In our endeavour to provide you the best coverage along with a host of other value-added services, our online system for general insurance claims has been designed keeping your ease in mind. With a convenient claim process for your health insurance policy, you can now register your claim, upload the necessary documents, and know the status instantly.

Register Your Health Insurance Claim

The health insurance claim process with Bajaj General Insurance Limited (BGIL) is structured for your convenience. If your doctor advises treatment or hospitalisation, your first step is to inform Bajaj General Insurance Limited. For a cashless claim, the insured must inform within 48 hours before planned admission and within 24 hours in case of emergency admission, visit any network hospital where the hospital’s third-party administrator (TPA) will connect with Bajaj General Insurance Limited’s Health Administration Team (HAT) for pre-authorisation. Upon approval, Bajaj General Insurance Limited directly settles your medical expenses with the hospital. If you prefer a reimbursement claim, choose any hospital, cover the initial expenses, and later submit the original documents to Bajaj General Insurance Limited, which will process your claim efficiently. Also, we are providing cashless services for all in all panelled and non-panelled hospitals.

Medical Insurance Claim Process

Typically, the medical insurance claim process involves the following steps:

1. You realise you require treatment or hospitalisation after consulting with your doctor
2. You intimate the claim on your health insurance through our website or app
3. You visit a network hospital (for a cashless claim) or visit a hospital of your choice and pay accordingly (for a reimbursement claim)
4. Third-party administrator (TPA) desk of network hospital contacts us for treatment (for cashless claim) or submits original hospitalisation-related documents to our health administration team (HAT) upon discharge (for reimbursement claim)
5. We verify the claim documents and proceed accordingly

Here is a list of TPAs associated with us:

- Medi Assist Insurance TPA Pvt Ltd

- Family Health Plan Insurance TPA Pvt Ltd (FHPL)

- Paramount Healthcare Services Pvt Ltd

- Good Health Insurance TPA Pvt Ltd (GHL)

- Vidal Health Insurance TPA Pvt Ltd

- MDIndia Insurance TPA Pvt Ltd

- Health India Insurance TPA Pvt Ltd

- Volo Health Insurance TPA Pvt Ltd

- In-house public disclosures

For Cashless Health Insurance Claim

While we hope you stay healthy, in case of any untoward incident, please do the following:

- Approach any of the BGIL network hospitals for a complete cashless facility

- The hospital will verify your details and send the duly filled pre-authorization form to our HAT

- We will duly verify the details of the pre-authorisation request with the policy benefits and intimate our decision to the healthcare provider within one working day

Congrats! Your cashless claim is approved; you can expect the following:

- We send the first response to your healthcare provider within 60 minutes

- Your treatment costs at our network hospital will be settled by us and you don’t have to worry about the medical bills

In case it seems we have a query, you can expect the following:

- We will send a letter of query to the healthcare provider, asking for further relevant information that will allow us to initiate the health insurance claims process faster

- Once we receive the additional information, we will send the authorization letter to your healthcare provider within 7 working days

- Our network hospital will treat you and you won’t have to worry about the medical bills

In case your claim is denied, you can expect the following:

- We will send the letter of denial to the healthcare provider

- The provider will carry out the treatment, as fully payable

- We're sorry your claim is denied. However, you can certainly file a claim for reimbursement at a later date with proper documentation to check for its viability.

For Health Insurance Reimbursement Claim

While we hope you stay healthy, in case of any untoward incident, please do the following:

- Collect all hospitalisation-related documents and submit them, in original, to our HAT

- We will carry out a customary verification of the required documents

In case we need more information, you can expect the following:

- We will send you a prior intimation of such deficiency so that you have sufficient time to provide further information

- Upon receiving the requisite documents and some more enquiries, you can bank on us to initiate the insurance claims settlement process and release the payment via ECS within 10 working days (may be subject to terms and conditions)

- In case you still fail to provide us with the pending paperwork, we will send you three reminders, each 10 days apart, from the date of intimation

- However, please note that we will be forced to close the claim and send you a letter stating the same if you fail to come up with the pending documents beyond 3 reminders (30 days) from the date of intimation

In case your claim is approved, you can expect the following:

We initiate a customary verification of the authenticity of the documents and if found permissible within the policy’s purview, we will release the payment via ECS within 7 working days.

However, if your general insurance claim doesn’t fall within the policy’s purview, we will have to deny the claim and send you a letter stating the same.

