insurer : bajaj allianz general insurance co. ltd policy no: og-14-1901-8403-00000037 policy period:...
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Insurer : Bajaj Allianz General Insurance Co. Ltd
Policy No: OG-14-1901-8403-00000037
Policy Period: 25th April 2013 to 24th April 2014
Group Mediclaim Policy Renewed Terms : 2013-14
Group Mediclaim – Standard Coverage features of the policy
Hospital Expenses,
Pre Hospitalisation expenses (30 days) & Post Hospitalisation expenses (60 days) excluding Maternity
Cashless Hospitalisation at over 2300 hospitals all over India
Reimbursement claims
GENERAL HOSPITALISATION EXPENSES:
In-patient hospitalisation (for a period exceeding 24 hours)
Expenses on hospitalisation for minimum period of 24 hours are admissible. However, this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (kidney stone removal), tonsillectomy, D&C taken in the hospital/Nursing Home.
Expenses reimbursed under the policy:
Room Charges as provided by the hospital / nursing home, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists fees Anaesthesia, Blood oxygen, operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostics Materials & X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of organs & similar expenses
Group Mediclaim – Policy Coverage Details
Floater Policy: Sum insured Various as specified.
Cover: Employee/Self + any 5 dependants
Dependants – Self, Spouse, 2 children – Upto the age of 21 and 2 Dependant Parents /
Parents – in law (Parents - Only 1 set of parents upto the age of 90 years)
Maternity limito Rs.35,000/- for normal and Rs.45,000/- for Caesarian. No waiting period.
Baby cover from day one.
Maternity coverage applicable only for self and spouse.
Pre & post natal expenses covered within maternity limit only in case of hospitalization.
OPD treatment for pre and post natal expenses will not be covered
Room rent restricted to 1% of the SI in case of Normal Hospitalization & 2% of the SI in
case of ICU. All other charges in accordance with room rent restrictions.
Pre-existing diseases are covered./1yr exclusion + 30 days exclusions are waived.
Pre & post hospitalization is 30 & 60 days.
Group Mediclaim – Policy Coverage Details
Capping on below :
a)Cataract Rs. 25,000/- b) Appendicitis Rs. 30,000/- c) Hernia Rs. 30,000/-
d) Haemorthoids Rs. 20,000/-
Internal congenital diseases are covered under the policy.
Cashless e-cards will be provided for each family covered under the policy.
Cashless Facility only to employees and not to dependants.
Dental treatment as per policy conditions ie only in case of accident
No Individual (Employee or Dependant) can be covered more than once in
a policy.
Mid term additions allowed for newly wed spouse & newly born children
only.
Any additions for new employee, spouse or children would be allowed
within 30 days of date of joining, marriage or birth respectively.
Any endorsements will be from the date of joining if float is maintained.
Group Mediclaim - Standard Exclusions
Treatment for injuries arising out of an act of War.
Circumcision unless necessary for treatment of a disease due to an accident or as a part of any illness.
Routine eye examinations and cost of glasses, contact lenses and hearing aids and all external aids.
Dental treatment or surgery of any kind unless requiring hospitalisation arising out of an accident.
Convalescence, general debility, "Run-down" condition or rest cure
Congenital external disease
Venereal diseases, AIDs/HIV
Intentional self-injury and use of intoxicating drugs/alcohol.
Any fertility, infertility, sub-fertility or assisted conception operation, treatment for sterility.
Charges incurred in the hospital purely for diagnostic purpose.
Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/materials or
radioactive contamination.
Dental treatment or surgery of any kind unless requiring hospitalisation arising out of an accident.
Convalescence, general debility, "Run-down" condition or rest cure
Congenital external disease
Venereal diseases, AIDs/HIV
Group Mediclaim - Standard ExclusionsIntentional self-injury and use of intoxicating drugs/alcohol.
Any fertility, infertility, sub-fertility or assisted conception operation, treatment for sterility.
Charges incurred in the hospital purely for diagnostic purpose.
Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/materials or radioactive
contamination.
Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the
attending Physician.
Treatment arising from or traceable to pregnancy
Voluntary termination of pregnancy
Any routine or preventative examinations, vaccinations, inoculation or screening.
