M-Care Health Insurance Policy

Cashless Claim Procedure

Filing claims on your M-Care plan is easy and effortless. After all, setting new benchmarks in terms of turnaround time has been a key part of our commitment to you!

Claims can be made either via the cashless or reimbursement mode. Here is how it works

Firstly, cashless claim settlement is only available at network hospitals subject to the terms and conditions of your M-Care policy such as cashless authorisation and Limit of Benefits.

OK! Let’s walk you through the process for filing a cashless claim. You need to:

• Ask for a pre-authorisation form by calling us before you go in for treatment/consultation at one of our Network Hospitals.
• Let us know within 24 hours if you had to be hospitalized following an emergency.
• We’ll get back to you within 2 hours of getting a duly filled and signed form from you. Based on the outcome- approval, decline or request for more information- we quickly help you get the ball rolling on getting the best possible treatment or seeking other alternatives.
• We’ll settle the claim directly with the network hospital against the original bills and evidence of treatment. Please note that coverage is subject to the policy terms and conditions such as Limitation of Benefits, even if pre-authorisation is obtained.. These terms and conditions are subject to review and may change at the discretion of the company.
• Note that any difference between the benefit payable and the final hospital bill will be directly paid to you. In case the bill amount is higher, you would need to pay the difference on your own.
• Produce the authorisation letter, ID card, M-Care policy document and any other information issued to you by Bajaj Allianz at the network hospital prior to admission.

Reimbursement Claim Process

You can opt for reimursement if:

• Pre-authorisation is denied by us
• You choose hospital which is not part of our network
•  You prefer to pay by cash

Here’s how our reimbursement claims process works:

• Let us know in writing within 48 hours of being diagnosed with any listed vector borne disease.
• Consult your doctor immediately and follow the prescribed treatment.
• If required, we may ask you to undergo tests with our empanelled doctors as many times as necessary. The costs, of course, will be borne by us.
• We need you to submit the following documents within 30 days of being diagnosed/discharged in relation to a vector borne disease.

Documents to be submitted for filing a claim:

i)                    Claim Form duly signed by the insured along with NEFT Form signed by the Claimant.

ii)                    Copy of Discharge Summary / Discharge Certificate

iii)                 Attested copies of Indoor case papers

iv)                 Copy of Final Hospital Bill

v)                  All required Investigation Reports

vi)                  Medical certification from specialist

vii)                In cases where a fraud is suspected, we may call for any additional document(s) in addition to the documents listed above

viii)              Aaadhar card & PAN card Copies is as per the IRDAI guidelines read with.