What is restoration benefit in health insurance?
Restoration benefit in health insurance - Importance, types and points to note before claim.
July 11, 2022
Claim settlement ratio (2019-20)
Total GHI lives insured (2020-21)
Total GHI claims incurred (2020-21)
Rs. 441 crores
Care Health Insurance Company Limited (formerly known as Religare Health Insurance) is a joint venture of Reliance Enterprises Limited, Corporation Bank, and Union Bank of India. The company offers a range of health insurance, travel insurance, and corporate insurance products. With a strong network of 8300+ network hospitals, Care Health insurance offers a wide range of retail health products such as Personal Accident Cover, Maternity cover, Critical Illness cover, group health cover, and group personal accident cover. Moreover, some even provide coverage for IVF treatments.
Care Health Insurance has been awarded the prestigious “Editor’s Choice Award for Best Product Innovation” at Finnovity and the “Best Medical Insurance Product Award” at the FICCI Healthcare Awards. With a high claim settlement ratio, active customer support, and quick cashless claim approval, Care health insurance remains the most preferred in the market.
If you are wondering how you can enjoy the group health insurance benefits provided by Care Health Insurance, you do not have to worry. You can easily access all the services provided by Care health insurance with the tech-enabled, hassle-free process at Pazcare. The employee dashboard will help you navigate the inclusions and exclusions of your policies in your finger-tip for both employees and employers. Our dedicated team of experts at Pazcare will help you find the best quote at the most affordable prices.
If you’re wondering how to buy Care group health insurance at Pazcare, here’s how:
Step 1: Get in touch with Pazcare and submit a basic form that asks for your name, company details, employee strength, etc. The information will be crucial for estimating the cost of the group health insurance plan that you’re looking for.
Step 2: It is important for you to communicate your requirements clearly. Your group insurance policy is highly customizable as per your needs. You can choose to have an employee-only plan (E), employees, spouse, and children plan (ESC), and employees, spouse, children, and parents or in-laws plan (ESCP). You will also have several other add-ons as well. Make sure you communicate your requirements well, and we will ensure it is covered under your group health insurance.
Step 3: After you have given your requirements, it’s time to get competitive quotes from Care group health insurance and other health insurance companies. After our team figures out your requirement, they will reach out to different insurers and help get you the best quote in the market.
Step 4: After you decide on the plan and agree to the terms and conditions of the group health insurance policy, it’s time to make the payment. Once the premium for the policy is paid, the group health insurance for your team is valid for the year.
Step 5: The final step is the onboarding process. After the payment is made, the onboarding process is done within 24 hours. Our team will explain and provide all the necessary resources to get your team started with a group health insurance policy with Pazcare during the onboarding process.
At Pazcare, we provide the employer dashboard to the HRs or the admins. All the inclusions and exclusions are mentioned in the app. The employees will also be provided with an employee app where they can access the entire plan, health insurance ID card, list of network hospitals, etc.
For further information, write to us at email@example.com or call our customer care at +91 78291 11300. Alternatively, connect with us on Whatsapp using the number +91 81973 79596.
Care has three types of group health insurance plans offered for corporations. It is discussed below:
Your comprehensive group care health insurance plan safeguards employees against all the financial risks raised by medical emergencies. For any organization, employees are the real asset, and therefore it is important to safeguard them against all medical emergencies. Under group care health insurance, it offers a range of sum insured options starting from fifty thousand to ten lakhs with different family definitions and additional benefits. Some include wellness initiatives, complementary annual health check-ups, and much more.
Your group secure insurance plan comprises group personal accident insurance which safeguards employees from the risks like death or permanent disablement caused by accidents. Your group personal accident policy is a complete package that provides coverage like ambulance benefits, fractures, accidental hospitalization, and more.
Now the businesses are becoming extremely global which involves employees traveling to different parts of the world. Your group travel policy provides complete coverage and protection when you are traveling or taking multiple trips in a year. In addition, personal accidental coverage is also there for your additional protection to safeguard employees from financial risk arising from the travel. You can also customize the policy if you want. Some benefits covered by group travel insurance are emergency medical costs, evacuation, hijack distress, and much more.
With the range of group health insurance benefits offered by Care group health insurance, it is definitely great insurance to opt for. Some of the reasons are highlighted below:
Quick cashless claim approval
The claim settlement process at Care group health insurance is impressively easier and faster. It takes a maximum of 2 hours to settle the claim. This makes the experience of policyholders extremely smooth.
High claim settlement ratio
Care group health insurance has an excellent history of claim settlement with 95.47% in the financial year 2020-21.
Good customer support
You can reach out to the Care team 24*7 in case you have any queries. The experienced professionals will be available from settling the claim to resolving your problem 24*7.
8,300+ Network Hospitals
Care group health insurance has partnered with over 8,300+ network hospitals pan India. Policyholders can get cashless medical treatment from the nearest network hospital.
