Care Health Insurance Claim Settlement

1. Visit Bajaj Markets

2. Click on the ‘Register a claim’

3. Upload the necessary documents

4. Wait for your request to be assessed 

5. Check claim status online

6. Resolve the query, if any

• Pre-authorisation form

• Valid ID proof along with photograph

• Documents such as voter ID, Aadhar card, PAN card

• Duly filled claim form with your signature

• Doctor’s prescription for diagnostic tests, consultation and medicines

• Original medical bills

• Doctor’s prescription recommending hospitalization

• Case papers

• Policy details including your name, policy number, address and illness details

• Ambulance receipt

• FIR, if applicable

Unlike cashless claims, in case of reimbursement claims you have to take care of the medical bills initially. These expenses are then reimbursed. You can make a reimbursement claim if your treatment was done at a hospital not listed in their network. 

It is important to keep track of all the documents and medical bills, as will be needed to file the reimbursement claim.

Here’s how you can file a reimbursement claim:

• Inform the insurer about your treatment (If it is planned ensure that the intimation is sent 48 hours prior and within 24 hours in case of an emergency).

• Submit the claim form with the required documents at the earliest.

• You may receive the approval, rejection, or query from the insurer

  On approval your claim will be settled and the amount will be transferred

  If a query is raised, you will have to respond to reach a resolution

  Upon rejection, the insurer will communicate the reason for rejection

• Valid ID proof

• Complete KYC if the claim amount exceeds more than 1 LAC (ID, address, photographs)

• Duly filled claim form with your signature

• Doctor’s prescription for diagnostic tests, consultation and medicines

• Discharge summary

• Final bill, break up bill with payment receipt.

• All investigation reports including x-ray /MRI/CT image.

• Original medical bills

• Doctor’s prescription recommending hospitalisation

• Case papers

• Policy details including your name, policy number, address and illness details

• Ambulance receipt

• FIR, if applicable

Check Out Health Insurance Plans Available at Bajaj Markets.

Disclaimer: The premium mentioned above are indicative and may vary depending on the coverage you select.

Despite taking care of all your documents and details, here are some reasons why your health insurance claims may get rejected:

• Claim for expense or treatment that falls under exclusion

In case you file a claim for an expense or treatment that is not covered in your policy, your claim may get rejected

• Incorrect Details

In case any discrepancies, misinformation, or inaccuracy in the details provided for the claim, your claim will be rejected

• Delay in intimation

In case you fail to inform about your medical emergency or planned hospitalisation, your insurer may not be able to assess the situation completely, resulting in rejection

• Invalid policy

In case you file a claim after your policy is lapsed, your claim would be denied

• Waiting period

In case you file a claim for the expenses of the treatment of a disease having a certain waiting period that has not been completed, your claim will be denied.

There are certain key points that you must be careful about when beginning the Care Health Insurance claim settlement process. These steps would help in a hassle-free and quick claim settlement.

• Keep a check on the documents required

Apart from the pre-authorisation form, hospital bills and medical reports, there are some other documents that you need to keep handy. Here’s a list of commonly required documents:

• Your valid ID proofs

• Bills of any medicines or equipment used

• Policy document

• Cancelled cheque                           

This is not an exhaustive list and you may need to furnish additional documents based on your claim, policy, and treatment/care availed. You can check the document requirement by contacting the customer support.

• Read the list of exclusions carefully

Every health insurance policy has some scenarios listed that are not covered by the insurance company. These are referred to as exclusions. In case the claims are filed for scenarios that are listed in the exclusions, they will not be approved. Hence, it is imperative that you check the exclusions before making a claim.

• Ensure your claim is admissible to the sum insured limit

When you buy health insurance, the insurer is liable cover the expenses only up to the sum insured amount. In case your claim amount exceeds the available sum insured limit, you would have to take care of the excess. So, you should check the sum insured limit of the health insurance policy.

• Go through the list of network hospitals

A cashless claim settlement is possible only at the insurance company’s network hospital. So, in case you wish to take the advantage of the cashless claims, it is important to check the list of hospitals that the insurer has a tie-up with before seeking treatment.

• Check the validity of your insurance policy

It is important to check the validity of your health insurance policy when filing a claim as your claim may not get settled if the policy has lapsed.

An important thing to keep in mind is that the document requirement may vary depending on your insurer, among other factors. To proceed with you Care Health Insurance claim settlement process, you will need to submit the following documents:

• ID proof

• Medical reports and tests

• Prescription for hospital recommendation

• Original copy of bills and receipts, including chemist bills

• Case papers

• Discharge card

• Signed claim form with accurate details

• Post-mortem report, if applicable

• FIR, if required

In some cases, you may need to submit documents apart from the ones mentioned above. You can confirm the documents needed by contacting the customer support before submitting the claim form.

Read More: Claim Settlement Ratio in health insurance

Health Insurance Plans Available at Bajaj Markets