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  • Bajaj Allianz Health Insurance Claims Procedure

    Bajaj Allianz Health Insurance

    Health insurance is an important aspect of everyone’s personal finance because it helps protect one from unnecessary burdens of medical bills. The claim process of Bajaj Allianz Health Insurance is relatively easy and hassle-free, allowing for easy reimbursement or cashless treatment at any hospital across the nation. With over 5100 hospitals in its list of networked healthcare institutions, Bajaj Allianz Heath Insurance aims to make health insurance accessible to everyone.

    Incurred Claim Ratio for Bajaj Allianz Health Insurance:

    ICR or Incurred Claim Ratio is a standard measure across the insurance market of how well an insurer is performing. The incurred claim ratio for Bajaj Allianz Health Insurance is shown in the table below –

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    69512 51152 73.59

    A value from 50% to 80% is a good figure concerning ICR (Incurred Claim Ratios). Bajaj Allianz in 2013-14 had a claim ratio of around 83% and could have been under pressure to meet claims, but it now has a claim ratio that is within the appreciated limits. Thus, any kind of claims will not be taxing the financials of Bajaj Allianz in any condition.

    Claim Scenarios:

    Claim scenarios happen with cashless treatment as well as reimbursement cases. Both options for Bajaj Allianz are mentioned below.

    Cashless Treatment:

    Bajaj Allianz has tie-ups with many hospitals across the nation and that helps in availing cashless treatment. The bills generated in such cases are sent across to Bajaj Allianz and the policyholder or the claimant doesn’t need to pay anything.

    Procedure to file a claim (planned/emergency hospitalisation):

    1. Member card should be carried on person, or the policy number and member ID should be provided at the network hospital
    2. One would need to furnish personal details and policy ID or member ID to the hospital’s insurance desk and fill up the Pre-Authorisation form in the customer’s section
    3. Once the balance details are filled up by the hospital, the Pre-Authorisation form will be faxed to Bajaj Allianz
    4. The Bajaj Allianz in-house medical team will review the case and documents received and intimate the guardian and hospital in case of approval, pending approval or rejection
    5. In case of pending approval cases, Bajaj Allianz will contact the hospital to furnish more details and in cases of rejection, a claim reimbursement process needs to be followed

    Claims process for cashless treatment:

    1. Post the filling up of the pre-authorisation form, the requisite details will be verified by the hospital and the TPA
    2. Upon submission of the pre-authorisation form, all communications will be taken care of by Bajaj Allianz pertaining to the settlement of the bill
    3. If in case some expenses are not covered or are beyond the scope of the policy, the same will be intimated to the patient before or post release from hospitalisation

    Reimbursement of Treatment Expenses:

    Reimbursement needs to be done if treatment has been availed at a non-network hospital or cashless claim has been rejected. The following process will need to be followed in such cases.

    Procedure to file a claim:

    1. The details required during this procedure will be the following –
      • Policyholder’s name
      • Claimant’s name and customer ID
      • Details of the hospital
      • Details of diagnosis and treatment
      • An approximation of the claim amount
      • Date of admission
    2. Collection of all related documents from the hospital to be done

    Documents Required:

    The claim form can be downloaded from Bajaj Allianz’s website and along with the filled up form, the following documents need to be provided –

    1. The original copy of the claim form, fully filled and duly signed
    2. Government approved valid photo ID proof
    3. Referral letter from medical practitioner advising hospitalisation
    4. Letter from medical practitioner detailing the list of tests, medications and consultations if any
    5. Original copies of bills, receipts and discharge card from the hospital or the medical practitioner
    6. Original copies of bills or receipts from pharmacies or druggists involved
    7. Original copies of tests and reports done along with payment receipts
    8. Indoor case papers
    9. If applicable, the First Information Report and the Final Police Report
    10. Original copy of the post mortem report, if conducted

    The above list of documents are the bare minimum necessities. Bajaj Allianz might require additional documentation as and when needed.

    The above mentioned list of documents and the claim form needs to be sent via post to the address at the office of Bajaj Allianz General Insurance.

    Claims process for Reimbursement Cases:

    Once the filled claim form along with the relevant documents is received by Bajaj Allianz, the claims process is initiated and the following happens –

    1. The in-house medical team of Bajaj Allianz reviews the case and documents received
    2. The case if approved, will cause the reimbursement of funds to be processed and the procedure will be completed within a week and a fortnight. Intimation of the same will be sent to the claimant
    3. In case the request has incomplete information, the same will be intimated to the claimant and requisite details will be requested to ensure claim resolution at the earliest
    4. In case of request rejection, the reason will be mentioned for the same and an intimation sent to the claimant. If there are further documents to strengthen the case, the same will be studied and the claim can be reopened for review
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