Claim Management Process During Emergencies

A health insurance cover promises to take care of most of the financial burden of a policyholder in case of a claim. It, therefore, makes claim settlement an extremely important function, since it is not only about managing claims expenditure, but is also an important mechanism for earning customer loyalty.

In India, health insurance claim management has evolved significantly, over the past 10 years. Majority of the health service providers have been working with external Third Party Administrators (TPA), to provide its customers with claim related services. However, with the ever increasing cost of medical treatment, and a significant rise in claims pertaining to health insurance, companies across the industry are now aiming at providing instant in-house healthcare and claims related services to their customers.

Having an in-house or a dedicated TPA is an emerging trend in the industry today, However, Bajaj Allianz General Insurance was the pioneer in the industry, to set up an in-house Health Administration Team in July 2004, which serves as a single window for all health insurance related claims. Today, this team approves cashless health claims within average TAT of  one hour, which is an unprecedented milestone in the industry.

“Health insurance claim settlement is all about how fast we can cater to the requirement of our customers in their time of distress. Since its inception, the health claims team at Bajaj Allianz has leveraged on technology and has been continuously re-engineering the claims approval process to provide faster claim solutions to the customers and other stakeholders.”, says Mr. Suresh Sugathan, Head- Health Administration Team, Bajaj Allianz General Insurance.

Initiatives for claims management

Multiple touch-points for customers

These touch-points help the customers for an easy access through various mediums of communications, both traditional and new media.

Call Center

Bajaj Allianz offers a dedicated toll free number to its health customers, for 24x7 support, where majority of their concerns are addressed on call. If in any case the call does not get completed, active call backs are made.

Dedicated Email Id

These are in place to address queries from customer with a record turnaround time of 24 hours

Senior Citizen Cell

A dedicated priority customer care cell is initiated to prioritize assistance to senior citizen customers. Services offered include; IVR prioritization via toll free, exclusive email ID, and a dedicated webpage on company website for senior citizens. Informative posters put up in all Bajaj Allianz offices inviting senior citizens to come forth with their queries and doubts pertaining to medical insurance for senior citizens.

Intermediaries

The intermediaries are interlinks between the Insurance Company and the insured. Periodic meeting are held with them and they are sensitized for any new developments or any new service being brought out.

Branches

The customers can easily avail the services in person from any of our branch offices spread across the country.

Image based claims processing

Bajaj Allianz was amongst the first insurers to adopt image based claims, which involves minimal documentation, reducing the turnaround time for claim settlement by 77.08%. The company’s turnaround time for cashless claims stands at 55 minutes, and 9 days for reimbursement claims.

Dedicated platforms for intermediaries

An intermediary acts as a direct link between a company and its customers therefore must be well informed at all times. Bajaj Allianz has initiated SMS and email alerts to its IMD’s, at each stage of a health claim. The company also provides agents with a duly filled sample claim form, on the Agents Portal, for ready reference. The company seeks periodic feedback to further improve the claims process. The survey is a first of its kind in the industry, where the top agents gave feedback and suggestions, helping the organization to strive for perfection.

Portal for network Hospitals

Bajaj Allianz has tied-up with 3700 plus hospitals across India providing cashless and hassle free claims experience to its customers. The company has designed a Hospital Portal for its empanelled hospitals. On this portal, hospital authorities can keep tab on the preauthorization status, claims status, with ease of uploading documents or fetching claim related documents. They have access to all the transaction details of the patient kept available. The portal has a digital form, reducing the overall turnaround time and manpower involvement.

Customized services

Bajaj Allianz provides value added features to its customers to facilitate faster claim intimation and processing, such as auto SMS, email alerts, pull SMS facility and online web portals. These initiatives enable the company to deliver best in class service. Bajaj Allianz has a strong network of empanelled Hospitals, who provide cashless at special discounted rates. Discounts range anywhere from 8-11% this discounts saves the sum insured of the client.

Mechanism for customer feedback

Bajaj Allianz constantly works towards enhancing customer experience. Fifteen days after the claim is approved, the Health team sends a feedback form to its customers, to seek their opinion on the services provided by the Company and the empanelled Hospital. With the help of this feedback, the Company is able to gauge the satisfaction level of the customer, and makes improvements wherever required. This mechanism has helped the Company to provide best in class services to its customers, at the time of a claim.

Value added services beyond insurance for customers

The Company follows a holistic approach towards managing claims, by way of empathy, judgment, and a preferred provider network concept. Apart from cashless claim facility available at the network hospitals, the Company also offers discounts on various OPD facilities, on holiday stays at network resorts, discounts on online food portals, travel related sites like Makemytrip, Yatra, etc., consumer durable products, orders from confectioners and florists for special occasions, to its policyholders.

The Health Insurance team at Bajaj Allianz ensures regular visits to the policyholders’ home, for medical check-ups and discounts at diagnostic centers. The team has also drastically increased the number of wellness programs that are being carried across India, covering a client base of approximately 30,000 in metros and semi-metros. One amongst these programs has been the health checkups for clients, at a discounted rate from various empanelled vendors.

Currently, the wellness activities being conducted include- extensive onsite health check-ups, specialized workshops for lifestyle management, stress management, yoga and meditation, dependency management, and offsite health check-ups consisting of comprehensive packages at reasonable pricing, for all customers of the company.

The various wellness initiatives and value added services being offered by Bajaj Allianz, has acted as a building block in strengthening relationship with its customers beyond Insurance. These innovations have also helped the company to achieve a milestone claim settlement ratio of 93.8 percent in FY 13-14.

Cashless Claims:

1. The insured intimates network hospital about the claim. On intimation, the hospital sends an authorization request to the insurer, seeking verification regarding the policy benefits.
2. If the documents are approved by the insurer, the patient is admitted for cashless treatment; else, the patient pays for his treatment and then gets the expenses reimbursed from his insurer.
3. For a cashless health insurance claim on cashless basis, the treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing the policy of the insured.
4. The insured must seek authorization for availing the treatment on a cashless basis, as per procedures laid down and in the prescribed claim form.

Reimbursement Claims:

1. For a reimbursement claim, when a claim arises, the claimant must inform the insurance company as per said procedures.
2. After hospitalization, the insured must obtain and keep ready all documents related to the hospitalization such as claim form, discharge summary, prescriptions and bills, to be submitted at the time reimbursement.

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