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  • Bajaj Allianz Health Insurance Claims Procedure

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    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 –

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    28773 16472 57.25

    For 2014-15:

    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 2014-15 and 2015-16 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

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Bajaj Allianz Health Insurance Claims Procedure Reviews

  • Page 1 of 16 1 2 3 4 5
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a company provided health insurance policy with Bajaj Allianz from last 4 months. It is a family policy where the coverage value is up to Rs 5 lacs for this insurance. I have not claimed anything so far from this health insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 05, 2018
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance policy with Bajaj Allianz from last 3-4 years, i am not aware of the premium amount as my company pays it. I am not aware of the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy.
      Was this review helpful? 0
      , pune
      Reviewed on Aug 30, 2018
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Bajaj Allianz from last 1 year, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. I pay a premium of Rs 4000 and the coverage value of this insurance policy is 3 lakhs.
      Was this review helpful? 0
      , chennai
      Reviewed on Aug 17, 2018
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Bajaj Allianz from last 1 year, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. I pay a premium of Rs 7000 has to be paid for this insurance and it is covered up to Rs 4 lakhs.
      Was this review helpful? 0
      , kolkata
      Reviewed on Aug 09, 2018
    • Bajaj Allianz Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have my health insured with Bajaj Allianz from last 2 years, i am happy with the coverage value of this insurance policy. They cover up to Rs 5 lakhs for this insurance. My claim experience was good and they covered 40% of the billed amount and it was a cashless treatment.
      Was this review helpful? 1
      , pune
      Reviewed on Aug 09, 2018
    • Bajaj Allianz Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have my health insured with Bajaj Allianz from last 3 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. Premium is paid by the company which i work for and the coverage value is Rs 2 lakhs.
      Was this review helpful? 1
      , coimbatore
      Reviewed on Jul 23, 2018
    • Bajaj Allianz Health Insurance
      "Useful Service"
      0.5 4.0/5 "Great!"
      I've an employer provided insurance policy with the Bajaj Allainz. The company is paying the premium, I do have a claim experience with the policy where I claimed 100% amount needed for the treatment. It was a cashless treatment and the whole process was smooth and hassle free.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jul 16, 2018
    • Bajaj Allianz Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the Bajaj Allianz. Their service is very good. I have raised almost three claims and the processed those claims with out any delays. Everything was smooth and hassle free. I am really impressed with their services.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jul 11, 2018
    • Bajaj Allianz Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've been using the Health insurance policy from Bajaj Allianz for a while now. The Experience is good, don't have any claim experience. I pay a premium of 8000 Per year. I never had any claim experience with the policy so far. When considering the features it is a good policy to have.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jul 10, 2018
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Bajaj Allianz from last 3 years and it is a good policy to use. I paid an one time payment for Rs 6000 for this insurance policy. I have not claimed anything so far from this insurance policy and i have a coverage value of Rs 1 lakh for this insurance.
      Was this review helpful? 0
      , ratlam
      Reviewed on Jul 06, 2018
    • Bajaj Allianz Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the Bajaj Allianz Insurance company. I pay a premium of 11000 per year for the entire family for four members. I started paying 8000, the premium was increased as per age. I Do not have any claim experience . I'll have to wait and see how they respond to my requirements in future.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 26, 2018
    • Bajaj Allianz Health Insurance
      "BEST"
      0.5 4.0/5 "Great!"
      I have been using since 2 years. The premium is i do through the cheque. Premium is normal when compared to the others. There is a free medical checkup in my policy but i have not used it. I had a no claim experience so far. Diastase coverage is there.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jun 23, 2018
    • Bajaj Allianz Health Insurance
      "Good Health Insurance policy"
      0.5 5.0/5 "Blown Away!"
      So far i have never claim the health insurance. I can claim upto 7 lakhs. I have taken this insurance policy for me and dependent. The employer take care of the premium amount. I have never contact the customer care. Almost most of the hospital has been covered in this health insurance
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 14, 2018
    • Bajaj Allianz Health Insurance
      "Best"
      0.5 5.0/5 "Blown Away!"
      I am having the health insurance policy with the Bajaj allianz general insurance company. I would like to say that the coverage value is around three lakh Rupees. Cashless treatment is applicable there, so I have not faced any such claims with them as such.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 12, 2018
    • Bajaj Allianz Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Bajaj allianz from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. A premium of Rs 6000 has to be paid for this insurance and it is covered up to Rs 3 lakhs./
      Was this review helpful? 0
      , mumbai
      Reviewed on May 31, 2018
    • Bajaj Allianz Health Insurance
      "Average Policy"
      0.5 4.0/5 "Great!"
      My company provided me a Bajaj health insurance. They offered me a claim amount of Rs. 1.5 lakhs. I can avail this policy for my family. I can use this insurance for medical emergency. I have never any claim experience. My company pay according the corporate premium amount.
      Was this review helpful? 0
      , new delhi
      Reviewed on May 29, 2018
    • Bajaj Allianz Health Insurance
      "Not satisfied with the response from Bajaj"
      0.5 2.0/5 "Expected more"
      For the corporate requirement we have taken health insurance from BAJAJ ALLIANZ GENERAL INSURANCE and the service was not up to the mark. if we want to remove the employee name from the policy then will be not quiet easy and if we contacted them the response will be not much friendly.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 26, 2018
    • Bajaj Allianz Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've a health insurance policy which is provided by my employer. The company pays a premium of 1500 Per year. I never had any claim experience with the policy and I am not aware about a core details of this policy.
      Was this review helpful? 0
      , chennai
      Reviewed on May 18, 2018
    • Bajaj Allianz Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy from the Bajaj Allianz. I don't have any claim experience I pay a premium of 800 per month for annual coverage of 9 lacs which is very good. I never had any issues with the policy and its features and I make the premium payments online.
      Was this review helpful? 0
      , hyderabad
      Reviewed on May 18, 2018
    • Bajaj Allianz Health Insurance
      "Excellent Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance form the Bajaj Allianz . I pay a premium of 3000 annum, for a coverage of 3 lacs. I had a claim experience with the policy where they paid 95% for a cash less treatment. Everything was done from the hospital. The whole process was quick and hassle free.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 18, 2018
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