Care is one of the top standalone health insurance service providers in the country. The company is renowned for its different types of health insurance plans suitable for individuals, families, and groups. Care Health Insurance is promoted by Fortis Healthcare, which is renowned for its extensive network of medical facilities in different parts of the country. The company has extensive network tie-ups with reputed hospitals located in different parts of the country to ensure easy access to cashless hospitalisation for its customers.
Plans Offered by Care Health Insurance
Care Health Insurance has a diverse range of medical insurance plans in its lineup. Each plan offered by the company comes with flexible options to cater to the needs of people with different requirements. Some of the top plans available with the company can be listed as follows:
Care Care: This is a comprehensive health insurance plan available with the company. This policy is available on an individual basis and family floater basis depending upon one’s requirement. One of the distinct features of this policy is that it offers sum insured options for up to Rs.6 crore. In addition to the regular benefits, policyholders can also avail a range of rider covers for various benefits such as air ambulance coverage, unlimited automatic recharge, personal accident coverage, international second opinion, etc.
Care Care Freedom: This is a health insurance plan developed specifically for senior citizens in the country. Anyone over the age of 46 years can avail this policy, and there is no maximum entry age limit for this policy cover. Care Freedom is available in multiple sum insured options up to Rs.10 lakh. This policy is designed in such a way that senior citizens could benefit the most for their common health ailments. Benefits such as recharge of sum insured, dialysis cover, annual health checkup, etc. make this a must-have policy for senior citizens.
Care Enhance: This is a top-up health insurance cover that provides benefits after the exhaustion of a specific deductible amount. Deductible options for this cover ranges from Rs.1 lakh to Rs.10 lakh, whereas the sum insured options range between Rs.1 lakh and Rs.30 lakh. This policy comes with all the benefits typically offered by a comprehensive health insurance plan, and it is available in flexible terms.
Care Joy: Joy is a comprehensive health insurance plan that comes with the added benefit of inbuilt maternity and newborn baby coverage. The waiting period of 9 months under the ‘Joy Today’ plan is one of the lowest in the industry. Though lifelong renewability option is available here, the maximum entry age is capped at 45 years. In addition to maternity and newborn coverage, this policy offers a range of other benefits including daycare treatment, ambulance cover, newborn birth defects coverage, etc.
Care Group Care: As the name implies, this policy is a group cover designed for groups like employees of an organisation. This policy helps employers safeguard the wellbeing of their employees. Some of the key benefits available under this policy include AYUSH coverage, coverage for chemotherapy & radiotherapy, inbuilt outpatient cover, etc.
Significance of Care Health Insurance Network Hospitals
Care provides coverage for medical treatments undertaken in its network hospitals as well as non-network hospitals. However, there are some significant advantages involved in getting treatment from the company’s network hospitals. Cashless hospitalisation is available only in the network hospitals that have tie-ups with the company. In this type of claim settlement, the settlement process happens between the insurer and the medical facility after the approval of the claim request.
Care has over 5,420 network hospitals located in different parts of the country. This makes it one of the top health insurance service providers with extensive presence throughout the country. The company has branch offices in all major cities across the country, and it can be reached easily for any issues in policy purchase or claim settlement. When it comes to network hospitals, the extensive presence makes it easier even for people in rural areas to access these medical facilities.
Types of Claims Executed at Care Network Hospitals
Both cashless treatment claims and reimbursement claims can be made at network hospitals associated with Care Health Insurance.
- Cashless treatment: In this type of claim settlement, the company coordinates directly with the medical facility and settles the bill on behalf of the insured person. The settlement amount is honoured up to the sum insured amount chosen by the insured.
- Reimbursement claim: The insured may also choose to pay the bills to the hospital and claim the reimbursement later. This type of claim is honoured when the treatment is undertaken in both network hospitals as well as non-network hospitals. In this case, a separate claim request has to be filed along with the proof of medical expenses after discharge from the hospital.
Procedure for Filing Claims with Care Health Insurance
Cashless treatment request can be filed at network hospitals as follows:
- For planned hospitalisation, the company must be informed at least 48 hours in advance. Emergency hospitalisation may be notified to the company within 24 hours of admission.
