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 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; 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 network hospital.
What do you mean by Network and Non-network Hospital?
A Hospital, which has an agreement with Care Health Insurance 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 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.