Arogya Sanjeevani Health Insurance Policy

Cashless Claim Process (only applicable for treatment at a network hospital):

Cashless facility at network hospitals is available 24x7, throughout the year, without any interruption in service. The list of hospitals where cashless settlement can be availed is dynamic and liable to change without notice. You must check the hospital list before getting admitted. The updated list is available on our website and with our call center. Bajaj Allianz Health Card along with a government ID proof is mandatory at the time of availing cashless facility.

When you are opting for cashless claims, follow the steps given below:

• Get the pre-authorization request form filled and signed by the treating doctor/hospital and signed by member/patient, at the hospital’s insurance desk.
• Network hospital will fax the request to the Health Administration Team (HAT).
• HAT doctors will examine the pre-authorization request form & decide on cashless availability, as per the policy guidelines.
• Authorization letter (AL)/denial letter/additional requirement letter is issued within 3 hours depending on the plan and its benefits.
• At the time of discharge, the hospital will share the final bill and discharge details with HAT and based on their assessment, final settlement will be processed. Also, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses.

Important points to note

• In case of planned hospitalization, register/reserve your admission as per the network hospital’s procedure for admission in advance.
• Admission at network hospital is subject to availability of a bed.
• Cashless facility is always subject to your policy terms and conditions.
• The policy does not cover the following:
  • Telephone
  • Food and beverages for relatives
  • Toiletries

  The cost of the above services have to be borne by you and paid directly to the hospital before discharge.

• In-room rent nursing charges are included. However, if a higher cost room is used then the incremental charges will be borne by you.
• In case the treatment is not covered as per the policy terms and conditions, your claim, cashless or reimbursement, will be denied.
• In case of inadequate medical information, pre-authorization for cashless claim can be denied.
• The denial of cashless facility does not mean denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization.

Reimbursement of pre/post hospitalization expenses

Relevant medical expenses incurred before admission and after discharge from the hospital will be reimbursed as per the policy. Prescriptions and bills/receipts of such services should be submitted to Bajaj Allianz General Insurance along with the duly signed claim form.

Arogya Sanjeevani Policy Claim Process

Inform the Bajaj Allianz General Insurance HAT about the hospitalization.

Register your health insurance claim online.

To register your claim offline, please call us on our toll-free number: 1800-209-5858.

For reimbursement of claims the insured person may submit the necessary documents to the Health Administration Team (HAT) team within the prescribed time limit as specified below:

Documents required for reimbursement claim:

• Duly completed claim form
• Photo identity proof of the patient
• Medical practitioner’s prescription advising admission.
• Original bills with itemized break-up
• Payment receipts
• Discharge summary including complete medical history of the patient along with other details
• Investigation / Diagnostic test reports etc. supported by the prescription from attending medical practitioner
• OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases)
• Sticker/Invoice of the Implants, wherever applicable.
• MLR (Medico Legal Report) copy if carried out and FIR (First Information Report) if registered, wherever applicable.
• NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque
• KYC (identity proof with address) of the proposer, where claim liability is above Rs. 1 Lakh as per AML Guidelines.
• Legal heir/ succession certificate, wherever applicable
• Any other relevant document required by Company/ TPA for assessment of the claim

Complete set of claim documents needs to be forwarded to

Health Administration Team,
Bajaj Allianz General Insurance Co. Ltd.
2nd floor, Bajaj Finserv Building, Behind Weikfield IT Park, Off Nagar Road,Viman Nagar-Pune - 411 014.