Bajaj Allianz Health Insurance Claim Settlement

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When buying a health insurance plan for yourself, it is better to know and understand the insurance claim procedure in detail as it is a vital aspect of the policy. Individuals opting for the Bajaj Allianz health insurance plan can utilise its simple, quick and hassle-free claim process. A high Bajaj Allianz health insurance claim settlement ratio party speaks volumes of the company’s efficiency in settling claims of the insured. Besides, Bajaj Allianz provides all the associated details required to go through the procedure without any issues. Similar to its competitors, you will get two types of insurance claims under the Bajaj Allianz health insurance plan. This means you can make a claim through either a cashless or reimbursement method.

Bajaj Allianz Cashless  Health Insurance Claim Settlement

Bajaj Allianz provides a highly secure and accessible cashless treatment to its policyholders at its various network hospitals, which count more than 8000 institutions across the country. This means access to top-quality medical and health care services and professionals. The key point to remember is that this cashless treatment procedure of insurance claim is only available to you if you visit a network hospital of the company. You can get admitted to such an affiliated institution and receive the necessary medical care without needing to pay the treatment cost from your own pocket, as the Bajaj Allianz health insurance is liable to cover such costs as per the coverage policy.  A lofty Bajaj Allianz health claim ratio further makes for a pleasant customer experience. 

Guide to the Cashless Claim Treatment

Policyholders can be admitted to any of the partnered hospitals under the policy and receive medical treatment without paying for it on their own. More details about the cashless claim are mentioned in the section down below.

This is how you can submit a cashless Bajaj Allianz health insurance claim settlement:

The first point to mention here is that there are two types of cashless claims that you can make under the Bajaj Allianz health insurance policy. The two options are a planned cashless settlement procedure and an emergency cashless settlement procedure.

Planned Cashless Bajaj Allianz Health Insurance Claim Settlement Process

If you are planning to visit the hospital for treatment in the near future as a part of planned hospitalisation, you can avail of the cashless claim procedure to get treatment. You are required to contact that hospital in advance, along with the required documents for the claim procedure. Then, you will need to fill out a pre-authorization form at the select partnered hospital, which will forward this form to your health insurance plan provider. The insurer will then check and verify all the details and provide consent for the cashless treatment.

Emergency Cashless Bajaj Allianz Health Insurance Claim Settlement Process

In case of a medical crisis like an accident or a critical health failure, there is no time to inform the insurer or the network hospital in advance to avail of the cashless treatment procedure. However, the policyholder can still utilise the cashless treatment through a simple procedure. All they need to do is visit a network hospital, use the provided health card by the insurer and submit it alongside the pre-authorization letter. Once the approval for treatment comes through, the policyholder can claim the cashless benefits.

The Cashless Claim Procedure After Admission

  1. At the network hospital, the TPA will send your pre-authorization application form and other related documents to the insurance company.
  2. Once the initial permission comes through after evaluating your claim, the hospital treatment procedure will commence.
  3. All the essential documents are required to be provided to the hospital TPA for review and verification, and it can then request the insurer to extend the allowable cashless treatment amount for the patient at the facility.
  4. The hospital TPA will send you the final invoice at the time of discharge at the hospital, alongside the release statement.
  5. A conclusive review of the claim submission provided by the policyholder is done, and the TPA or the insurance company then releases a final grant for the total charged amount.
  6. After the final clearance is made, certain non-included hospital expenditures under the health insurance plan will be charged directly to the policyholder by the hospital.

List of Documents Required for Bajaj Allianz Health Cashless Claim

These are some important documents required for a Bajaj Allianz health cashless claim procedure: 

  1. Doctor’s prescription for hospitalisation needs.
  2. The health card given by the insurer.
  3. Proof of age, identity and address.
  4. Reports and test details that have been made before hospitalisation.

When using the cashless claim facility, the partnered hospital will take care of the remaining documents on your behalf.

How to Check Bajaj Allianz Health Insurance Policy Claim Status?

The Bajaj Allianz health insurance claim ratio is excellent, and if you want to check more related details on your policy claim status,  you can do so by following the few simple steps mentioned below:

The Online Process for Bajaj Allianz Health Insurance Claim Settlement

  1. Go on to the official Bajaj Allianz health insurance website and select the ‘claim’ option.
  2. Then click on the ‘health insurance claim’ section from the dropdown menu.
  3. After that, click on ‘check claim status’ and mention the claim number to track the claim progress.
  4. Click on the ‘proceed’ button next, and the status of the Bajaj Allianz health insurance claim settlement will be displayed.

You can also check out the official website of the company to get details about the Bajaj Allianz health insurance claim ratio.

The Offline Process for Bajaj Allianz Health Insurance Claim Settlement

You can also check the progress status of your Bajaj Allianz health insurance claim settlement by dialling the company’s toll-free number, 1800-209-5858, or visit a company branch  near you. The online method is more convenient out of the two as it allows you to get real-time status details with a few clicks, terminating the cost of time and effort.

