sent to us; and if found rational, the case will be reopened for review of the documents and response, if any.
We will ensure that you are updated at all important stages of your claim process. To help us serve you better, please ensure the following-
The Pre-Authorization/Claim form is filled completely, sincerely and truly and all the required documents are submitted along with the form and in original, wherever specified. Retain a copy of the duly filled forms.
We will provide a reference id for all communication pertaining to claim request. Kindly quote that reference number for all communication related to the above.
assure - critcal illness claim form
Care Reimbursement Claim Form
Group Insurance - Secure- personal accident- claim form
Group Insurance - Care - claim form
List of standard exclusions
What are the lists of Non Payable items?
for list of non-payable items
How do I find a list of Care Health Insurance Limited(formerly known as Religare Health Insurance Company Limited) Network hospitals?
You can view our list of Network hospitals
. You may also call us at 1800-200-4488 if you wish to enquire about a specific hospital.
What happens to my Sum Insured after a claim is filed?
Sum Insured is reduced by the amount of claim paid for the rest of policy year.
What are the reasons for deduction in claim amount?
Claim amount can be deducted for any of the following reasons:-
a) Non-Medical expenses such as telephone bills, snacks etc. are non-payable,
b) Treatment details without proper bills or prescription,
c) Sum Insured exhausted,
d) Amount exceeding specified Sub-limits
e) Co Payment applicable,
f) Capping of expenses for any particular treatment or benefit,
g) Original reports/bills not available,
h) Expenses related to any investigations/treatment not related to ailment for which patient is admitted."
How to Track your claim?
Claim status can be tracked online
or contacting customer care at 1800-200-4488. You can also visit our nearest branch
or write to us at firstname.lastname@example.org.
How does one file a claim for reimbursement?
In case of a reimbursement claim, the insured pays the hospitalization expenses (which is otherwise claimable under his insurance contract) himself and then claims for a reimbursement of those expenses from the Insurer. The Insured should submit all the bills and treatment papers in original to us and intimate regarding the hospitalization as per policy terms & conditions.
For a detailed process – please click on "Process" tab.
How do we avail cashless treatment for planned/emergency hospitalization?
For any emergency hospitalization,the insured should intimate us within 24 hours from the time of hospitalization. For any planned hospitalization, the Insured should seek cashless authorization from us at least 48 hours prior to hospitalization.
Can a request for Authorization of cashless treatment be declined?
"Yes, a request for authorization of cashless treatment may be declined if:-
a) Inadequate / vague / wrong information is provided and we are unable to get access to further information.
b) The ailment/ disease for which hospitalization is required, is not covered by the scope of the insurance policy.
c) The person does not have an adequate sum insured left to cover the hospitalization costs.
This only means that cashless access is declined, AND IS IN NO WAY TO BE CONSTRUED AS DENIAL OF TREATMENT. The insured person must obtain the treatment as per his/ her treating doctor's advice, and may subsequently file a claim for reimbursement."
How does one obtain the Authorization letter?
The Authorization form is available at the TPA desk of the hospital. The form can also be downloaded from here
. The duly filled form has to besent by the hospital through fax or email to Care Health Insurance Limited(formerly known as Religare Health Insurance Company Limited); post-review of the same an authorization letter will be sent to the hospital.
What is Cashless Claim?
In a cashless claim, the insured/hospital intimates us regarding the hospitalization and submits a pre-authorization request. On authorization, the claim is directly settled with the network hospital and the insured is not required to pay any charges except for expenses not covered under the policy. Cashless facility can only be availed at a Care Health Insurance Limited(formerly known as Religare Health Insurance Company Limited) network hospital.
What do you mean by Network and Non-network Hospital?
A Hospital, which has an agreement with Care Health Insurance Limited(formerly known as Religare Health Insurance Company Limited) for providing Cashless treatment to its customers, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at network hospitals.
Non-network hospitals are those which will not provide a cashless treatment facility toCare Health Insurance Limited(formerly known as Religare Health Insurance Company Limited) customers. Customers availing treatment at these hospitals will have to pay for the same and later file a claim as per the reimbursement procedure.
What is the maximum number of claims allowed during the policy period?
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.