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  • Claim Settlement
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Overview

While we wish a good health to you, in case any unprecedented were to occur, knowing all about your claim process is critical. Bajaj Allianz, with its customer-first approach, understands the importance of bringing the best to the table when it comes to customer satisfaction. This is why, the claim settlement process of Bajaj Allianz is painless and hassle-free. With huge network of hospitals in its list of partnered healthcare centres, Bajaj Allianz General Insurance takes care of health insurance claims with easy reimbursement and cashless treatment at any network hospital in India. Moreover, with an impressive claim settlement ratio of more than 90%, the company highlights its commitment to serve better.

How to Claim Your Bajaj Health Insurance Policy Online

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

  • 1

    Visit Finserv MARKETS

  • 2

    Click on the ‘Register a claim’ button

  • 3

    Upload the necessary documents

  • 4

    Your insurer will assess the claim

  • 5

    Check claim status online

What are Cashless Claims

A pioneer in cashless claim settlement, the company works towards making this process better. With cashless treatments across the empanelled hospitals, you get treated for a particular illness without paying a single penny of the medical bills. With over 6500 network hospitals in the country, this process becomes even more easy. 

 

Here’s how you can file a cashless claim:

 

  1. Fetch a Bajaj Allianz network hospital in a city where you want to get treatment done
  2. Inform the insurer regarding your hospitalisation
  3. Carry your identity proof and your Bajaj Allianz cashless card while visiting the hospital
  4. Fill the pre-authorization request form available at the hospital desk and submit it to the hospital.
  5. The hospital sends the pre-authorization request form to Bajaj Allianz-HAT (Pune), post verification.
  6. The insurer reviews your application and conveys the claim decision
  7. On approval, the hospital begins the cashless treatment. 

Document Required for Filing a Cashless Claim

  • Duly signed Hospitalization Claim form and signed by the insured
  • Original paid receipts
  • Original Discharge summary document
  • Original hospital bills with detailed cost break-up
  • All Lab and test reports
  • Copy of Invoice/Stickers/barcode in case of implants
  • First consultation letter from doctor
  • KYC form

What are Reimbursement Claims

While cashless claims highlight the ease of getting your cashless treatments done, you can also choose to get your treatment done at your cost and reimburse the claim amount later. Here’s where the reimbursement claim process gains significance. 

 

This is what you need to do, in case you were to face those rainy days–

 

  1. Submit all original hospitalization related documents to the insurer
  2. Bajaj Allianz General Insurance will then complete the verification, for which other documents may be required
  3. The insurer then takes the process forward
  4. Once your claim is approved, the customary verification is initiated, post which the team releases the payment 

Document Required for Filing a Reimbursement Claim

  • Hospitalization Claim form signed by the insured and duly signed by you
  • Completely filled and signed NEFT form by Policy Holder/propose
  • Original paid receipts and discharge summary document
  • Copy of Invoice in case of implants
  • Original hospital bills with detailed cost break-up
  • All Lab and test reports
  • Doctor’s first consultation letter
  • KYC documents and form
  • Process
  • Download
  • Emergency Contact
  • Cashless Claims
  • Claim Intimation
  • Claim Reimbursement
  • Cancellation Process

  • You need to approach the network hospital along with your policy details.

  • The network hospital verifies the details provided by you and sends a pre-authorization form to the network hospital.

  • The insurance provider verifies the pre-authorization request and informs the network hospital about your policy's coverage. If needed, the insurance provider may send a query letter to the network hospital requesting more details. The network hospital needs to respond to this query with the information requested for.

  • Once the network hospital receives approval from the insurance provider, treatment begins. Upon discharge from the network hospital, the final bill, along with the discharge papers, are sent to the insurance provider. The insurance provider will settle the final amount with the network hospital after deducting co-payment (if applicable) and other consumable expenses.

  • Should the pre-authorization request get rejected; you will have to bear all treatment expenses which can be reimbursed later.

  • Claim Intimation

    • Claims should intimated within 48 hours in case of emergency hospitalization*
    • Claims should be intimated within 24 hours in case of planned hospitalization*

  • Claims can be intimated on the following platforms:

    • Contact the executes at the Call Center- 1800 209 5858 (Main Toll Free) and dedicated health toll free (1800 103 2529)
    • Email on health.admin@bajajallianz.co.in
    • Branch walk-in at the customer care desk
    • Visit the website- https://general.bajajallianz.com/BagicHCM/cstprtl/getCustDtls.do
    • Download the Caringly Yours App on App store/Play store

  • Following details are required for claim intimation:

    • Policy Number
    • Name of the Patient
    • Hospital Name
    • Hospital Address
    • Date of Admission
    • Diagnosis
    • Mobile Number
    • Email Id

*Note: Relaxations in the timelines mentioned above may be considered in the extreme cases of hardship where it is proved to our satisfaction that under the circumstances in which you were placed, it was not possible for you or any other person to give notice or file claim within the prescribed time limit.

  • Once discharged from hospital, you need to collect all original documents and bills and submit them to the insurance provider.

  • The insurance provider initiates scrutiny of all claim-related documents. If additional documents are needed, you will be intimated about the additional documents required.

  • Once all necessary documents are received, the insurance provider approves the claim.

