What is Health Insurance Claim Process?

The health insurance claims process is a request by the policyholder to the insurance company for reimbursement of medical expenses incurred. There are two types of health insurance claim processes. You can either file a reimbursement claim or a cashless claim on health insurance coverage.

In a cashless claim, the insurer will pay your medical expenses directly in accordance with the terms and conditions of the policy. After completing a claim with appropriate documentation, the insurance company will pay to the hospital. Whereas, in case of reimbursement, you can file a claim with all the relevant documents of the entire expenditure incurred for the treatment.

Quick Overview

1
Claim Process : We provide a hassle-free claim procedure for both reimbursement claims and cashless claims. You just have to notify us.
2
TPA Claim Status : Identify the TPA partner with which you have your health insurance policy and provide the necessary documents.
3
Documents Needed : Necessary documents include a completed and signed claim form, investigation reports, prescriptions from doctors, and so on.
4
Claim Form Types : You can download numerous claim forms, such as the cashless request form, reimbursement form, personal accident, and global personal guard.

How to Register a Health Insurance Claim with Bajaj General Insurance?

The health insurance claim process with Bajaj General Insurance is very easy. If your doctor advises treatment or hospitalisation, follow the steps below:

Inform Bajaj General Insurance about your treatment or hospital admission.

For a cashless claim, contact the team at least 48 hours before hospital admission.

For emergency cashless claims, contact the team within 24 hours of admission.

Get admission to an eligible hospital and make a cashless claim at the TPA desk.

They will coordinate with the in-house claim settlement team to get pre-authorisation.

We make the payment for the eligible medical expenses straight to the hospital.

For reimbursement, pay the hospital bills and contact us with your documents.

Register Claim

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How to Make a Medical Insurance Claim Process?

Now that you know the health insurance claim registration process, let us understand both the cashless and reimbursement claim procedures:

Cashless Claim

Present your health insurance card while getting admitted to the network hospital.

The hospital will provide you with a pre-authorisation form after identity verification. Fill out the form and submit it at the TPA desk.

The form will be sent to your insurance company by the network hospital.

Our claims management staff will examine your pre-authorisation request. Following the assessment, your claim will be approved as per the policy terms.

We will pay the cost directly to your network hospital.

Reimbursement Claim

Notify the health insurance company that you were admitted to a non-network hospital and get the medical care.

Pay the amount in full at the time of discharge and gather any necessary documents.

Complete the claim form and provide the necessary documents.

As per the terms and conditions of the policy, the claim management team will examine the papers you have supplied and provide their approval.

You will get the claim amount once it has been approved.

Health Insurance TPA Claim Status

Follow the steps below to track the real progress of your health insurance TPA claim status:

Identify the TPA partner that you have with your health insurance policy.

Send all the necessary documents for your claims either to the TPA or your insurer.

Approach the TPA directly or use Bajaj General Insurance’s claim status tracker.

Provide the necessary information about your claim and track its status.

Check the claim status update from the TPA or Bajaj General Insurance Limited.

Forward any further documents if asked to prevent delay in the process.

Get the final claim status and amount paid in your account within 10 working days.

Health Insurance Claim Process

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Health Insurance TPA Network

Here is the step-by-step process to find a TPA for your Bajaj health insurance claim:

To find your TPA name, look at your health insurance card.

Visit your TPA's official webpage.

Select the ‘Network Hospitals’ or ‘Provider Network’ tab.

From the list, choose your insurance provider and the name of your particular policy.

Put your city and state here.

If necessary, filter by medical speciality.

Get the list of local hospitals by downloading it.

What Documents Are Required for a Health Insurance Claims?

Document submission is one of the essential steps in the health insurance claim process. Here are the steps to follow:

Completed and signed claim form.

Investigation reports and prescriptions from doctors.

Original receipts and bills from the hospital.

A duplicate of the health insurance policy.

KYC records like a PAN card or Aadhaar card.

Pharmacy bills and matching prescriptions.

For reimbursement claims, bank account information or a cancelled cheque.

Any extra document needed for verification that the insurer or TPA requests.

Hospitalisation Claim Checklist: What Do You Need to Submit?

To file a hospitalisation reimbursement claim, you must submit the original discharge summary documents. Here are the other documents:

You must submit the hospitalisation claim form duly filled and signed by the insured.

