Health Insurance: Tax Gain Plan

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 a dynamic list and is liable to change without notice. You must check the hospital list before getting admitted to the hospital. 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, the process can be summarised as follows:

• Get the pre authorisation request form filled and signed by the treating doctor/hospital and signed by you, at the hospital’s insurance desk.
• The network hospital will fax the request to the Health Administration Team (HAT).
• HAT doctors will examine the pre authorisation request form and 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 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 along with the duty signed claim form.

Reimbursement claim process

• Inform the BAGIC HAT team about the hospitalization.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 department (IPD) papers, if required.
• All documents to be sent to the 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 IFSC code and name of the insured.
• Indoor case paper copy attested from the hospital from date of admission to date of discharge with detailed medical history and doctor’s notes with TPR (temperature, pulse and respiration) charts.
• X-ray films (in case of a fracture).
• Obstetric history from treating doctor (in maternity cases).
• FIR copy (in accident case).
• A requirement 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 for outpatient treatment claims

• The treating doctor’s consultation prescription with diagnosis, receipts and bills.
• Prescriptions for all medicines purchased along with original bills/receipts.
• The treating doctor’s referral for diagnostic tests conducted.
• Diagnostic test reports, bills and receipts.

All original claim 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.