Comprehensive Health Insurance: Health Care Supreme

Claim by Direct Click (CDC)

Bajaj Allianz General Insurance has introduced an app-based claim submission process known as Health Claim by Direct Click.

This facility allows you to register and submit claim documents through the app itself for claims up to Rs 20,000.

What you need to do:

• Register your policy and card number in the Insurance Wallet App.
• Register your policy and health card number in the app.
• Register the claim.
• Fill the claim form and arrange hospital-related documents.
• Upload the documents using the app menu.
• Submit the claims for further processing.
• Get confirmation within a few hours.

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 is liable to change without notice. You must check the hospital list before getting admitted. The updated list is available on our website and 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 mentioned below:

• Get the pre-authorisation 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-authorisation request form & decide on cashless availability, as per the policy guidelines.
• Authorisation letter (AL)/denial letter/additional requirement letter is issued within 3 hrs 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.

Important points to note

• In case of planned hospitalisation, 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.
• 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-authorisation 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 hospitalisation.

Reimbursement of pre/post hospitalisation 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.

Reimbursement claim process

• Inform the Bajaj Allianz General Insurance HAT about the hospitalisation. To register your claim online click here To register your claim offline, please call us on our toll-free number: 1800-209-5858.
• After discharge, you must submit the following documents to HAT within 30 days: Duly filled and signed claim form with mobile number and email ID. Original hospital bill and payment receipt. Investigation report Discharge card Prescriptions Bills of medicines and surgical items Details of pre-hospitalization expenses (if any) In-patient papers, if required.
• All documents to be sent to HAT for further processing and based on the assessment, the final settlement will be done within 10 working days.
• Post hospitalisation claim documents must be sent within 90 days from the date of discharge.

Documents required for reimbursement claim

• Original pre-numbered hospital payment receipt duly sealed and signed.
• Original prescriptions and pharmacy bills.
• Original consultation papers (if any).
• Original investigation and diagnostic reports along with original bills and payment receipt for the investigation done within and outside the hospital.
• If you availed a cashless claim but did not utilise it, a letter from the hospital stating the same.
• A letter from the treating doctor mentioning incident details (in case of an accident).
• Hospital registration certificate and hospital infrastructure on the letterhead.
• A cancelled cheque bearing your name and the bank’s IFSC code.
• Indoor case paper copy attested from the hospital from the date of admission to the date of discharge with detailed medical history and doctor’s notes with temperature, pulse and respiration charts.
• X-ray (in case of a fracture).
• Obstetric history from the treating doctor (in maternity cases).
• FIR copy (in case of an accident).
• Additional requirements for some special cases: In case of a cataract operation, lens sticker with a bill copy. In case of a surgery, implant sticker with a bill copy. In case of a heart-related treatment, stent sticker with a bill copy.

Documents to be submitted:

Critical illness claim:

• A duly completed claim form signed by the insured.
• A copy of discharge summary/discharge certificate.
• A copy of the final hospital bill.
• A copy of the policy documents.
• First consultation letter for illness.
• Medical certificate for the duration of illness (if required).
• All required investigation reports as per the illness (if required).
• Letter from the employer clarifying the type of work.
• A copy of your Aadhaar card, or any other government photo ID and PAN Card. This is not mandatory if your ID card is linked with the policy while issuance or in a previous claim.

Death claim:

• Duly completed claim form signed by the claimant.
• Attested copy of the death certificate.
• Attested copy of the post-mortem report, if conducted.
• Attested copy of the viscera/chemical analysis report (if viscera is preserved).
• Diatoms report from a forensic lab in case of death on account of drowning (if sample is preserved).
• Attested copy of the statement of witness (if any).
• Burial certificate (wherever applicable).
• Legal heir certificate containing affidavit and indemnity bond both duly signed by all legal heirs and notarised is mandatory to process the claim.
• Insured’s/claimant’s photo-identity proof.
• Insured’s/claimant’s address proof.
• Other documents as may be required by Bajaj Allianz General Insurance to process the claim.
• A copy of your Aadhaar card, or any other government photo ID and PAN Card. This is not mandatory if your ID card is linked with the policy while issuance or in a previous claim.

PTD, PPD and TTD claim:

• Duly completed claim form signed by the claimant.
• Attested copy of FIR/Panchanama/Inquest Panchanama.
• A copy of Medico Legal Certificate.
• A copy of discharge summary towards hospitalisation immediately after the injury.
• X-ray films/investigation reports supporting the diagnosis.
• Disability certificate from a government authority certifying insured’s disability.
• Other documents as may be required by Bajaj Allianz General Insurance to process the claim.
• Leave certificate from the employer.
• A copy of your Aadhaar card, or any other government photo ID and PAN Card. This is not mandatory if your ID card is linked with the policy while issuance or in a previous claim.

All original documents need to be submitted to the following address:

Health Administration Team

Bajaj Allianz House, Airport Road, Yerawada, Pune-411006

Mention your Policy Number, Health Card Number and Mobile Number clearly on the face of the envelope.

Note: Keep a photocopy of the documents and courier reference number for your records.