The original hospital bill with a detailed cost breakdown is also necessary.

You should also provide all lab and test reports.

Copy of invoice/stickers/barcode in case of implants.

Original paid receipts.

KYC form.

First consultation letter from the doctor.

Filled and signed NEFT form by the policyholder or proposer.

What Documents Are Required for a Hospitalisation Death Claim?

For a hospitalisation death claim, the original death summary document is mandatory to submit. Here are the other documents you must submit:

Claim form duly filled and signed by the insured.

All lab and test reports.

Original death summary document.

Original hospital bill with detailed cost break-up.

Original paid receipts.

Copy of invoice/stickers/barcode in case of implants.

Filled and signed the NEFT form by the policyholder/proposer.

First consultation letter from the doctor.

Legal heir certificate containing affidavit and indemnity bond.

How Do I File a Personal Accident Insurance Claim?

You can also file a claim for an accident against your health insurance plan. Here are the steps to follow:

Notify Bajaj General Insurance of the incident right away.

You will receive a claim form after notifying the company.

Provide specific details regarding the mishap and your previous medical procedure.

Submit medical bills, records, police reports, and images of the bruises.

Send the completed form and documentation to Bajaj General Insurance.

After reviewing your claim, the officials may get in touch with you to ask for more details.

Accidental Hospitalisation Claim Checklist

To file an accidental hospitalisation claim, you should immediately notify your insurer and gather the necessary documents:

A properly completed and signed claim form from the claimant or insured individual.

NEFT information, including the account type, branch, IFSC code, and full account number.

Name of beneficiary compared to policy and insured or nominee's NEFT details.

Provide the first page of your bank passbook if a pre-printed cheque is not available.

Details of the nominee, claimant, or insured person's PAN card and Aadhaar card.

How Do I Submit a Death Insurance Claim?

To submit a claim against your death insurance policy, you need to follow the steps given below:

Get in touch with the Bajaj General Insurance as soon as you can.

Send in the necessary documents, such as the Aadhaar card, death certificate and claim statement form.

For payout disbursement, provide a cancelled cheque and bank statement.

For cause-specific evidence, include supplementary papers such as a police FIR.

Submit the entire set of documents to the office.

Get a formal acknowledgement or tracking number for your submission.

Permanent Partial and Total Disability Claim Checklist

To file a claim against Permanent Partial (PPD) or Permanent Total Disability (PTD), you must submit the following documents:

A properly completed medical certificate is attached to a personal accident claim form.

Diagnosis is supported by X-ray films and investigation reports.

Certificates of PD and PTD issued by the government attest to the insured's disability.

To support the disability, a photo of the patient is taken after the accident.

How Do I Claim Temporary Total Disability Benefits?

Filing a claim under temporary disability insurance is a structured process. Here are the steps you should follow:

You have to notify Bajaj General Insurance as soon as a temporary disability arises.

Submit the medical records attesting to the temporary disability.

We will evaluate the claim after you submit the documents.

Then it confirms the condition's eligibility for short-term disability insurance coverage.

The officials may also request additional medical opinions or follow-up reports.

We will pay the benefits as per the terms of the policy after claim approval.

The insured's bank account is directly credited with these payouts.

How to Claim Children's Education Bonus Benefits?

To claim children’s education bonus benefits, you must verify that your accidental policy provides this particular add-on. Here are the steps to follow:

Notify Bajaj General about the event using different communication modes.

Obtain an authentic certificate from the child’s school, college, or educational institute.

Forward the authentic certificate along with other documents needed for claiming the education bonus benefit.

Be prompt in supplying any more information that may be requested by the authority.

You will get the benefit of the Children’s Education Bonus as per the policy guidelines.

What Documents Are Required for a Hospital Cash Claim?

Here are the documents you need to submit for a hospital cash claim under a health insurance policy:

Copy of final bill and discharge summary.

Lab reports and related documents.

Doctor’s prescription and other related documents.

Download Health Insurance Claim Forms

You can download your health insurance claim forms directly from this page. Below are the different types of claim forms, which you can choose:

Cashless Request Form

Reimbursement Form

Personal Accident

Global Personal Guard

Non-Medical Expenses List

KYC Form

NEFT form

Indemnity Bond Format

Legal Heir Certificate Format

Editable Reimbursement Claim Form

Editable OPD Claim Form

Editable Global Personal Guard

Other Claims

View All

Motor Insurance Claims

Travel Insurance Claims

Cyber Insurance Claims

Commercial and Retail Insurance Claims

Home Insurance Claims

Pet Insurance Claims

Cattle Insurance Claims

Frequently Asked Questions on Health Insurance Claim

Does health insurance offer options for covering my whole family?

