Health Insurance Claim Process

One Liner: The good things in life can last forever

In our endeavour to provide you the best coverage along with a host of other value added services, our online General Insurance claims system has been designed keeping your ease in mind. With a convenient claim process for your health insurance policy, you can now register your claim, upload the necessary documents and know the status instantly.

Register your Health Insurance Claim

The health insurance claim process with Bajaj Allianz General Insurance Company is structured for your convenience. If your doctor advises treatment or hospitalization, your first step is to intimate the claim with Bajaj Allianz General Insurance Company . For a cashless claim, insured must intimate within 48 hrs prior to planned admission and within 24 hrs in case of emergency admission visit any network hospital where the hospital’s Third Party Administrator (TPA) will connect with Bajaj Allianz General Insurance Company’s Health Administration Team (HAT) for pre-authorization. Upon approval, Bajaj Allianz General Insurance Company directly settles your medical expenses with the hospital. If you prefer a reimbursement claim, choose any hospital, cover the initial expenses, and later submit the original documents to Bajaj Allianz General Insurance Company, which will process your claim efficiently. Also we are providing cashless for all in all panelled and non panelled hospitals .

Medical Insurance Claim Process

1. Your doctor advises treatment or hospitalization
2. Intimate the claim on your health insurance
3. Visit Network hospital (For cashless claim) or Visit a hospital of your choice and pay accordingly (For reimbursement claim)
4. TPA desk of network hospital contacts BAGIC for cashless treatment (For cashless claim) or Submit original hospitalization related documents to BAGIC -HAT upon discharge (For reimbursement claim)
5. TPAs with us

List of TPAs associated with us

- Medi Assist Insurance TPA Pvt Ltd

- Family Health Plan Insurance TPA Pvt Ltd.(FHPL)

- Paramount Healthcare Services Pvt Ltd.

- Good Health Insurance TPA Pvt Ltd.(GHPL)

- Vidal Health Insurance TPA Pvt Ltd.

- MDIndia Insurance TPA Pvt Ltd.

- Health India Insurance TPA Pvt Ltd.

- Volo Health Insurance TPA Private Limited.

- In-house public disclosures

Life is an unpredictable roller-coaster ride. But amidst all the volatility, you can bank on us for being there by your side, all the time.

Should you want to file your health insurance claim online, click here. Conversely, you can also reach out to us at our Toll Free Number at 1800-209-5858 and we will be glad to help you out.

For Cashless Health Insurance Claim

While we drink to your good health, in case of any untoward incident

- Approach any of the Bajaj Allianz Network Hospitals for complete cashless facility

- The hospital will verify your details and send the duly filled pre-authorization form to Bajaj Allianz – Health Administration Team (HAT)

- We will duly verify the details of the pre-authorization request with the policy benefits and intimate our decision to the healthcare provider within 1 working day

Yay! Your cashless claim is approved

- We send the First response to your healthcare provider Within 60 mins

- Your treatment costs at our network hospital will be settled by us and you don’t have to worry about the medical bills

It seems we have a query

- We will send a letter of query to the healthcare provider, asking for further relevant information that will allow us to initiate the Health Insurance claims processes faster

- Once we receive the additional information, we will send the authorization letter to your healthcare provider within 7 working days

- Our network hospital will treat you and you won’t have to worry about the medical bills

We’re sorry, your claim is denied

- We will send the letter of denial to the healthcare provider

- The provider will carry out the treatment, as fully payable

- However, you can certainly file a claim for reimbursement at a later date

For Health Insurance Reimbursement Claim

While we drink to your good health, in case of any untoward incident

- Collect all hospitalization related documents and submit them, in original, to BAGIC HAT

- We will carry out a customary verification of the required documents

Oh, we need some more information

- We will send you a prior intimation of such deficiency so that you have sufficient time to provide further information

- Upon receiving the requisite documents and some more enquiry, you can bank on us to initiate the insurance claims settlement process and release the payment via ECS within 10 working days (may be subject to terms and conditions)

- In case you still fail to provide us with the pending paperwork, we will send you three reminders, each 10 days apart, from the date of intimation

- However, please note that we will be forced to close the claim and send you a letter stating the same if you fail to come up with the pending documents beyond 3 reminders (30 days) from the date of intimation

Yay! Your claim is approved

We initiate a customary verification of the authenticity of the documents and if found permissible within the policy’s purview, we will release the payment via ECS within 7 working days.

