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Updated on: Reviewed on:A health insurance claim process is the procedure used by a policyholder to request coverage or reimbursement from their insurance company for medical expenses incurred during treatment.
The claim process at Care Health Insurance is straightforward and hassle-free. You are supposed to inform our customer support team about your hospitalisation within24 hours during emergency hospitalisation and 48 hours during planned hospitalisation.
At Care Health Insurance, we aim to provide optimum healthcare coverage complemented with an affordable premium. Choose from some of the best-selling health insurance plans at Care Health Insurance:
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Health insurance claim process generally follows two paths that have been explained below:
This type of claim facility allows you to receive cashless treatment at a network hospital. After your treatment, your medical bills will be directly settled by the insurer as per the policy terms and conditions.
When receiving treatment at a non-network medical facility, you pay the upfront hospital charges yourself. Once discharged, you can submit a claim with the required supporting documentation to obtain a full reimbursement of the hospital expenses.
Let’s understand the functioning of both cashless and reimbursement claims with the help of case studies.
The below table shows the difference between cashless and reimbursement claims based on different factors.
| Factors | Cashless Claims | Reimbursement Claims |
|---|---|---|
| Meaning | The insurer directly settles the medical expenses of the insured with the network hospital. | The insured pays upfront for medical expenses and receives the reimbursement later. |
| Pre-treatment approval | The insurer is supposed to approve the insured member’s claim request before treatment | The insured member is not required to get the approval before the start of the treatment |
| Hospitals | The insured member is supposed to choose from the list of network hospitals provided by the insured | The insured member can choose any hospital |
| Documents required | Policy copy, pre-authorisation form, doctor’s prescription, ID proof, discharge summary, medical reports | Documents required are similar except duly filled claim form, diagnostic test reports bills and bank details |
| Time taken for claim settlement | 2 hours for each transaction | It can take up to 45 days for claim settlement |
To provide a better understanding, we have bifurcated the medical health insurance claim procedure into cashless claims and reimbursement claims. Cashless hospitalization offers a seamless step-by-step experience at network hospitals; however, if you are admitted to a non-network hospital, you can easily follow our reimbursement claim steps instead.
| Step | Action Required | Details |
|---|---|---|
| Step 1 | Locate Hospital | Find a network hospital using the Care Health-Customer App. |
| Step 2 | Submit Documents | Present the patient's Medical ID card, Cashless Pre-Authorisation Form, E-Health Card, and a valid Govt. ID at the hospital’s insurance desk. (Access your e-card anytime on the app). |
| Step 3 | Pre-Authorization Request | The hospital/TPA desk submits your pre-authorization approval documents to us. If information is missing, we may request details from the hospital. |
| Step 4 | Approval Decision | We review the submitted details and issue the pre-authorization decision based on policy terms. |
| Step 5 | Discharge & Final Review | Post-treatment, the hospital submits the discharge summary and final bills for evaluation. |
| Step 6 | Direct Settlement | We evaluate the bills per policy terms and sum insured, settling the approved amount directly with the hospital. |
| Step | Action Required | Details |
|---|---|---|
| Step 1 | Register Claim | Register your claim by scanning and uploading documents on the Care Health Insurance &lsquo Self-Help Portal or via the Care Health-Customer App. |
| Step 2 | Submit Claim Form | Download the reimbursement claim form for your specific product and submit it online or through the app. |
| Step 3 | Provide Banking Details | Upload a personalized cancelled cheque in the proposer's name. |
| Step 4 | Nominee Requirements (If Applicable) | If the employee/proposer passes away, submit the nominee's personalized cancelled cheque, ID proof, and Legal Heir Certificate. |
| Step 5 | Upload Medical Documents | Scan and upload all relevant hospital documents along with any additional requested files for processing. |
A medical emergency can knock on the door anytime. We understand the urgency of hospitalisation; that's why we keep the medical insurance claim process for accidental injuries and death simple. The next step involves submitting the claim form along with vital documents including:
Note: Show the health insurance card provided by us to get cashless benefits at our network hospitals.
In case of severe injuries leading to the accidental death of the policyholder, the nominee must fill out the former’s death claim along with the following documents;
At Care Health Insurance, we will directly pay your bills for the cashless claim process once you get discharged from the hospital after approval from the claim management team.
For medical claim reimbursement, you have to submit the required documents within 15 days of getting discharged from the hospital. Our claim management team will approve your claim within the stipulated period.
>> Check: Health Insurance Claim Settlement Ratio
Below is the list of documents that are required to file a cashless and reimbursement claim:
Duly filled and signed claim form providing all necessary details regarding the insured and hospitalization.
Original doctor's prescription and formal referral letter advising hospitalization or specific treatments.
All diagnostic test reports and medical evaluation documents supporting the treatment provided.
Original bills, payment receipts, and discharge summary provided by the hospital during discharge.
Original bills and receipts for medicines purchased from official pharmacies or chemists during treatment.
Policy copy including policyholder name, contact details, nature of illness, address, and Police FIR (in case of personal accident)...
Original discharge summary along with the final hospital bill containing an item-wise break-up of charges.
Original paid receipts generated against the final hospital bill payment.
MLC/FIR copy (if applicable) along with details on alcohol history where pertinent to the case.
All relevant investigation reports including X-Ray, MRI, CT Scan, and indoor case papers (attested copies).
In cases involving implant surgery, the original invoice and implant batch/sticker details must be submitted.
