Care (Religare) Latest Health Insurance Claim Settlement Ratio

Claim settlement ratios of health insurance companies is a measure of the company’s claim payment history. The ratio is measured and expressed as a percentage. The following formula is used to calculate the claim settlement ratio –

Claim settlement ratio = (number of claims paid during a financial year / total number of claims made on the company in the financial year) * 100

If the claim settlement ratio is in the 90% range, it is said to be a positive indicator. It states that the company paid 90% of the claims which were made during the year. Higher claim settlement ratios are better for the insurance companies and Religare Health Insurance also has high claim settlement ratios. Moreover, the company’s Incurred Claims Ratio is also good. Incurred Claims Ratio is an important measure for general insurance companies and the ratio is different from claim settlement ratio. Incurred claims ratio is calculated using the following formula.

Incurred Claims Ratio = (total amount of claims paid in a financial year / total amount of premiums collected in the financial year)* 100

The ratio thus helps to determine whether the company paid more in claims than it earned in premiums. In such cases, the ratio is more than 100% and the company suffers a loss. Continued losses are bad for the insurance company as they affect the company’s financial stability and solvency margins.

Claim Process of Care Health Insurance Formerly Religare Health Insurance 

Be it a cashless or reimbursement claim process, Care Health Insurance Company ensures smooth and hassle-free claim settlement for its customers. Here we are mentioning the steps to file both cashless and reimbursement claims under care health insurance.

Cashless Claim Process 

To file a cashless claim process, you will have to undergo treatment in a network hospital of Care Health Insurance Company. Here are the steps to follow to file a cashless claim request under Care Health Insurance:

• Inform the insurer – The first step involves informing the customer about the hospitalization. In the case of planned hospitalization, the insured is expected to inform the insurer over 48 hours before the hospitalization, whereas, in the case of emergency hospitalization, the insured (or a family member) is likely to inform the insurer within 24 hours of hospitalization.
• Start the process of pre-authorization – Once you reach the network hospital you can fill in the pre-authorization form and submit it at the insurance desk of the hospital. Next, the form will be sent to the insurer by the network hospital seeking approval for cashless treatment.
• Pre-authorization request process: The in-house team of the insurer for claim management will review the form to accept/reject it and inform the hospital. The treatment starts as soon as the request is accepted.
• Claim Settlement – Once the treatment is complete and the patient is discharged, the insurer settles the claim with the network hospital directly.

Reimbursement Claim Process 

In case of reimbursement claims under Care Health Insurance company below are the steps to follow:

• Inform the insurer – Here again, the first step remains the same. You must inform the insurer by calling the customer support team 48 hours before a planned hospitalization and within 24 hours of an emergency hospitalization.
• Save the Hospital Bills – Here, you can go to any hospital of your choice and start the treatment. Once the treatment is over you must pay the hospital bill at the time of discharge. Now, take all the documents and bills from the hospitals and keep them safe.
• Initiate the Claim Process: Within the stipulated time frame the insured must initiate the claim process. This can be done by filling out the claim form and submitting it to the insurer along with all the required documents.
• Processing of claims – Once you submit the documents, the insurer will review them and will accordingly accept or reject the claim. In case the claim is rejected, the insurer will state the reason, and if it is accepted the claim amount will be paid to the insured.

• What are the Documents Needed for Care (Religare) Health Insurance Claims?

You will have to submit the below-mentioned documents at the time of raising a claim with Care (Religare) health insurance:

• Original copy of the claim form (duly filled and signed)
• Photo ID proof of insured
• Doctor’s prescription (stating the need for hospitalization)
• Doctor’s letter (stating the required medical tests, medications, etc.)
• Original copies of all receipts and bills
• Original copies of all medicine/chemist bills
• Original copies of medical test reports and receipts
• Indoor case papers with complete records of treatment during your hospital stay
• Hospital discharge summary
• Police FIR (if needed)
• Post-mortem report (if needed)

As per IRDAI Annual Report 2021-22, Religare, now known as Care Health Insurance Company has a claim settlement ratio of 100%, which signifies good profitability of the company and the ability to pay the claims easily.