Bajaj Allianz Health Insurance Claim Settlement (Reimbursement Process)

If you are not opting for the cashless treatment option, you can always benefit from a reimbursement claim offered under the Bajaj Allianz health insurance plan. With a reimbursement claim, you will have to pay for the treatment cost on your own and then provide the hospitalisation cost, medical bills and other required documents to file the reimbursement claim. The insurance company will verify and review the claim request and the associated bills. Once they are approved, the company will transfer the money to your registered bank account.

This is a rather nice alternative for insurance claims in case you had to undergo emergency treatment from a non-network hospital due to the unavailability of a partnered one near your location. 

Here is how to submit a claim for reimbursement:

  1. Pay for the hospitalisation and medical bills upfront and then intimate a claim
  2. The reimbursement claim is required to be filed with the insurance company within 30 days of the hospital release of the patient.
  3. Collect all the pre and post-hospitalisation reports and bills alongside the hospital stamp and mention of admission date, patient name and doctor’s prescriptions.
  4. These documents are then required to be sent to the insurance company along with the duly filled claim form and the hospital release form.
  5. Once all the documents are received by the insurance company, it can take up to 21 days to review and process them, and the reimbursement amount will then be transferred to the registered bank account once the claim is approved.

List of Documents Required for Bajaj Allianz Health Reimbursement Claim

The essential information required for filing a reimbursement claim with Bajaj Allianz is mentioned below;

  1. The patient’s name.
  2. Policy number.
  3. The insured individual’s identity proof.
  4. Injury or illness type details.
  5. Name and location of the hospital.
  6. Name of the attending physician.
  7. Date of admission.
  8. Additional necessary information.

These are the documents you need to submit to Bajaj Allianz for claim settlement:

  1. Claim form of the insurance company, properly signed and filled.
  2. Hospital discharge card.
  3. All the hospital bills, duly signed and stamped by authorities.
  4. The doctor’s written consultation with receipts.
  5. X-ray reports, blood tests, urine tests and other test results.
  6. Medicine bills.
  7. Any additionally required documents related to treatment.

These are some crucial documents and paperwork that you will need to provide to the insurance company when filing a reimbursement claim.

Bajaj Allianz Health Insurance Incurred Claim Ratio (ICR)

The premium collected from the health insurance policies is how the insurance-providing company makes money. In health insurance, the incurred claim ratio or the ICR, is the ratio of the total value of settled claims to the total value of collected premium by the insurance company within a given period. The remaining amount after the claim payments are made for that particular period stays as the company’s collected revenue. According to the official IRDAI report, the ICR value of Bajaj Allianz health insurance was 77.31% for the fiscal year 2020-21.

Bajaj Allianz Health Insurance Claim Settlement Ratio (CSR)

On the other hand, the claim settlement ratio or CSR is the ratio of the total number of settled claims against the total number of received claims by the insurance company in a fixed period. As the CSR data is not required to be disclosed to the IRDAI, the exact value of the Bajaj Allianz health claim settlement ratio is unknown. However, the claim settlement ratio of Bajaj Allianz health insurance is known to be on the higher side of the spectrum, with 98.61% of claims being settled within a 3-month period and 0.97% of claims being settled within 3-6 months period in 2019-20.

Bajaj Allianz Health Insurance Claim Settlement FAQs

  • 1. Can I get a cashless claim if I receive treatment from a non-network hospital?

    No, if you get medical treatment from a non-network hospital using Bajaj Allianz health insurance, you are only eligible for a reimbursement claim. But there’s nothing to worry about as the Bajaj Allianz health insurance settlement ratio is great.

  • 2. What does ICR stand for in health insurance?

    ICR in health insurance stands for the incurred claim ratio, which is the ratio of the total value of claims that have been settled to the total value of premium amounts collected by the insurance provider. The same goes for a higher value of Bajaj Allianz health insurance claim settlement ratio.

  • 3. Where can I check the Bajaj Allianz health insurance claim status online?

    You can visit the official website of Bajaj Allianz and follow the steps below to check your claim status online:

    • Go to the ‘claim’ section and select health insurance.
    • Then select ‘check claim status’ and enter the claim number in the box.
    • Then press ‘proceed’ to get the status of your registered claim online.
  • 4. Where can I get an online claim form for the group personal accident policy?

    You can get your GPA claim form online through the Bajaj Allianz health insurance website.

  • 5. Will my Bajaj Allianz reimbursement claim be rejected if I fail to submit it within the stipulated time?

    If you fail to submit the reimbursement claim form and related paperwork on time, the insurer can reject your application. You will need to contact the insurance provider to justify the delay when submitting the claim for approval after the marked period.

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