For any claim totaling Rs. 1 lakh or above, please submit a copy of a valid KYC document (such as Aadhaar Card, Passport, Driving License, or Voter ID)...
If you have filed a claim, you can easily track its real-time status online using the 'Claim Genie' portal on your web browser or mobile phone:
Here are the major reasons for the rejection of health insurance claims:
Filing an insurance claim can be stressful and rejection can make it even more challenging. To enhance your chances of claim approval, follow these essential tips to avoid common mistakes that lead to claim rejections:
All metrics on this page are verified directly through our internal operational records and IRDAI filings. Our claim counts (74.5+ Lakhs) and network hospital numbers (22,100+) reflect real-time, actively settled cases and empanelment records across India. Starting rates (e.g., โน11/day) are calculated using base annual premiums for entry-level plans before applicable taxes and individual plan customisations.
Your family’s safety comes first. Here is how we guarantee accurate details:
The content is intended to provide general information about health insurance and should not be considered legal, financial, or medical advice. Please refer to the policy documents for complete terms, conditions, and exclusions. Click here to view our editorial policy.
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If you want to have faster claim approval under your health insurance, go for cashless hospitalisation at the network hospitals. You have to intimate our claim management team for the health insurance claim process within 24 hours in emergency hospitalization and 48 hours in case of planned hospitalisation.
Claim form and documents such as medical practitioner's prescription advising hospitalization, drugs, diagnostic test or consultations, original bills, receipts and discharge summary from the hospital, indoor case papers, etc. required to file a reimbursement claim.
In case you lost your health insurance claim card, inform our customer support team immediately. They will help you to get the new one and assist you in the claim settlement.
Reimbursement in the health insurance claim process means that you initially pay your hospital bills and apply for a refund within the stipulated time to get the entire amount back.
Not at all. We’ve designed our medical insurance claim process to be stress-free and transparent, so you can focus on your recovery rather than paperwork.
The cashless hospitalisation process allows you to receive treatment at network hospitals without paying out of pocket upfront. We settle the bills directly with the hospital, letting you focus entirely on getting better.
When you choose a non-network hospital, our health insurance reimbursement process kicks in. You’ll pay the bills upfront and submit the required documents for a smooth, quick refund. Just keep your documentation organized to ensure your health insurance claim process is handled without any hitches.
Our claim procedure is designed to be straightforward. Whether it’s an emergency or planned, just ensure you notify us within the specified timeframes (24 hours for emergencies, 48 hours for planned), and our team will guide you through the rest.
To check the claim status on the Care Insurance portal, you can visit www.careinsurance.com and click on the self-care portal option. Log in using your registered mobile number or email address and password. If you are a new user, then sign up first. Once logged in, go to the claim status, enter your claim number and then follow the instructions given on the screen to see the update. If you need any help during the process, you can call our customer support team at 1800-102-4488 / 1800-102-6655 or send an email to customerfirst@careinsurance.com.
To apply for Care health insurance, you can visit our website at www.careinsurance.com and search for the available health plans to select the one that suits you and your needs. Click Buy Now to fill in your personal and contact details in the application form. Next, upload any necessary identification, address, or medical documents, complete the premium payment using credit cards, net banking, or UPI, and receive your policy confirmation via email instantly.
To update your Care Health Insurance policy after a major life event, download the Change Request Form from ourofficial website. Fill in your policy details alongside any updates to your contact information, sum insured, policy tenure, or family members, noting that adding members requires a new proposal form. Disclose any relevant medical conditions with supporting prescriptions or reports, sign the form, and submit it to Care Health Insurance for review, pending approval and potential premium adjustments.
To file a reimbursement claim with Care Health Insurance, you must submit a few essential documents to ensure smooth processing. Start by providing a duly filled and signed claim form along with a copy of your health insurance policy and the policyholder's official identity proof. You will also need to submit all original hospital bills, payment receipts, and the official discharge summary or medical certificate issued by the hospital. Additionally, include all doctor prescriptions for medicines, lab work, and diagnostic tests, along with the actual test reports such as blood work or X-rays. Collecting and submitting these complete medical and financial records promptly will help speed up your claim approval and reimbursement. Contact Care Health Insurance directly at 1800-102-4488 or 1800-102-6655, or email customerfirst@careinsurance.com for additional assistance or specific requirements.
To claim Care Health Insurance, you must inform the Insurance Provider. Notify Care Health Insurance about the claim as soon as possible by calling 1800-102-4488 or 1800-102-6655, or emailing customerfirst@careinsurance.com. Submit all required documents, including policy details, a duly completed and signed claim form, medical reports, prescriptions, bills, discharge summary, and any other documents requested by the insurer. For cashless claims at a network hospital, show your health insurance card, complete the pre-authorisation form, and allow the hospital to coordinate approval with Care Health Insurance. For reimbursement claims at a non-network hospital, pay the hospital bills and submit the original bills and receipts to Care Health Insurance for processing. For detailed guidance, you can visit ourwebsite at www.careinsurance.com or refer to your policy documents.
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^^Number of Cashless Healthcare Providers as of Feb 2025
**Number of Claims Settled as of Dec 2025
^10% discount is applicable for a 3-year policy
^Annual premium for product 'Care' and 'Care Shield (add on)' is Rs. 6160/- for 1 adult falling under the age bracket 05-24 years, 1 Adult 18-24 age group 3 Yr with NCB Super (Add-on)..
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22100+
Cashless Healthcare Providers^^
74.5 Lakh+
Claims Settled Since Inception**
24x7
Claim and Customer Support
