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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

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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 17 1 2 3 4 5
  • Bajaj Allianz Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    It has been four years since i had taken this health insurance policy and i had been paying the premium on an annual basis. The premium amount has been nominal and is not too high, most of the hospitals are covered in my locality and there has been cashless treatment available as well.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 08, 2019
  • Bajaj Allianz Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    From Bajaj I got the medical policy with the value of Rs. 3 lakhs, its covers only for me. I done the claim because I had throat infection, I have admitted in hospital around 4 days, they gave me the cash less treatment. They have given the card I gave to the hospital member they gave me the treatment. Only admiration charges have paid from my end, remaining all taken care by the insurer.
    Was this review helpful? 0
    , pune
    Reviewed on Jan 04, 2019
  • Bajaj Allianz Health Insurance
    "Its Good for Health"
    0.5 4.0/5 "Great!"
    My company provided Rs. 2 lakhs of medical coverage for employee alone, they gave me the medical card on time. They sent me the list of hospitals which they got tie up in Bangalore, they are providing cover major or minor disease from the insurance company.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 20, 2018
  • Bajaj Allianz Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have selected the health insurance policy with Bajaj allianz because they have given me a offer like I have to pay the premium amount of Rs. 8700. I pay the premium amount of Rs. 830 per month. This policy covers only myself with the coverage value of Rs. 7 lakhs for five years.
    Was this review helpful? 0
    , pune
    Reviewed on Dec 17, 2018
  • Bajaj Allianz Health Insurance
    "Good Health insurance"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health insurance with Bajaj Allianz. Once i spoke with the call centre people and the service is fine. We do have a OP claim facility and the claim settlement was easy. The have given me a settlement within 15 days. They have given me a claim amount of Rs. 7500 and total coverage of the policy is 7 years. Total family is covered by this policy. They have very good network of hospital.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 15, 2018
  • Bajaj Allianz Health Insurance
    "Good Doctor for Health"
    0.5 5.0/5 "Blown Away!"
    My medical policy belongs to Bajaj Allianz, I am working same company hence they gave me best benefits. They do have pre existing disease they got tie up major hospitals, they have helpline of 24/7, the medical value around Rs. 5 lakhs for my entire family.
    Was this review helpful? 0
    , pune
    Reviewed on Dec 14, 2018
  • Bajaj Allianz Health Insurance
    "Not sure about this policy"
    0.5 4.0/5 "Great!"
    The health insurance was given by the employer. Its with Bajaj Allianz. I never interacted with their customer care. I had no claim experience with this policy. My entire family has been covered by this policy as of now. They have offered me a coverage amount of Rs. 5 lakhs and i didn't happy with it.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 02, 2018
  • Bajaj Allianz Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    My health is insured with Bajaj Allianz from last 5 years, i am not aware of the premium amount as my company pays it. My claim experience was very good, they covered 95% and it was a cashless treatment. The coverage value for this insurance policy is 5 lacs.
    Was this review helpful? 0
    , chennai
    Reviewed on Nov 29, 2018
  • Bajaj Allianz Health Insurance
    "Good policy"
    0.5 5.0/5 "Blown Away!"
    Earlier i was holding a health insurance policy with Bajaj allianz. I paid the premium amount of Rs. 4000 and most of disease got covered in this policy. Total coverage value of the policy is Rs. 5 lakhs per annum. So many hospitals has been registered with this policy. I have not claimed anything in this policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Nov 28, 2018
  • Bajaj Allianz Health Insurance
    "Yet to experience the policy"
    0.5 3.5/5 "Pretty good"
    My company has given me a health insurance policy with Bajaj Allianz. My entire family has been covered by this policy. Around 4 lakhs, i have received as a coverage value. They are giving a good cashless facility. I have not claimed anything from this policy. I have not gone through the hospitals list.
    Was this review helpful? 1
    , pune
    Reviewed on Nov 22, 2018
  • Bajaj Allianz Health Insurance
    "Average"
    0.5 3.0/5 "Satisfactory"
    I have paid between 8 to 9k and purchased the health insurance for a year. I got the documents on time. The customer service is not so much good. The medical coverage is 10L. I used to pay installment at every month as 850 rupees. Online option is easy to do the payment.
    Was this review helpful? 1
    , pune
    Reviewed on Oct 24, 2018
  • Bajaj Allianz Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    I took health insurance from Bajaj Allianz Am satisfied with the premium amount which am making the payment , i don't have claim experience . But this policy hold benefits of cashless hospitalization and network of hospital with coverage of Rs 3 lakhs Their customer explained the policy very well.
    Was this review helpful? 1
    , mumbai
    Reviewed on Oct 15, 2018
  • Bajaj Allianz Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    I hold a health insurance policy with Bajaj Allianz from last 1 year, i am not aware of the premium amount as my company pays it. I have not claimed anything so far with this insurance and the coverage amount of Rs 70000 is very less for family coverage.
    Was this review helpful? 0
    , ghaziabad
    Reviewed on Oct 11, 2018
  • Bajaj Allianz Health Insurance
    "Excellent Service"
    0.5 4.0/5 "Great!"
    I had taken this Health Insurance policy almost three years back and i had been paying the premium annually and the premium amount has been around 500. I had been making the premiums online and it has been easy in making the payments. Their customer support also had been good as well where they had been helpful at times.
    Was this review helpful? 0
    , new delhi
    Reviewed on Oct 09, 2018
  • Bajaj Allianz Health Insurance
    "CONVENIENT"
    0.5 5.0/5 "Blown Away!"
    I had a claim experience with the BAJAJ ALLIANZ GENERAL INSURANCE. I have used this insurance is for 7 years which is cashless. It gives the coverage for my entire family. I had a claim for 1.5 lakhs and the medical coverage is for 3lakhs.
    Was this review helpful? 0
    , new delhi
    Reviewed on Oct 08, 2018
  • Bajaj Allianz Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    From Baja allianz health insurance i have taken health insurance , am satisfied with the premium amount which am making . I am getting benefits of Cashless hospitalization and pre disease cover . Even they listed the network of hospitals . Their customer representative explained the policy . Overall am satisfied with this policy.
    Was this review helpful? 0
    , pune
    Reviewed on Oct 06, 2018
  • Bajaj Allianz Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I had taken this Health Insurance Policy almost two years back and it is going well so far. There has not been any claims made so far but there has been many hospitals covered in my locality. They also had been having the cashless treatment. I had been paying the premiums annually and the premium amount has not been too high.
    Was this review helpful? 1
    , new delhi
    Reviewed on Oct 06, 2018
  • Bajaj Allianz Health Insurance
    "Worst service"
    0.5 0.5/5 "Unacceptable"
    Paid amount of Rs. 10461 for Transaction Reference No 5583542 has been received by Bajaj Allianz on August 8th. Still insurance not confirmed. Not happy with the policy. Check in your database so many tickets raised but no use. Whats this bad. worst service. Don't know the other words to say it's worst worst. Suggesting that don't take Bajaj Health policy.
    Was this review helpful? 2
    , visakhapatnam
    Reviewed on Sep 28, 2018
  • Bajaj Allianz Health Insurance
    "Good Service"
    0.5 5.0/5 "Blown Away!"
    I've a Family Floater Health insurance policy from the Bajaj Allianz. I am paying a premium of 16000 per year. It covers the entire family and so far there hasn't been any issues with their services.
    Was this review helpful? 0
    , thane
    Reviewed on Sep 26, 2018
  • 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
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