Aditya Birla Health Insurance Claim Form

Aditya Birla Health Insurance Claim Form

Aditya Birla health insurance claim form is provided by Aditya Birla Health Insurance Company Limited through which the policyholder can raise a claim. It is critical to submit this form to initiate the claim process successfully. The policyholder can get their medical expenses reimbursed through the claim form.

What is the Aditya Birla Health Insurance Claim Form?

The Aditya Birla health insurance claim form is an important document that the policyholder is required to submit when raising a health insurance claim. This form includes information about the patient, policy, hospitalization, medical bills, bank details, etc. It is crucial that it is duly filled and signed as an incomplete form or the one with incorrect details can result in claim rejection.

Types of Aditya Birla Health Insurance Claim Forms

There are two types of forms available to raise a claim under Aditya Birla health insurance plan. One is for cashless hospitalization and the other is for reimbursement health insurance.

1. Reimbursement Claim Form

   Reimbursement health insurance is the one where the policyholder has to initially pay the medical expenses out of their own pocket and can later file a claim for the same. The Aditya Birla health insurance reimbursement claim form is necessary to successfully raise the request for the same.

2. Cashless Claim Form

   For filing a cashless health insurance claim, the policyholder must download the document called a pre-authorization form. This form allows the insured to initiate the process for cashless hospitalization, where the final medical bill is settled by the insurer directly with the hospital, and the insured needs to bear only non-medical expenses.

How to Download the Aditya Birla Health Insurance Claim Form?

Here are the different ways to download the Aditya Birla health insurance claim form:

Website

• Visit the Aditya Birla health insurance company's 'Downloads' page.
• Select the health insurance plan from the list mentioned on the left margin.
• Click on the 'Claim Documents' tab on the page.
• A list of forms will expand. You can choose to download the claim forms applicable to your policy/case.
• For reimbursements, the policyholder can download the Claim Form Part A.
• To raise a request for a cashless claim, download the Claim Form Part C.

Mobile Application

The policyholder can also download the Aditya Birla health insurance claim form through the insurer's Activ Health mobile app.

Other ways to get the Aditya Birla health insurance claim form:

A physical copy of the Aditya Birla reimbursement claim form can be obtained at the nearest branch office.

How to Fill the Aditya Birla Health Insurance Claim Form?

The Aditya Birla health insurance claim form comprises Part A and Part B. Here are the details a claim form includes:

1. Part A of the Aditya Birla Health Insurance Claim Form

   Section A - Details of Primary Insured

   Policy number, Sl. No./Certificate no., Company/TPA ID no., Policyholder's name and address and contact details

   Section B - Details of Insurance History

   If currently covered under any other health insurance, date of its commencement, company name, insurer's email ID, insurer's phone no., policy number, sum insured, if hospitalized in the last 4 years, its diagnosis, if previously covered by any other mediclaim and insurance company name

   Section C - Details of Insured Person Hospitalized

   Name, relationship with the primary insured, date of birth, gender, age, occupation, address and contact details

   Section D - Details of Hospitalization

   Name of the hospital where admitted, hospital's email ID, room category occupied, hospitalization reason, date of injury or first detection of the disease, date and time of admission, date and time of discharge, cause of injury, system of medicine, etc.

   Section E - Details of Claim

   Details of the claimed treatment expenses, claim for domiciliary hospitalization, details of lump sum/ cash benefit claimed, and the checklist for claim documents submitted

   Section F- Details of Bills Enclosed

   S.no., bill number, date, issued by, towards, amount

   Section G - Details of Primary Insured's Bank Account

   PAN number, account number, bank name and branch, cheque/DD payable details, and IFSC code

   Section H- Declaration by the Insured

   Date, place, and signature of the insured

   Disclaimer: The above-mentioned claim form details are indicative only. The policyholder must fill out all required details in the claim form provided by Aditya Birla Health Insurance Company Limited.

2. Part B of the Aditya Birla Health Insurance Claim Form

   Aditya Birla health insurance claim form Part B is to be filled out by the hospital.

Common Mistakes to Avoid when Submitting Aditya Birla Health Insurance Claim Form

Some of the mistakes that the policyholder must avoid while submitting the Aditya Birla health insurance claim form include the following:

• Not submitting original bills or discharge summary
• Submitting incorrect or incomplete documents
• Mismatch in name, policy number, contact information
• Leaving mandatory fields blank
• Submitting documents after the specified time limit
• Submitting claims for policy exclusions
• Mismatch in signature

Documents Required with the Aditya Birla Health Insurance Claim Form

The insured must submit the following mandatory documents along with the Aditya Birla health insurance claim form for a successful request initiation:

• Final hospital bill with detailed breakup
• Discharge summary
• Doctor's consultation
• Investigation and diagnostic reports
• All original bill receipts
• PAN & Aadhaar card
• Cancelled cheque
• Employer ID (in case of group medical policy)
• FIR/MLC report (in case of an accident)
• Other documents asked by the insurer

FAQs on Aditya Birla Health Insurance Claim Form