Health Insurance Claim

Knowing the process of filing a health insurance claim is crucial to getting timely financial assistance. Be it an emergency or a planned medical procedure, all you need to do is submit the necessary documents to your insurer. 

 

Opt for a cashless or reimbursement claim and follow the process as well as timelines set by the insurance provider. On Bajaj Markets, you can claim an amount of up to ₹2 Crores at a monthly premium starting at just ₹160.

There are primarily two types of medical claims as listed below:

• Cashless Claims

You do not need to pay bills related to hospitalisation as well as other medical treatment charges upfront, as per the policy terms. Your insurance provider is responsible for directly setting bills with the relevant hospital.

 

Earlier, cashless claims required the medical facility to be listed on the insurance provider’s network. This has not been the case since early 2024 when the General Insurance Council (GIC) launched the 'Cashless Everywhere' initiative. 

 

Now, you can file cashless claims at any hospital, provided you follow the guidelines listed by the GIC. However, visiting a network hospital can still offer you a quicker, seamless and more reliable claim settlement process. Check the list of partner hospitals by calling the insurer’s customer service or on its website. 

• Reimbursement Claims

When filing a claim for reimbursement, you need to pay medical expenses from your own pocket initially. After treatment, raise a request for compensation with your insurance company. 

 

The insurer checks your claim details and the supporting documents. If approved, it settles the claim by reimbursing your healthcare expenses as per policy terms.

To file a claim for health insurance, provide these documents to the insurance company along with a completed application form:

• Age Proof: Birth certificate, Driving licence, 10th or 12th marksheet, passport, Aadhaar card, Voter’s ID, or PAN card

• Identify Proof: Passport, Aadhaar card, Driving licence, Voter’s ID, or PAN card

• Address Proof: Passport, Aadhaar card, Driving licence, Voter’s ID, PAN card, or utility bills

• Medical Documents: Original reports of the required medical tests, discharge card, medical certificate, prescriptions, and more

• Passport-size Photographs

You can file a claim with your insurance provider for the following services:

• In-patient hospitalisation expenses

• Pre- and post-hospitalisation expenses

• Expenses for medicines and prescriptions

• Maternity expenses

• Expenses for outpatient services

• Ambulance charges

• Preventive care expenses

• Expenses for day care treatments

Here are some key points to consider before initiating the insurance claim process:

• Type of health insurance you have 

• Total tenure of your medical insurance

• Timeline for requesting a claim

• Terms and conditions of the insurer with regard to claim process and formalities 

• Process of filing a claim

• Proper communication with the insurer

• Inclusions and exclusions of your medical policy 

Follow these steps to file a claim with multiple insurance companies:

1. Initiate the medical insurance claim process with the first insurance company

2. Obtain the claim settlement summary from the first insurance company

3. Get the receipts and other documents of the hospital bills

4. Approach the second insurance company to settle the remaining expenses

5. Submit the first claim settlement summary and all the medical documents to the second company

Here are the steps to review the status of your claim request online:

1. Visit your insurance company’s website

2. Choose the ‘Register a Claim’ option

3. Select the ‘Track Claim Status’ option

4. Provide your policy number, customer ID, claim number, and birth date

5. Click on the ‘Submit’ button to check the status on the screen

 

You can also check the status offline by calling or visiting the nearest office of the health insurance provider. Remember, the process may vary slightly from one insurer to another. You can contact the customer support team of the insurer to address queries.

Here are some reasons that can lead to the rejection of your medical claim:

• Incorrect or incomplete information

• Undisclosed medical conditions

• Claim request after the expiration of the policy

• Incomplete documents or discrepancies in paperwork

• Claim filed for expenses or services not included in the policy

You can boost the chances of approval of your insurance claims in these ways:

• Inform the third-party administrator beforehand and fill out the cashless treatment form at the hospital carefully

• Cross-check the terms and conditions of your policy 

• Submit the request for claims as soon as possible 

• Understand and follow the claim procedure accurately

• Keep the required documents handy 

• Check the list of network hospitals included in the plan

• Review the treatments included and excluded in the policy

• Disclose your medical conditions and other details properly when getting the policy

• File for a claim before the tenure of the insurance policy ends

• Renew your health insurance policy by paying the premium prior to the due date

Health Insurance Plans Available at Bajaj Markets