What is really impressive about Care group health insurance, is the consistency with which the claim settlement ratio is rising. This definitely helps Care in building the trust and credibility of its potential policyholders. Here is the claim settlement ratio of Care over the last 2 financial years:
With 8300+ network hospitals under Care group health insurance, it is easier for the policyholders to seek cashless medical treatment in a hassle-free manner. With the widespread network of hospitals at Care group health insurance, the company offers cashless claim facilities. Just go to your nearest network hospital and get the high-quality treatment and avail your cashless claim facility.
Care group health insurance cashless claim
Care group health insurance provides a very smooth and hassle-free claim process which makes your insurance journey seamless. Here’s how you can make cashless and reimbursement claims under your insurance plans issued from Care group health insurance.
Follow these steps to avail of cashless treatment under your Care group health insurance plan.
Step 1: Get admitted to the nearest network hospital
Get hospitalized at the nearest network hospital that is under the network of Care group health insurance in order to avail of the cashless treatment.
Step 2: Identity verification
Show your health insurance ID card, company ID card, and proof of identity.
Step 3: Pre-authorization form submission
Fill in the pre-authorization form, which the hospital will then forward to the Care group Health Administration Team (HAT)
Step 4: Review of request
Now your documentation will be sent for verification purposes to the team Care, and they will check with your policy benefits. The insurer will then inform the hospital about the decision.
Step 5: Claim settlement
After your insurer accepts the claim request, it will directly be settled with the network hospital according to the terms and conditions of the policy.
Care group health insurance reimbursement claim
Follow these steps if you get hospitalized at a non-network hospital and have to file reimbursement claims from Care group health insurance.
Step 1: Inform your insurance carrier
Informing your insurance provider about your hospitalization is the first step you need to follow. In case of emergency hospitalization, make sure you inform the insurer within 48 hours of hospitalization. In case of planning, inform your insurance provider at least 3 days before you get hospitalized.
Step 2: Bill settlement at the hospital
After your treatment gets over at a non-network hospital, settle all the bills upfront at the hospital counter.
Step 3: Collect required documents
After the treatment is over at a non-network hospital, settle all the bills out of your pocket upfront.
The documents required to file a reimbursement claim
Step 4: Submit the documents
Make sure you collect all the relevant documents and then submit them to the nearest Care health insurance branch within 15 days of discharge.
Step 5: Claim processing
Your insurer will review all your documents once the documents are submitted. You will know if your documents get approved or rejected. This will be done as per the terms and conditions of your policy. Once approved, the claim will be settled in your bank account.
You can also contact us at firstname.lastname@example.org, to guide you through the whole process. We provide 24X7 claim assistance for your employees.
The Care group health insurance can be renewed in a hassle-free manner easily at Pazcare at the end of your policy term. Here are the steps to renew your Care group health insurance plan.
Step 1: Get in touch with Pazcare and submit required documents with details containing your name, name of the company, number of employees you wish to insure, work email address, and phone number.
Step 2: Once you submit the form, our consultants will contact you. Since this is not a fresh policy, you will have to submit the following documents.
Step 3: You have the option to choose additional add-ons to your existing policy like dental insurance riders, maternity insurance riders to your existing policy. Additionally, with Pazcare you will be able to choose additional health and wellness add-ons to your Care group health insurance. These add-ons include wellness and therapy sessions, unlimited doctor consultations, comprehensive check-ups, and many more.
Step 4: Our team of consultants will get back to you with the competitive quotes for your Care group health insurance. Based on your claims report and the add-ons you choose, your health insurance premium might differ from the previous financial year.
Step 5: Now in this step, after you agree to the terms and conditions of the policy and pay the premium for your Care group health insurance policy, the policy will be usually valid for a year after the renewal.
Step 6: If you are purchasing your Care group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours.
At Pazcare, we make sure that your Care group health insurance experience will be seamless and hassle-free using our Pazcare dashboard. Your employees can access their policy using Pazcare’s employee app easily. The app is available on both the app store and the play store.
The Care group health insurance premium is directly proportional to the risks involved. There are several other factors that influence the premium for your group health insurance policy which are discussed below:
When the premium is being calculated, it is based on the average age of the people insured. The younger the age, the lower the premium. Generally, the younger generation poses lesser health risks compared to the older ones.
Type of plan opted
There are different types of group health insurance policies that you can go for and the premium you pay differs from each policy you take. Different plans are employee only (E), employee+spouse+children (ESC) and employee+spouse+children+parents (ESCP) plans.
Nature of the job
The nature of the job can be a significant factor when calculating the annual premium. Jobs that are riskier will have a higher premium compared to the lower-risk jobs. For example, employees working in a factory will have higher group health insurance premiums than the ones working in the hotel industry.
