Cashless treatment is only available at a Network Hospital. In order to avail of cashless treatment, the following procedure must be followed by you:
Reimbursement Claim Procedure:
- Prior to taking treatment and/or incurring Medical Expenses at a Network Hospital, you must call Bajaj Allianz and request pre-authorization by way of the written form the company will provide.
- After considering your request and after obtaining any further information or documentation sought, the company may if satisfied send you or the Network Hospital, an authorization letter. The authorization letter, the ID card issued to you along with this Policy and any other information or documentation that the company has specified must be produced to the Network Hospital identified in the pre-authorization letter at the time of your admission to the same.
- If the procedure above is followed, you will not be required to directly pay for the Medical Expenses in the Network Hospital that the company is liable to indemnify and the original bills and evidence of treatment in respect of the same shall be left with the Network Hospital. Pre-authorization does not guarantee that all costs and expenses will be covered. The company reserves the right to review each claim for Medical Expenses and accordingly coverage will be determined according to the terms and conditions of the Policy. You shall, in any event, be required to settle all other expenses directly.
If any treatment, consultation or procedure for which a claim may be made is required in an emergency, then the company or the TPA must be informed within 7 days of the completion of such treatment, consultation or procedure.
You or someone claiming on your behalf must inform the company in writing immediately and in any event within 14 days of the aforesaid Illness or Bodily Injury.
- You must immediately consult a Doctor and follow the advice and treatment that he recommends.
- You must take reasonable steps or measure to minimize the quantum of any claim that may be made under this Policy.
- You must have yourself examined by the company’s medical advisors if asked for, and as often as considered to be necessary.
- You or someone claiming on Your behalf must promptly and in any event within 30 days of discharge from a Hospital give the documentation (written details of the quantum of any claim along with all original supporting documentation, including but not limited to first consultation letter, original vouchers, bills and receipts, birth/ death certificate (as applicable) and other information asked for to investigate the claim or the company’s obligation to make payment for it.
- In the event of the death of the insured person, someone claiming on his behalf must inform the company in writing immediately and send a copy of the post mortem report (if any) within 14 days.
Form mentioning the following mandatory details:
- 1. The illness / claim should be reported to BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD. with an immediate notice by telephone or in Writing (email / Letter)
- On receipt of claim intimation, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD will forward a claim form and check list for the documents to be submitted by the claimant.
- After receiving the claim form the claimant should submit the completed claim
- Insured details (Name / Address / Age / Sex / Contact No.)
- ID card number and the current policy number
- Hospitalization details (Date and time of admission and discharge).
- Details of the other mediclaim policies in force.
- Signature of the claimant.
- The other relevant documents to be submitted along with the claim form are as below:
- A photocopy of your previous policy details prior to taking your Health Guard policy from Bajaj Allianz (if applicable).
- A photocopy of your present policy document with Bajaj Allianz.
- First Prescription from the Doctor.
- The Claim Form duly signed by the claimant or family member.
- The Hospital Discharge Card
- f. The Hospital Bill giving detailed break up of all expense heads mentioned in the bill. E.g. if Rs.1000 has been charged towards medicines in the bill, the names of the medicines, the unit price and the quantity used should be mentioned. Similarly e.g. If Rs.2000/- has been charged towards Laboratory Investigations, then the names of the investigations, the number of times each investigation has been performed and the rate should be mentioned. In this way clear break ups have to be mentioned for OT Charges, Doctor’s Consultation and Visit Charges, OT Consumables, Transfusions, Room Rent, etc…
- The Money Receipt duly signed with a Revenue Stamp.
- All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG,MRI Scan, Haemogram etc…(Please note that it is not mandatory to enclose the films or plates, a printed report for each investigation is sufficient)
- If the medicines have been purchased in cash and if this has not been reflected in the hospital bill, a prescription from the doctor and the supporting medicine bill from the Chemist have to be enclosed.
- If the insured has paid in cash for Diagnostic or Radiology tests and it has not been reflected in the hospital bill, it is mandatory to enclose a prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic centre for the tests.
- In case of a Cataract Operation, Please enclose the IOL Sticker
PLEASE NOTE THAT ONLY ORIGINAL DOCUMENTS SHOULD BE ENCLOSED (EXCEPT FOR POLICY COPY), DUPLICATES OR PHOTOCOPIES WILL NOT BE ENTERTAINED
Pre & Post Hospital Expenses:
Medicines: Mandatory to provide doctor’s prescription advising medicines and the relevant chemist bill.
Doctor’s Consultation Charges: Mandatory to provide the Doctor’s prescription and the doctor’s bill.
Diagnostic Tests: Mandatory to provide the Doctor’s prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre.
The claims team would assess the claim for completeness of documentation and Admissibility. A written communication would be sent to the insured regarding requirement of documents if any or if the claim is deemed to be inadmissible as per Policy terms and conditions.
In case the claim is determined to be admissible a pay order and discharge voucher would be sent to the insured address as mentioned on the policy document.