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Bajaj Allianz Health Insurance Claim

One of the most important factors in looking for health insurance is to clarify and know the ICR of an insurance company. Luckily, Bajaj Allianz boasts a 77.31% incurred claim ratio, which helps it stands out among the cluster of health insurance providers in the market. More than that, its claim process is pretty simple and hassle-free, which is very much required to be a customer-friendly insurer. Moving forward, we are going to talk about the health claim settlement process of Bajaj Allianz in detail. Have a look at the below mentions.

Claim Process of Bajaj Allianz Health Insurance

Cashless Claim Procedure

To avail of a seamless cashless claim settlement process, follow the below step-by-step guide.

  • It is to be noted that for the cashless claim process, you need to visit one of the network hospitals of the company.
  • After that, the TPA desk of the network hospital will contact BAGIC for cashless treatment.
  • The hospital will verify all the necessary documents of yours and send the duly filled and signed pre-authorization form to Bajaj Allianz – Health Administration Team (HAT).
  • Now the company will verify, evaluate and assess those documents along with the policy documents. Then, within 1 working day, the insurer will inform the network hospital about their final verdict on your claim.
  • On behalf of the company, your healthcare provider will be notified about their First Response within 60 minutes.
  • If no discrepancy is found, the claim will be approved, and the claim amount will be settled directly with the network hospital.
  • If the company has any further queries, it will notify the network hospital about the same, asking for the further relevant documents to process the claim procedure faster.
  • Once the insurer receives the additional required documents, an authorization letter will be sent to the network hospital within 7 working days, and your claim will be settled.
  • But, if the insurer is not satisfied or any discrepancy is found, your claim will be denied, and the same will be communicated to your healthcare provider.
  • In that case, you can also file a reimbursement claim at a later date.

Reimbursement Claim Procedure

For reimbursement claims, it is not mandatory to get admitted to a network hospital of the insurer. You can choose any proper healthcare provider of your choice and follow the below steps to file a claim effortlessly.

  • At first, you need to collect all hospitalization-related documents and submit those in original to BAGIC HAT.
  • The company will verify and evaluate the documents against your policy wordings.
  • If the company needs more information, you will receive a prior intimation about the same so that you can get enough time to produce the documents.
  • Once the company receives all the required documents and is satisfied, your claim settlement process will be initiated, and the company will release the payment via ECS within 10 working days, which is subject to the terms and conditions of the insurer.
  • If you fail to produce the requisite documents, the company will send you three reminders each ten days apart from the date of intimation. Even after that, if you do not respond properly, the company will be forced to close your claim intimation.
  • Once your claim is approved after final assessment and verification, the company will release the payment via ECS within 7 working days.

Health CDC (Claim by Direct Settlement)

Health Claim by Direct Settlement (CDC) is a unique feature that is offered by Bajaj Allianz. It helps you to settle your health insurance claims up to Rs. 20,000 instantly (within 20 minutes). This facility is only available through their mobile app-Caringly Yours, which can be easily downloaded from App Store and Google Play.

What are the possible reasons for the denial of the Bajaj Allianz Health Insurance Claim?

The company may decline your claim for the following reasons.

  • If you file a claim for self-inflicted injury, and it is proved, the company will deny the claim instantly.
  • In case of any kind of misinterpretation, fraud, nondisclosure of material facts, or non-cooperation from the insured’s end, the company may terminate your claim intimation.
  • If the insured person files any claim for pre-existing diseases before the specified waiting period, the claim will be considered void.
  • If you file a claim against anything that is mentioned under the category of exclusions in the policy wordings, your claim will get rejected.
  • If the insured person cannot produce the requisite documents even after the specified time (the time period may vary depending on the nature of the claim), the company will be forced to decline your claim intimation.

Can Insured Change Hospital During Course of Treatment? Will It Affect Claim?

Yes, you can certainly change your hospital during the course of your treatment. In that case, you need to inform the company about the same and have to produce the relevant required documents to them. However, the claim may or may not get affected due to this depending on the nature of the claim and the terms and conditions of Bajaj Allianz General Insurance Company.

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