Care Health Insurance Limited: Official Claim Record & Policy Terms
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Care Health Insurance Limited (Care Health) is registered under IRDAI with flagship health policy Care Supreme. Official audited disclosures report a Claim Settlement Ratio of 93.5% and an Incurred Claim Ratio of 58.4%. The policy provides Up to Single Private Room and enforces a statutory 36-month pre-existing disease waiting period under the IRDAI 2024 Master Circular.
Audited Policy Terms: Care Supreme
| Policy Parameter | Verified Value | Source |
|---|---|---|
| Room Rent Capping | Up to Single Private Room | Policy Wording |
| Pre-Existing Disease (PED) Waiting | 36 months (IRDAI Statutory Cap) | IRDAI 2024 |
| Specific Ailment Waiting Period | 24 months | Verified |
| Co-Payment Rules | Zero Co-pay (Standard Plan) | Policy Clause |
| Disease Sub-Limits | None (No Disease Sub-limits) | Disclosures |
| Restoration Benefit | Unlimited Automatic Recharge | Policy Terms |
| No Claim Bonus (NCB) | 50% per year up to 500% (CB Super) | Schedule |
| Anywhere Cashless Support | Yes (Via GIC Portal / Insurer intimation) | GIC Portal |
Known Claim Disputes & Traps: Care Health
Recurring reasons cited by Care Health when rejecting or short-paying claims, and how to counter them under statutory IRDAI circulars.
Excluded Hospital / Non-Network Bed Denial
high riskDenying reimbursement claims stating the hospital lacks 10/15 beds or is on an undisclosed blacklisted registry. IRDAI 2024 explicitly protects emergency care across all medical facilities.
Inception Non-Disclosure Policy Voiding
high riskCancelling health insurance policies during claim assessment citing minor past consultations. Under the 60-month moratorium rule, policies past 5 years cannot be repudiated.
Cashless Denial Treated as Reimbursement Rejection
medium riskHospitals and third-party administrators advising that denial of cashless pre-authorization bars reimbursement. In reality, reimbursement claims can be submitted with full receipts.
Official Grievance Escalation Hierarchy for Care Health
If your claim is stalled, delayed, or repudiated, follow this statutory 3-tier escalation path under IRDAI guidelines.
Submit formal written complaint with policy & claim number
Email: gro@careinsurance.com • SLA: 30 days mandatory resolution
Official regulator grievance token & regulator visibility
If the GRO does not reply within 30 days or rejects your appeal unfairly
Quasi-judicial hearing with award binding on Care Health
Zero court fees, no advocate required, 90-day statutory resolution timeline
Compare Care Health with Major Competitors
Explore head-to-head claim safety comparisons against other leading Indian health insurers.
Frequently Asked Questions: Care Health
Regulatory and operational inquiries for Care Health policyholders.
Verify if your rejection violates IRDAI guidelines
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