However, if your General Insurance claim doesn’t fall within the policy’s purview, we will have to deny the claim and send you a letter stating the same.

Hospitalization Claim Checklist

- Hospitalization Claim form duly filled and signed by the insured

- Original Discharge summary document

- Original hospital bill with detailed cost break-up

- Original paid receipts

- All Lab and test reports

- Copy of Invoice/Stickers/barcode in case of implants

- First consultation letter from doctor

- KYC form

- Completely filled and signed NEFT form by Policy Holder/proposer

Hospitalization Death Claim

- Claim form duly filled and signed by the insured

- Original Death summary document

- Original hospital bill with detailed cost break-up

- Original paid receipts

- All Lab and test reports

- Copy of Invoice/Stickers/barcode in case of implants

- First consultation letter from doctor

- Legal heir certificate containing affidavit and indemnity bond

- Completely filled and signed NEFT form by Policy Holder/proposer.

Personal Accident Claims

- Claim form duly filled and signed by the insured / Claimant.

- Beneficiary Name against the Policy and NEFT Details of Insured / Nominee.

- Completely filled NEFT details stating Branch, Branch IFSC Code, Account type, Complete Account Number duly signed by Nominee / Claimant with original pre printed cancel cheque if pre-printed cheque is not available Kindly provide 1st Page of Bank Pass Book/ Bank statement Attested by the Bank which clearly indicates Beneficiary Name & Complete Account no as well IFSC code.(All Fields in the form are mandatory to process).

- Aadhar Card & Pancard details of Nominee / Claimant/ Insured.

- We will require Salary Slip/ ITR at the time of issuance of the policy for Salary Commensuration.

Accidental Hospitalization

- Original Discharge Summary.

- All the previous Consultation Papers.

- Investigation Reports supporting the diagnosis.

- Operation Theatre Notes.

- Original Final Bill with detailed bill break up and Paid Receipts.

- Original Pharmacy and Investigation Bills.

Death

- Attested copy of Death certificate.

- Attested copy of FIR / Panchanama / Inquest.

- Attested copy of Post Mortem Report.

- Attested copy of Viscera /Chemical analysis Report if any.

- Hospitalization documents, if any.

- In case of Death if Nominee is not defined on the policy copy then we will require the below documents.

- Legal heir certificate containing affidavit and indemnity bond on 200 INR (As per attached format).The same should be duly signed by all legal heirs, notarized.

- If the Nominee is minor then we will require a Decree Certificate from the Court stating the guardian of the insured..

Permanent Partial Disability and Permanent Total Disability

- Duly filled Medical Certificate attached in the Personal Accident Claim Form.

- X-ray films /Investigation reports supporting the diagnosis.

- Permanent Total Disability and Permanent Partial Disability Certificate from the Government authority certifying the disability of the insured.

- Photograph of the patient before and after the accident to support the disability.

Temporary Total Disability / Loss of Income

- Duly filled Medical Certificate attached in the Group Personal Accident Claim Form

- Leave certificate from employer stating the exact leave period, duly signed and sealed by the employer.

- All the consultation papers with details of treatment during TTD period.

- Final medical fitness certificate from the treating doctor stating the type of disability, disability period and declaration that the patient is fit to resume his duty on a given date.

- X-ray films /Investigation reports supporting the diagnosis.

Children Education Bonus

- In Case of Death and PTD, kindly provide bonafide certificate from the school authorities stating that child of the insured is studying over there. (Mentioning - Name, S/D/o, Date of Birth and Class) School Identity Card.

- Burial Expenses & Transportation Expenses

- Original Paid Receipts

Hospital Cash Expenses

- Copy of Final Bill and Discharge Summary.

- Investigation reports toward diagnosis.

Health Insurance TPA Claim Status

Bajaj Allianz General Insurance Company partners with multiple health insurance TPAs of India, including Medi Assist, FHPL, GHPL, and MDIndia, to offer seamless claim support. To check your health insurance TPA of India claim status, you can contact the TPA directly or use Bajaj Allianz General Insurance Company’s online claim tracking services. After submitting the necessary documents, Bajaj Allianz General Insurance Company keeps you informed with timely updates on your medical insurance claim process. For cashless claims, the hospital liaises with Bajaj Allianz General Insurance Company to manage approvals and provide status updates, while for reimbursements, you’ll receive updates on any additional information required. Bajaj Allianz General Insurance Company strives to release reimbursement payments within 10 working days after all documents are received, ensuring a smooth experience during challenging times.