  • Payment will be released to you based on what is admissible under the insurance policy.

  • Company Cancellation

    The insurance provider may cancel your insurance policy providing a written notice 15 days prior to cancellation date. If no claim has been made, a refund of the premium for the unexpired policy period shall be provided on a pro-rata basis.

    Your insurance policy will be cancelled for reasons such as non-disclosure of material facts, misrepresentation, fraud and non-cooperation.

  • Customer Cancellation

    As a customer, you may cancel your insurance policy by providing a written notice 15 days prior to cancellation date. If you've made no claims, the insurer will refund short-term rates for the unexpired policy period as per the rates detailed below.

    Period of Risk Premium Refund - 1 Year Policy Period
    Exceeding 15 days but less than 3 months 65.00%
    Exceeding 3 months but less than 6 months 45.00%
    Exceeding 6 months but less than 12 months 00.00%
    Period of Risk Premium Refund - 2 Year Policy Period
    Exceeding 15 days but less than 3 months 75.00%
    Exceeding 3 months but less than 6 months 65.00%
    Exceeding 6 months but less than 12 months 45.00%
    Exceeding 12 months but less than 15 months 30.00%
    Exceeding 15 months but less than 18 months 20.00%
    Exceeding 18 months but less than 24 months 00.00%

  • Cashless Claims
  • Claim Reimbursement
  • Other Health Insurance Related Claims
  • Links for Claim Settlement Forms
  • List of Network Hospitals
  • Brochure
  • Cashless Claims Request Form
  • Reimbursement Form
  • Self Declaration of KYC Document Submission - For Individual Partner
  • Non-Medical Expenses List of Exclusions
  • Personal Accident Claim Form
  • Cashless Claims Request Form
  • Reimbursement Form
  • Self Declaration of KYC Document Submission - For Individual Partner
  • Personal Accident Claim Form
  • Non-Medical Expenses List of Exclusions
  • List of Network Hospitals

You can fetch your nearest network hospital here

  • Health Guard Brochure
  • Extra Care Plus Brochure

Need further assistance? Reach out on the Toll-Free Number: 1800-209-5858 to connect with an insurance expert.

 

Why Your Bajaj Allianz Health Insurance Claims May Get Rejected

Apart from understanding the process, it is also very important to note why your claims on your health insurance may get rejected. This way, you can prevent the rejection of your claim and make full use of your insurance coverage. Here are a few reasons why your claims may get rejected:

 

Cost exceeds sum insured

In case the treatment cost exceeds the sum insured amount you are entitled for, your claims may get rejected

Ignoring exclusions 

In case the claim is made for a treatment cost that is not covered under the plan, you claim request is rejected.

Invalid claim 

If any incorrect or false information is provided during claim intimation, the claim is held invalid and is rejected.

Inactive policy 

If you file a claim after your policy has lapsed, the claims stand null. This further reinstates the importance of renewing your health insurance on time.

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.

We are Here to Help You

  • At Finserv MARKETS
  • At Bajaj Allianz General Insurance

You can also get in touch with the Finserv MARKETS team, should you need any help with Bajaj Allianz Health Insurance

Here’s how you can connect with the Bajaj Allianz health insurance team, in case you need any assistance regarding the product. 

  • Contact the executes at the Call Centre- 1800 209 5858 (Main Toll Free) and dedicated health toll free (1800 103 2529)
  • Email on health.admin@bajajallianz.co.in
  • Branch walk-in at the customer care desk
  • Visit the website- https://general.bajajallianz.com/BagicHCM/cstprtl/getCustDtls.do
  • Download the Caringly Yours App on App store/Play store

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Manage all Your Queries Here

  • ✔️What is a claim settlement ratio?

    A claim settlement ratio (CSR) helps understand the percentage of claims an insurer has settled during a financial year. It is the percentage of insurance claims settled by an insurer with regards to the total number of claims received.

  • ✔️What if my cashless claim request is rejected by the insurer?

    On denial of cashless claim request, you need to get the treatment done at your expense. You can choose to file for claim reimbursement later.

  • ✔️What is the contact number for claim related queries?

    You can call on the dedicated health toll free number 1800 103 2529 for any claim related queries.

Health Insurance Claim Settlement Reviews

Health Insurance Claim Settlement Reviews

4.2out of 5

4 reviews

Hassle Free Claims

My decision of getting a Bajaj health plan was great! When my hospitalization costs were to be taken care of, the plan acted as a great friend to me. Further, wiith quick and hassle-free claims, I had nothing to worry about.

Deepika

Posted on 1 Feb 2020

Awesome Customer Support team

The customer support team at Finserv MARKETS was at great help to me when i had to get claim my Bajaj Allianz Health Insurance. The executive helped me through the process, very nicely.

Nitin D

Posted on 18 Mar 19

Easy claim process

Purchasing the Bajaj Allianz individual health insurance plan was very easy. And, so was the its claim process. Quick assistance and easy process made it very convenient.

Deepa Saha

Posted on 4 Jan 19

Super-fast Claim Settlement

During my recent hospitalization for a surgery, I experienced the quick and hassle-free claim settlement process of the Bajaj Allianz individual health insurance policy.

Varun More

Posted on 26 Aug 19