Health Administration Team's Address

Please send all the hardcopy of relevant medical documents for your claim to the following address:

Bajaj General Insurance, 2nd Floor, Bajaj Finserv Building Survey no- 208/ 1 B, Off. Nagar Road Behind Weikfield IT Park Viman Nagar, Pune-411014

Hospitalisation Claim Checklist

- Hospitalisation claim form duly filled and signed by the insured

- Original discharge summary document

- Original hospital bill with detailed cost break-up

- Original paid receipts

- All lab and test reports

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

- First consultation letter from doctor

- KYC form

- Completely filled and signed NEFT form by the policyholder/proposer

Hospitalisation Death Claim Checklist

- Claim form duly filled and signed by the insured

- Original death summary document

- Original hospital bill with detailed cost break-up

- Original paid receipts

- All lab and test reports

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

- First consultation letter from doctor

- Legal heir certificate containing affidavit and indemnity bond

- Completely filled and signed NEFT form by the policyholder/proposer

Personal Accident Claim Checklist

- Claim form duly filled and signed by the insured/claimant

- Beneficiary name against the policy and NEFT details of the insured/nominee

- Completely filled NEFT details stating branch, IFSC code, account type, complete account number (duly signed by nominee/claimant with original pre-printed cancel cheque). If a pre-printed cheque is not available, kindly provide the first page of your bank passbook/ bank statement attested by the bank, which clearly indicates the beneficiary name & complete account number & IFSC code (all fields in the form are mandatory to process)

- Aadhar card & PAN card details of nominee/claimant/insured

- Salary slip/ITR at the time of issuance of the policy for salary commensuration

Accidental Hospitalisation Claim Checklist

- Original discharge summary

- All the previous consultation papers

- Investigation reports supporting the diagnosis

- Operation theatre notes

- Original final bill with detailed bill breakdown and paid receipts

- Original pharmacy and investigation bills

Death Claim Checklist

- Attested copy of death certificate

- Attested copy of FIR/panchanama/inquest

- Attested copy of post-mortem report

- Attested copy of viscera/chemical analysis report (if any)

- Hospitalisation documents (if any)

- In case of death, if the nominee is not defined on the policy copy then we will require the following documents:

- Legal heir certificate containing affidavit and indemnity bond on INR 200 (as per attached format) (the same should be duly signed by all legal heirs, notarised)

- If the nominee is a minor, then we will require a decree certificate from the court stating the guardian of the insured

Permanent Partial Disability (PPD) and Permanent Total Disability (PTD) Claim Checklist

- Duly filled medical certificate attached to the personal accident claim form.

- X-ray films/investigation reports supporting the diagnosis.

- Permanent Total Disability and Permanent Partial Disability certificates from the government authority certifying the disability of the insured.

- Photograph of the patient before and after the accident to support the disability.

Temporary Total Disability / Loss of Income Claim Checklist

- Duly filled medical certificate attached in the personal accident claim form.

- Leave certificate from employer stating the exact leave period, duly signed and sealed by the employer.

- All the consultation papers with details of treatment during TTD period.

- Final medical fitness certificate from the treating doctor stating the type of disability, disability period and declaration that the patient is fit to resume his duty on a given date.

- X-ray films/investigation reports supporting the diagnosis.

Children's Education Bonus Claim Checklist

- In case of death and PTD, kindly provide bonafide certificate from the school authorities stating that the child of the insured is studying there. (Mentioning - Name, S/D/O, date of birth and class) school identity card.

- Burial expenses & transportation expenses

- Original paid receipts

Hospital Cash Expenses Claim Checklist

- Copy of final bill and discharge summary.

- Investigation reports toward diagnosis.

Claim Forms

Please fill out the required claim form based on the nature of your claim from the following:

• 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

Health Insurance TPA Claim Status

Bajaj General Insurance Limited partners with multiple health insurance TPAs of India, including Medi Assist, FHPL, GHPL, and MDIndia, to offer seamless claim support. To check your health insurance TPA of India claim status, you can contact the TPA directly or use Bajaj General Insurance Limited’s online claim tracking services. After submitting the necessary documents, Bajaj General Insurance Limited keeps you informed with timely updates on your medical insurance claim process. For cashless claims, the hospital liaises with Bajaj General Insurance Limited to manage approvals and provide status updates, while for reimbursements, you’ll receive updates on any additional information required. Bajaj General Insurance Limited strives to release reimbursement payments within 10 working days after all documents are received, ensuring a smooth experience during challenging times.