Frequently Asked Questions on Extra Care – III

Here is the final part of the Frequently Asked Questions on Extra Care Policy.

1.     What is the minimum period of hospitalization required to be eligible for Claim Reimbursement? The minimum period of hospitalization required is 24 hours. 2.     In case of a claim for renal failure there would be multiple hospitalizations for renal dialysis. Please confirm how would the deductible be calculated for such claims? Is the deductible applied afresh for each claim of dialysis? As per the definition of “deductible amount”, if the first hospitalization claim is paid under Extra Care policy and further claims are made within 45 days after the discharge, then they would be considered under the same claim. The deductible would not be applied afresh for the recurrent claims for the same illness if they are within 45 days of discharge from hospital. 3.     If a person has a Mediclaim policy of sum insured of Rs. 5 lacs, and he opts for an Extra Care policy of a sum insured of Rs. 10 lacs, with Rs. 3 lacs deductible. He is hospitalized for cardiac illness and the claim amount is Rs 5 lacs. He has claimed Rs 3 lacs from his Mediclaim policy. Please confirm if the remaining claim amount of Rs 2 lacs is paid under Extra Care? The remaining claim amount would be paid on rateable proportion between both the policies. In this case, the remaining claim amount of Rs 2 lacs would be distributed in rateable proportion, Rs 66,666/ would be paid from the Mediclaim policy and Rs 1,33,334/- would be paid from the Extra Care policy. 4.     If a person has taken a plan of Rs. 10,00,000/3,00,000 and he lodges a claim of Rs. 13,00,000/- then how much claim he will get? The SI for this proposal will be Rs.10 lacs. 5.     Where can I get the claim form? Insurance claim form can be obtained from the local office or can be downloaded from our website 6.     I have lost my membership card, what do I do? If you lose your membership card, please call our Toll Free No. 1800-22-5858 and report the loss immediately. A duplicate card will be issued to you within 7 days of reporting the loss. Extra changes will be applicable to issue a duplicate card. The information given above is indicative in nature. Please refer the policy wordings and brochure for details. 7.     Who do I contact in case of a claim? You may kindly call our 24 hrs Call Centre number on 1800-22-5858 or 020-30305858. Our executives would cater to your needs. 8.     What do terms Cashless Facility and Claim Reimbursement mean? Cashless Facility The cashless health insurance can be availed in case of admission in network hospitals. If the policy holder presents the heath card or cashless card at the network hospital, the hospital authorities contact us and provide the details of the hospitalization. If the illness is covered as per the policy terms and conditions, authorization letter is issued to the hospital. The hospital sends all the bills and documents to us for settlement. The insured has to pay the non-admissible expenses to the hospital. Claim-Reimbursement If the admission is in non-network hospital, you need to settle the hospital bills and submit the hospitalization documents along with the claim form for reimbursement of hospitalization expenses. 9.     How do I avail the cashless facility? -  For cashless hospitalization, present the health card at the network hospital and the hospital will contact our cashless department with all the details. -  As per the policy terms and conditions, the admissibility is decided and the authorization letter or denial letter is sent to the hospital -  In case of denial, the client can submit the claim documents for reimbursement -  The claim under cashless and reimbursement would be admissible in excess of the deductible limit, subject to terms, conditions, exclusions and definitions as per the policy wordings 10. What are the documents to be submitted in case of reimbursement? We would require the following documents for easy processing of your claim:

• A photocopy of your present policy document with Bajaj Allianz
• First prescription from the doctor
• The claim form duly signed by the claimant or family member.
• The hospital discharge card
• All the bills and money receipts of hospitalization expenses, diagnostics, medicines etc.
• All original laboratory and diagnostic test report.

Only the original documents need to be enclosed, duplicates or photocopies are not allowed. If part of the claim is settled by any other insurance company, attested Xerox copies should also be attached. Also, the letter from that company mentioning the amount paid / deducted should be attached. 11. Pre and Post Hospital Expenses: For Pre and Post Hospitalization expenses, please provide the following documents:

• Medicines: Please provide the doctor’s prescription advising medicines and the relevant chemist bill.
• Doctor’s Consultation Charges: Please provide the doctor’s prescription and the doctor’s bill and receipt.
• Diagnostic Tests: Please provide the doctor’s prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre. Once you have collected all the above documents, please send them to the following address.

The Claims Manager, Health Administration Team Bajaj Allianz General Insurance Company Ltd. Bajaj Finserv, 2nd floor, Survey # 208/1-B, Behind Weikfield IT-Park Viman Nagar, Pune – 411 014 Tel: (020)-30459200 View our entire range of health insurance plans.