Bajaj Health Insurance Claim Process

The claim is a formal request made by the policyholder to the insurance provider to seek compensation for the medical expenses incurred due to treatment. In the constantly evolving world of insurance, filling claims accurately is the key to maintaining financial stability. Bajaj General has designed a simple process to do so, so that, you can easily submit your claims in a matter of few steps.

Bajaj General stands at the forefront of providing comprehensive and affordable healthcare. The company has a Claim Settlement Ratio of 93.54%, which translates to the readiness of the company to settle the claims.

Types of Claims Offered by Bajaj General

The claim process can be submitted in two ways, based on the payment we make in the hospital following the treatment. The two types are 

• Cashless Claims: In cashless claims, the policyholder receives the treatment and does not pay upfront for the covered expenses. The insurance provider directly settles the medical bills with the hospital.
• Reimbursement Claims: Reimbursement claims give policyholders the flexibility of getting treated at any of the healthcare facilities and later getting the medical costs reimbursed from the insurance provider.

How To Claim Bajaj General Health Insurance?: Cashless Claims

In the case of cashless claims, the policyholder must initiate the claim by informing the company about the claim. It can be done by either  TPA (Third Party Administrator) or by directly contacting Bajaj General Health Administration Team- (HAT). TPA acts as a mediator between the policyholder and the company. TPA will verify the policy coverage and help to facilitate the pre-authorization of the cashless treatment.

Here are a few actions to raise a cashless claim:

• Step 1: Inform the Company and Contact the TPA

  Upon admission to a network hospital, inform the company about the claim. Contact the TPA for claim intimation, you can show your ’Health Insurance Card’ to the TPA for policy details. You can find the list of Bajaj General TPA, on the official website of the company.

• Step 2: Document Submission

  The TPA will coordinate with the hospital and collect all the documents along with the duly filled pre-authorization form. Then the TPA desk of the hospital contacts BAGIC (Bajaj General General Insurance Company Limited) and submits all details and the form to the company.

• Step 3: Verification Process

  BAGIC team will verify all the details about the claim and notify the policyholder after verification, whether the claim is accepted or rejected. Bajaj General Health Insurance Company asserts that it only takes 60 minutes for the verification.

  More Details Asked By The Company

  Sometimes the company asks for more details. Here are the steps taken by the healthcare provider:

  • The company will send a letter of query to the hospital asking for more documents or details.
  • Once the company receives all the additional documents they will send the authorization letter within 7 days.
  • After receiving the authorization letter the, network hospital will notify the patient.

• Step 4: Settlement

  Finally, after completing all the treatment procedures the bill will be settled with the hospital.

How To Claim Bajaj General Health Insurance?: Reimbursement Claims

The reimbursement process gives the liberty to the policyholder, to choose the hospital of his choice. Let us go through the procedure:

• Step 1:

  After completing treatment procedures and paying the bill at the hospital, collect all documents from the hospital.

• Step 2:

  Submit documents along with the duly filled claim form to BAGIC-HAT. (Bajaj General Insurance Company - Health Administration Team)

  More Details Asked By The Company

  • Advance Notice: If any documents or details are missing, Bajaj Health Insurance Company will send advance notice and give time to the policyholder to send the details.
  • Document Submission: After receiving the required documents and clarification on additional detail the company will start the claim processing.
• Step 3:

  The company will settle the compensation amount with ECS within 10 days and will notify the customer about the same.

  Note:

  • If in case, the company doesn’t receive the pending document, they will send 3 reminders within 10 days apart from the initial notice.
  • If the policyholder is unable to provide the missing document within 30 days, from the initial notice, the claim will be considered closed. The company will notify the policyholder of the closure.

Documents Required For Filing a Bajaj Health Insurance Claim

Here is the list of documents required to file a claim:

• Original discharge summary documents
• Original hospital bill with cost break-up
• Original paid receipt
• All lab and test reports
• Copy of invoice/stickers/barcode in case of implants
• The first consultation letter from the doctor
• KYC Form
• Filled and signed NEFT form by the policyholder

Conclusion

Bajaj General is committed to providing accessible and reliable healthcare solutions. Designing a comprehensive plan is not enough, settlement of the claim is also crucial as it is the ultimate goal of the lifecycle of a policy.

An insurance company is regarded as a trustworthy partner when it provides good healthcare plans along with a robust claim process. Bajaj Health Insurance is one of them as the company has an efficient mechanism to settle the claim. Backed by technology and trained staff, their claim settlement process is fast and seamless.