Bajaj Health Insurance Claim Form

Bajaj Health Insurance Claim Form

Bajaj health insurance claim form is provided by Bajaj General Insurance Company Limited (formerly known as Bajaj Allianz General Insurance Company Limited). It is an official document without which the insured cannot raise a successful claim request.

What is the Bajaj Health Insurance Claim Form?

Bajaj health insurance claim form contains details about the insured, their health insurance, hospitalization, treatment, medical bills and claim history. A health insurance claim form is required when the insured wants reimbursement for medical expenses incurred by them. It is important that the claim form is submitted on time (usually within 15 days of discharge).

Types of Bajaj Health Insurance Claim Forms

Claims can be of two types, cashless and reimbursement. The insured needs a claim form depending on the type of health insurance claim.

• For cashless hospitalization, the policyholder must complete a pre-authorization form, which allows the insured to receive cashless treatment without an initial payment from their own pockets.
• Under reimbursement health insurance, the insured has to initially pay the medical bill themselves and can later raise a request to get the amount reimbursed through a claim form.

How to Download the Bajaj Health Insurance Claim Form?

Here are different ways through which you can download the Bajaj health insurance claim form:

Website - Claims Page

• Visit the website's homepage
• Click on 'Claim' on the horizontal menu bar
• Select 'Health Insurance Claim'
• Scroll down to the section 'Claim Forms'
• Select 'Reimbursement Form' if you have already paid for the medical expenses
• Select 'Cashless Request Form' for a cashless hospitalization
• Once the claim form opens, you can download it

Website - Customer Portal

• Visit the official website of the Bajaj General Insurance company
• Click on 'Support' on the horizontal menu bar
• Select 'Customer Service'
• Scroll down to 'Our Assistance'
• Click on 'Download Claim Forms'
• You will be directed to the General Insurance Claim Process page
• Click on the 'Health' tab
• Scroll down to the 'Claim Forms' section
• Select the form per your claim type
• Download the displayed claim form

Mobile App

The policyholder can also access the Bajaj health insurance claim forms via the Bajaj General mobile application.

Other ways to get the Bajaj health insurance claim form

A physical copy of the Bajaj health insurance claim form can be obtained by visiting the branch office.

How to Fill the Bajaj Health Insurance Claim Form?

The Bajaj health insurance claim form has two parts, A and B. It is important to submit both the claim documents to successfully raise a health insurance claim.

1. Part A of the Bajaj Health Insurance Claim Form

   Bajaj health insurance claim form Part A is to be filled out by the proposer or the insured. It contains the following particulars that must be filled out correctly:

   Details of Primary Insured: Policy no., Sl. no./certificate no., company/ TPA ID no., customer ID, company name, primary insured's name, address, contact details

   Details of Insurance History: Currently covered by any other mediclaim/ health insurance; date of its commencement, company name, policy no., sum insured; if hospitalized in the last four years, its date and diagnosis; if previously covered by any other claim and its company name

   Details of Insured Person Hospitalized: Patient's name, health ID card no., gender, age, date of birth, relationship to primary insured, occupation, address, contact details

   Details of Hospitalization: Name of hospital where admitted, room category occupied, reason for hospitalization, date of illness first detected or injury, date and time of admission, date and time of discharge, name of treating doctor, diagnosis, additional details for Covid-related claims, etc.

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

   Details of Bills Enclosed: Sl. no., bill no., date, issued by, towards, amount

   Details of Primary Insured's Bank Account: Account holder's name, account number, bank name, branch name and address, account type, MICr no., IFSC code, PAN, cheque/DD payable details, CKYC no.

   Declaration: Date, place, signature

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

2. Part B of the Bajaj Health Insurance Claim Form

   Bajaj health insurance claim form Part B is to be filled out by the hospital. It is also a mandatory document that is required to be submitted for a successful claim request. It contains details about the hospital, admitted patient, diagnosis and treatment, etc.

Common Mistakes to Avoid when Submitting Bajaj Health Insurance Claim Form

Committing even minor mistakes when submitting the Bajaj health insurance claim form can lead to a claim rejection. Here are some of the most common mistakes that the insured must avoid when raising a claim under Bajaj health insurance plans:

• Not matching the names, IDs, bills, etc.
• Incorrect signature
• Mentioning incorrect or misleading information
• Submitting the documents after the specified time period
• Mentioning incorrect bank account details
• Raising a claim when the waiting period is not over
• Filing for a claim that is not included in the policy's terms
• Not keeping copies of the submitted documents

Documents Required with the Bajaj Health Insurance Claim Form

The policyholder is required to submit the following documents in addition to the accurately filled Bajaj health insurance claim form:

• Original hospital discharge summary
• Original, final hospital bill with detailed break-up
• Pharmacy bills
• Original payment receipts
• Medical records and diagnostic reports
• KYC documents
• Cancelled cheque or bank statement
• Copy of FIR or MLC, in accidental cases
• Death certificate, in death cases

FAQs on Bajaj Health Insurance Claim Form