Aditya Birla Health Insurance Claims

When looking to buy a health insurance plan, one of the most important factors you must consider is the ‘Claim Settlement Ratio’ of the insurance company. You also need to thoroughly understand the claim settlement process of the insurance company you choose. This will make it much easier for you to register claims with your insurance provider and get your claims approved. In this article, we’ll take a look at the Aditya Birla health insurance claim settlement ratio as well as their claim settlement process.

Aditya Birla Health Insurance Claim Settlement Ratio

The Aditya Birla Health Insurance boasts of an impressive claim settlement ratio of 94% and is one of the most reliable insurance providers in the business.

Health insurance claim settlement ratio or CSR, refers to the total percentage of insurance claims that an insurance provider settles out of the total number of claims received in a given period. Here is the formula for claim settlement ratio:
Claim Settlement Ratio = (No. of claims settled in the year/No. of claims received in the year) x 100

The higher the claim settlement ratio of an insurance company, the higher the chances that your claim will be approved. 

How to File Aditya Birla Health Insurance Claim Online Through Bajaj MARKETS

Filing health insurance claims was never so simple. Just follow these steps and you’re done!

1. Register your claim through Bajaj MARKETS online.

2. Upload the necessary documents.

3. Your insurer will assess the claim.

4. Check claim status online.

Types of Aditya Birla Health Insurance Claims

There are two types of health insurance claims you can choose from:

• Cashless Claim

• Reimbursement Claim

Let’s take a deeper look into these two Aditya Birla health insurance claim processes.

What are Cashless Claims

Ever been stuck in a medical emergency and were low on cash? Such an uncertain health emergency can drill a hole in your pocket and exhaust your savings! Here's when a health insurance plan with cashless claim settlement acts as a saviour. Under a cashless facility, your insurer directly settles the medical bill with the hospital without you having to pay the bills first. The Aditya Birla health insurance plans are no different. With a cashless treatment facility available at its wide network of 6,500+ hospitals, you need not worry about those hefty hospital bills!

Aditya Birla Health Insurance has simple procedures that enable a hassle-free cashless claim process. All you need to do is:

1. Inform Your Insurer
   In case of planned hospitalisation, inform your insurer at least 1-2 days in advance and in case of an emergency, notify them within 24 hours.

2. Submit Documents
   Submit the required documents like your health card, identity card and medical report.

3. Insurer’s Assessment
   Your insurance company will verify the details against your health insurance policy coverage and terms.

4. Claim Decision
   If your claim request is within the coverage, the insurance company will send the approval to the hospital for the specified amount and the hospital will then start your treatment under the cashless treatment facility.

Documents Required for Filing Cashless Claim

Keep the following documents handy when filing a cashless claim with Aditya Birla Health Insurance:

• Duly filled Aditya Birla health insurance claim form

• Photo ID and age proof

• Original discharge card of the hospital/day care summary/transfer summary

• Previous consultation papers mentioning medical history and treatment details for current ailment

• All the original final hospital bills with all original payment receipts

• All original diagnostic reports, medical practitioner’s prescription and invoice/bill with payment receipt from the diagnostic centre

• Duly filled CKYC form which is signed by the proposer (For claims above ₹1 Lakh)

• All Original Pharmacy and medicine bills along with doctor’s prescription

What are Reimbursement Claims

Under reimbursement claims, you must pay all the hospital bills and expenses out of your pocket initially. You also need to carefully record and store all the hospital and pharmacy bills. Once the treatment is complete and you are discharged, the insurance company reimburses you (the policyholder/insured) for your medical expenses. The reimbursement is done on the basis of providing accurate medical bills and expenses to the insurance company.

As a result, reimbursement claims are a bit more time-consuming when compared to cashless claims. However, you can opt for reimbursement claims for treatments done in non-network hospitals. 

When making a reimbursement claim, follow the steps below –

1. Intimate the Insurer
   Inform your insurance provider about the hospitalisation and intent to file a reimbursement claim.

2. Submit Documents
   After the necessary medical treatment, submit the documents like claim form, discharge summary, medical bills, and OPD expense bills with your insurance company.

3. Claim Verification
   After verifying the documents against the claim, your insurance provider will either accept or deny your claim request.

4. Claim Decision
   If the claim is approved, the said amount is disbursed and will be deposited in your registered bank account.

Documents Required for Filing Reimbursement Claim

You will need the following documents when filing a reimbursement claim with Aditya Birla Health Insurance:

• Duly completed claim form

• Photo ID and age proof

• Original discharge card/day care summary/transfer summary

• Original final hospital bills with all original payment receipts

• All previous consultation papers indicating medical history and treatment details for current ailment

• All original diagnostic reports along with doctor’s prescription and invoice/bill with receipt from the diagnostic centre

• All original medicine/pharmacy bills along with doctor’s prescription

• Cancelled cheque copy for proposer with pre-printed name. In case the name is not pre-printed, please provide a copy of the bank passbook/bank statement

• Duly filled CKYC form which is signed by the proposer (For claims above ₹1 Lakh)

Why Your Aditya Birla Health Insurance Claims May Get Rejected

Here are some reasons why the claims on your health insurance policy may get rejected:

• Misinterpreted Details
  In case any incorrect details and information are provided during the claim, the claim stands rejected as the insurer assesses the claim as per the details provided.

• Excluded Incident
  In case you file a claim for an incident that is excluded from your health insurance policy, your claim may get rejected.

• Inactive Policy
  In case you file a claim after your policy has lapsed, your claim would be denied.

• Delay in Intimation
  In case you fail to inform the insurer regarding the incident, your insurer may not be able to fully assess the scenario, resulting in claim denial.

• Waiting Period
  In case you file a claim for the expenses of the treatment of a disease having a certain waiting period which is still not completed, your claim could be denied.

Note: Kindly refer to the policy wordings to check the complete list of policy exclusions.

We are Here to Help You

At Bajaj MARKETS 

At Bajaj MARKETS, we are committed to serving you better. Here’s how you can connect with us, should you need any help with your Aditya Birla health insurance:

• Customer Care Number: You can call us on 020-66399444 & our executive will be at your service from Monday to Saturday between 10 am to 6 pm.

• Email: You can write to us at insuranceconnect@bajajfinservmarkets.in. 

• Customer Portal: You can also login to our Customer Portal https://www.bajajfinservmarkets.in/cust/#/

• App Assistance: We like to be connected! Download the Bajaj MARKETS App, so you can easily manage your account and track your applications - anytime, anywhere!

At Aditya Birla Health Insurance

The Aditya Birla Health Insurance team is dedicated to providing complete customer support, when it comes to managing queries and offering assistance regarding products, claim process, renewal, and more. Here is how you can connect with the Aditya Birla Health Insurance customer support team:

• Customer Care Number: Call the Aditya Birla Health Insurance team at 1800-270-7000.

• Email: You can write to the team of experts at care.healthinsurance@adityabirlacapital.com. 

• WhatsApp Contact: Want quicker support? You can connect through WhatsApp by sending “Hi/ Self Service” at +91 8828800035.

Address to Dispatch Claim Documents:
Aditya Birla Health Insurance – Claims Team,
5th Floor, MBC Park, Near Hypercity Mall,
Ghodbunder Road, Kasarwadavali,
Thane West – 400615

Health Insurance Plans Available at Finserv MARKETS