Yes, many health insurance plans offer family coverage. However, the exact definition of 'family' can differ between providers. Generally, family health insurance covers you, your spouse, and dependant children (up to 2); you may need to get seperate policies for parents.

What are the common inclusions of health insurance?

Health insurance commonly covers hospitalisation costs, medical treatments, emergency services, and expenses related to pre- and post-hospitalisation care. Coverage for daycare procedures is also frequently included in health insurance plans; however, specific policy inclusions may vary from one plan to another.

Are pre-policy medical examinations common in health insurance?

Yes, many health insurance providers asks for pre-policy medical examinations for certain age groups, when applying for higher amount of coverage, or in other scenarios. Such examinations help insurers assess your current health conditions and potential risks. The specific tests and requirements can vary based on the provider and the policy chosen.

Do health insurance providers offer discounts for healthcare workers?

Health insurance providers may offer discounts on special concessions to healthcare workers on special occasions. The availability and specific details of these discounts can vary between insurers and different policies.

Does health insurance offer options for covering my whole family?

What are the common inclusions of health insurance?

Are pre-policy medical examinations common in health insurance?

Yes, many health insurance providers asks for pre-policy medical examinations for certain age groups, when applying for higher amount of coverage, or in other scenarios. Such examinations help insurers assess your current health condition and potential risks. The specific tests and requirements can vary based on the provider and the policy chosen.

Do health insurance providers offer discounts for healthcare workers?

What is a pre-existing condition, and how it impacts the policy?

A pre-existing condition is any health issue you had before your insurance coverage began. Most health insurance policies have a waiting period for pre-existing conditions, meaning they won't be covered immediately. It is very important to disclose all pre existing conditions when purchasing a policy.

Is there any co-payment at the time of raising claims?

If you have opted for the co-payment option in your policy, you will be required to bear part of your hospitalisation expenses based on the policy terms.

To whom should I submit claim documents?

You can submit your claim documents to the third-party administrator (TPA) managing your claim process or directly to your insurer depending on the procedure specified by your insurance provider.

Why health insurance policies include co-payment requirements?

Health insurance policies may include co-payment requirements to strike a balance between affordability and comprehensive coverage.

How can I raise my health insurance claim after hospitalisation?

You can file your claim after hospitalisation in case of an emergency hospitalisation. However, you must notify your insurance provider or third-party administrator (TPA) as soon as possible; the usual timeline for informing the insurer or third-party administrator is within 24 hours of being hospitalised.

What is a network hospital?

A network hospital is a hospital that has an agreement with your insurance company to provide cashless treatment to policyholders.

What are the standard renewal terms for health insurance plans?

Many health insurance plans offer long-term or lifetime renewal, requiring for consistent annual renewals and adherence to policy terms. However, policy renewal might get denied in case of misrepresentation, fraud, or non-compliance. It is important to renew your insurance plan. Contact your insurance provider for specific renewal details.

Any exclusions while renewing the policy, if having a claim pending?

Depending on your policy terms at 60-day cooling off period may be applicable if the policy is renewed within 60 days from the date of admission of the previously paid claim. In case, the policy is renewed post 60 days from the date of admission of the previously paid claim, a fresh waiting period of 15 days may be applicable as per policy terms.

Can I enhance my sum insured during policy renewal?

You may be able to apply for sum insured enhancement during policy renewal depending on the guidelines shared by your insurance provider. You may have to submit a fresh proposal form to your insurance provider. Based on the terms and conditions you may get enhanced sum insured.

What is the process of renewing health insurance plans?

You can log in to the app, enter your current policy details, review and update coverage (if required), check for renewal offers, add or remove riders, confirm details, and proceed with health insurance renewal. Then, you can receive instant confirmation for your policy renewal by completing the renewal payment online.

What is the grace period for renewing my health insurance policy?

There is a grace period offered by the insurance provider even if you have exceeded the date of policy's expiration, during which you can still renew it without losing coverage. The length of the grace period varies by insurer.