Sum insured refers to the maximum amount that an insurance company will pay you in case you have to be hospitalized in that particular year. If the hospital expenses cross the sum insured, the policyholder has to pay themselves.Mind you, the higher the sum insured, the higher the premiums paid towards the group health insurance policy.
The add-ons opted will increase your group health insurance premium. For instance, maternity insurance riders, and dental insurance riders with the existing group health insurance policy will have to pay a higher premium in their group health insurance plan. Thus, the premium increases depending on the type of add-ons you choose.
In the time of a group health insurance policy renewal, the claim history is a significant factor in calculating the premium for that particular financial year. For instance, if the number of claims made in a previous financial year is higher, then the premium towards the policy will increase during the policy renewal.
Your Care group health policy is personalized according to your preferences. Here is what your Care group health insurance covers.
All your pre-existing diseases
Your policy will cover all of your pre-existing diseases. For example, diabetes, cancer, asthma, hypertension, etc from day 1 of your policy coverage. There is no waiting period to cover these diseases.
Pre and post-hospitalization expenses
With Care group health insurance, your pre, and post-hospitalization expenses are all covered. However, this depends on the terms and conditions of your policy and can usually range between a period of 30 to 60 days.
By opting for a maternity insurance rider, you will be able to cover all your maternity-related expenses for a normal and c-section delivery.
Covid -19 cover
The group health insurance policy covers all your hospitalization expenses relating to Covid-19.
Accidental hospitalizations coverage
In case you have to be hospitalized due to a sudden accident, your group health insurance policy will cover all the medical expenses. However, the hospitalizations must be for more than 24 hours and your coverage is limited to India only.
Cosmetic treatments like plastic surgery, liposuction, and botox are not generally covered in your Care group health insurance plan.
Expenses due to gender-changing treatments or surgeries are excluded from your Care group insurance policy.
Under your Care group health insurance, injuries due to self-harm, like suicide and hospitalization expenses for the same are not covered.
Treatments for substance abuse
Treatment expenses due to substance abuse like drugs or alcohol are exempted from coverage in your Care group health insurance.
Cost of supplements like protein powders and other health tonics which are taken by individuals cannot be claimed in your group medical policy. However, these can be covered if the doctor recommends it as part of treatment during your hospitalization. These are covered as per your policy terms.
Modern treatments for the modern workforce
Care group health insurance plans offer a range of treatments to their clients. They offer advanced-level medical treatments while they take care of your financial issues. Care group health insurance covers modern treatments like robotics surgery, HIV/AIDS, and much more.
Auto recharge feature
Financial crisis can hit you anytime during the time of your treatment. Auto recharge policy offers you an immediate recharge after your sum insured gets exhausted. This feature comes in extremely handy in times of health emergencies.
Health earning benefits the policyholders by helping them gain up to 25% of the return of their premium amount by just inviting your colleagues, friends, and family to get the insurance from Care group health insurance.
Easy portability option
The switch from an existing insurance plan to the other is really easy under Care group health insurance. With one small, hassle-free process, you can make the switch from the existing insurance plan.
Intimate your insurer
In case of emergency, Intimate your claim to the insurer within 48 hours and at least 3 days before in case of a planned hospitalization.
Verify your identity
Provide all the necessary documents that give the proof of identity - policy number/health insurance ID card, company ID, and a valid unique government ID card.
Submit the pre-authorization form
Fill out the pre-authorization form and submit it to the hospital.
Once your details are verified, the claim will be settled directly at the network hospital.
Contact us for assistance
For any questions or assistance contact Pazcare at email@example.com or call us at +91 78291 11300.
Intimate your insurer
Intimate your claim to the insurer within 48 hours in case of an emergency. If it's a planned hospitalization, inform at least 3 days prior.
Settle your bills
Settle all your bills and collect the original copies of hospital bills, doctor consultation reports, and other essential documents.
Submit the documents
Submit all the required documents along with the claim form to the insurer.
Once verified, the claim will be settled in your bank account directly.
Contact us for assistance
For any questions or assistance contact Pazcare at firstname.lastname@example.org or call us at +91 78291 11300. We will guide you through the process.
Our insurance advisors are looking into it. You can expect a call back in the next 10 minutes.Okay
Why buy a group health insurance
policy online from Pazcare?
For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.
The comprehensive group health insurance plan, 19000+ widespread network hospital with 95.2% claim settlement ratio, Care group health insurance offers insurance at the most affordable prices. Care group health insurance offers modern treatments catering to the modern workforce.
You can claim Care group health insurance in two ways. You can go for a cashless claim at a network hospital and a reimbursement claim at a non-network hospital.
The claim settlement ratio of Care health insurance for the year 2020 is 95.47%
Care Health Insurance settles the claim within 7 working days from the receipt of the last necessary document. It does not take more than 30 days.
You can pay the premium of the Care group health insurance plan in cash or by using online or digital payment gateways.
To go about the Care group active health insurance renewal process, kindly follow these steps.