- The company’s customer care department may be contacted to notify about the claim. Any doubts regarding the claim procedure may also be cleared by enquiring with the customer service department.
- Pre-authorisation must be obtained from the insurer before proceeding with the cashless treatment. The hospital’s insurance desk or Care website can provide the authorisation claim form and other information about the process. Once the authorisation form is submitted at the insurance help desk, it will be faxed to the company.
- The company will verify the policy details of the insured and provide its authorisation for all valid claims. It is essential to provide all the required details without fail. Any discrepancy in the authorisation form may result in rejection of the request.
- Even if the cashless treatment is not authorised, the insured can still file for reimbursement claims after discharge from the hospital.
The procedure for reimbursement claims can be given as follows:
- The claim request may be filed after discharge from the hospital. However, the insurer must be intimated soon after admission in a hospital. Planned hospitalisation must be informed 48 hours before admission, whereas emergency hospitalisation can be informed within 24 hours of admission.
- Following discharge from the hospital, the reimbursement claim request may be filed along with all the supporting documents. These documents may include medical bills, discharge summary, diagnostic reports, physician certificate, prescriptions, pharmacy receipts, etc.
- Once these documents are submitted, the company will verify the validity of the claim request. The company will communicate the acceptance or rejection of the claim to the insured within a specified time.
- In case of rejections, the company will provide the reason for rejection. The company will contact the insured if there are any more documents required before approving the claim.
- For all approved claims, the settlement amount will be paid to the insured within the specified time.
General Exclusions Applicable to Care Health Insurance Plans
Care is not liable to provide any compensation for the following list of exclusions:
- Any diseases contracted within the first 30 days of policy coverage (not applicable for renewals and accident claims)
- Pre-existing diseases for at least 24 months of continuous policy coverage
- Claims attributable to self-inflicted injuries or suicide attempt
- Claims attributable to war or warlike activities
- Expenses related to non-allopathic treatment procedures
- Claims related to sexually transmitted diseases or venereal diseases
- Treatment for congenital diseases, birth defects, and anomalies
- Expenses related to childbirth, pregnancy, and related complications (except under Care Joy policy)
- Expenses related to infertility treatments
- Claims attributable to drug or alcohol abuse
- Cost of external accessories such as spectacles, contact lenses, hearing aids, etc.
What are the documents required for reimbursement claims?
The following documents are usually requested by insurers while processing reimbursement claims:
- Duly filled claim form
- Policy details
- Discharge summary
- Photocopies of original bills
- Main bill provided during discharge
- Diagnostic reports
- Pharmacy receipts
- Doctor’s prescriptions
- Police FIR (in case of accident claims)
- Any other documents that may be requested by the insurer
What is co-payment?
In certain cases, the insurance company may ask the insured to pay a portion of the claim amount. This is referred to as co-payment. For instance, the insurance company may ask policyholders over 60 years of age to co-pay 10% of the claim. Voluntary co-payment is also provided by certain companies in exchange for discount in premiums.
What is a critical illness policy?
In a critical illness policy, a fixed benefit is provided to the insured following the first diagnosis of any of the named critical illness. Most health insurers offer a lump sum payment of the chosen sum insured amount. Care provides global coverage for up to 12 critical illnesses including cancer and stroke.
What is a no-claim bonus?
The insurance company offers a certain percentage of additional sum insured amount for every year during which no claim has been made. This is referred to a no-claim bonus. This can be accumulated to a certain limit and can be used when the need arises.
Care care provides a no-claim bonus of 10% of the sum insured for every claim-free year subject to a maximum of 50% of the sum insured amount. If the chosen sum insured is Rs.5 lakh, it will become Rs.7.5 lakh after 5 continuous claim-free years.
How can I contact the customer service department of Care?
The company can be contacted by dialing any of these two toll free numbers: 1860-500-4488 and 1800-200-4488. The company’s customer service department can also be contacted by sending a mail to customerfirst@Carehealthinsurance.com.