Health Insurance Plans For Family: Health Guard

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 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 for the 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. You must check the hospital list before getting admitted to the hospital. Hospitals that provide cashless settlement are liable to change their policy without notice. The updated list is available on our website and with our call centre. 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 is as follows:

• Get the pre-authorisation request form filled and signed by the treating doctor/hospital and signed by you or a family member, at the hospital’s insurance desk.
• The network hospital will fax the request to HAT.
• HAT doctors will examine the pre-authorisation request form and decide on cashless availability, as per the policy guidelines.
• Authorisation letter/denial letter/additional requirement letter is issued within 3 hours 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 charges 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.
• In-room rent nursing charges are included. However, if a higher cost 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  General  Insurance along with the duly signed claim form.

Reimbursement claim process (in case of a non-network hospital)

• Inform the BAGIC HAT team about the hospitalisation. 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 or a family member must submit the following documents to the 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 papers, if required.
• All documents to be sent to 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 or a family member availed a cashless claim but did not utilise it, a letter from the hospital stating so.
• 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 the date of admission to the date of discharge with detailed medical history and doctor’s notes with 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).
• Additional requirements 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.

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.