Health insurance claims decoded
Aug 7, 2010

Your Detailed Guide to Health Insurance Claims

Health Insurance is an insurance product that covers your medical expenses in case you need to use health care services. Your medical costs can be covered either via cashless claims settlement or via reimbursement of the claim amount. You can avail the cashless health insurance claim settlement facility if you are admitted to a network hospital. If you are admitted to a non-network hospital, then you need to settle the hospital bills yourself and submit the hospitalization documents along with the claim form for the reimbursement of the hospitalization expenses. Documents Required: The documents required for quick and worry-free processing of your claim are listed 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 health insurance claim form duly signed by you or your family member.
  • The hospital discharge card.
  • The hospital bill giving detailed break up of all expense heads mentioned in the bill. For e.g., if INR 1,000 has been charged towards medicines in the bill, please ensure that the names of the medicines, the unit price and the quantity used are mentioned. Similarly, if INR 2,000 has been charged towards laboratory investigations, please ensure that the names of the investigations, the number of times each investigation has been performed and the rate is 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 and diagnostic test reports. For e.g., X-Ray, E.C.G, USG, MRI scan, haemogram etc. (Please note that you do not have to enclose the films or plates, a printed report for each investigation is sufficient.)
  • If you have purchased medicines in cash, and if this has not been reflected in the hospital bill, please enclose a prescription from the doctor and the supporting medicine bill from the chemist.
  • If you have paid cash for diagnostic or radiology tests and it has not been reflected in the hospital bill, please enclose the prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic center for the tests.
  • In case of a cataract operation, please enclose the IOL sticker.
For pre and post hospitalization expenses you would be required to submit the following documents:
  • Medicines: Please provide the doctor’s prescription advising medicines and the relevant chemist’s bills.
  • Doctor’s Consultation Charges: Please provide the doctor’s prescription and the doctor’s bill and receipt.
  • Diagnostic Tests: Please provide the doctor’s prescription advising tests, the actual test reports and the bill and receipt from the diagnostic center.
Important: Please ensure that you only submit the original documents. Duplicates or photocopies are usually not accepted by the insurance companies. Non-claimable Items in Hospital Bill: There are a few items in your hospital bill for which you might have to bear the expense on your own. These generally include:
  • Service charges, administration charges, surcharge, establishment cost, registration charges
  • All non-medical expenses
  • Private nurse expenses
  • Telephone calls
  • Laundry charge etc.
Learn more about our health insurance policies to get maximum coverage for any kind of medical emergency.

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