Outpatient treatment charges
Change of Sex.
Any cosmetic, plastic surgery, or aesthetic procedure.
Any treatment received outside India.
Naturopathy treatment.
Use of intoxicating drugs / alcohol and the treatment of alcoholism, solvent abuse, drug abuse or any addiction
and medical conditions resulting from, or related to, such abuse or addiction.
Any stay in hospital for any domestic reason or where there is no active regular treatment by a specialist.
Group Mediclaim - Claims Process
In case of treatment at empanelled hospital across India, intimate Bajaj Allianz to avail
cashless facility.
In case of treatment at non empanelled hospital, submit claim form along with all the
necessary documents for reimbursement immediately or within 3 days for registration.of
claims.
The updated list of network hospitals is also available on our website under quick links
section (refer below link) and check the same by updating State and City
https://www.bajajallianz.com/BagicNxt/hm/hmSearchState.do
Attached is the claim form along with the NEFT form and pre-authorisation form
Pre-Authorisation Form
UPL Claim Form with NEFT Mandate
Policy issued by BAGIC
Health card and hospital list & Mediclaim forms will be available on the link..
Planned admission
Hospital verifies the card
Emergency admission
Pre-authorization sent to BAGIC callcentre
by hospital
HAT Medical team at HO reviews details of
pre-authorization
Cashless granted
Patient avails treatment and is
discharged
Hospital sends claim to HAT
Claim documents are verified by
HAT team
Insured approaches hospital
Patient avails treatment and is discharged
Insured intimates and send claim form and
required documents to HAT for reimbursement
Claim payable, payment send to
insured or hospital
Cashless Hospitalization Reimbursement claims
Get hospitalized Pay deposit, which will be
refunded after cashless approval
Network Hospital Non Network Hospital
Claim Process
Necessary Documents for claim submission
Bajaj Allianz claim form duly signed by insured with a copy of the E-card
Reimbursement check list
Bill detail sheet
First Consultation Letter
Original Discharge Summary
Original Final Hospital Bill giving detailed break up of all expense heads
mentioned in the bill
Stamped receipt for final hospital bill
Pharmacy cash receipts/ cash bills along with supporting prescription Reports
towards investigations done, Pathology/ Radiology/ Cardiology
Original paid receipt towards the investigation charges
In case of a Cataract Operation, the IOL Sticker
( Each bill with prescription pasted & numbered on separate paper)
Claims Procedure & Health Helpline
Insured intimates BAGICL regarding Accident / Hospitalization
BAGICL Register claim & intimate requirements to insured
Process claim after receipt of complete documents
Dispatch Cheques along with discharge vouchers are sent to Insured
Health Helpline
Exclusive Health Call Centre to service our cardholders
24 X 7 helpline available for emergencies
Facility to send online requests / queries
Response Turn Around Time of 20 minutes
Follow up with member for complaints received
Information on special discounts / packages / schemes
Information on hospitals, doctors, diagnostic centres, ambulance services and health
products
How we are different……… HAT services only Bajaj Allianz clients (HAT is our own inhouse TPA)
No Third Party Administrator (TPA) involved between the insurer and HAT
Exclusive Network with special benefits and Faster claim settlement due to
centralized operations
Preferred services extended as HAT services only clients insured by Bajaj Allianz
A HEALTH CARD is issued to all members
This card entitles the member for identification ONLY as a Bajaj Allianz member
Photo ID identification is necessary for admission
Exclusive discounts / schemes at network hospitals
Admissions without deposits at network hospitals
Claim Documents
Claim Documents may be sent directly to:Health Claims Team, Bajaj Allianz General Insurance Company Limited, Rustomjee Aspire,
3rd Floor, Everard Nagar – 2, Near APEX Honda, Priyadarshini Circle,Off Eastern Express Highway, Chunabhatti-Sion, Mumbai- 400022Email: [email protected]
Once the claim is registered the status of the claim may be checked also under the below link by
updating the card No: https://general.bajajallianz.com/BagicNxt/InHouseSP/hm/externalUserCC.jsp
or under our Website : www.bajajallianz.com
(Under Quick links – General Insurance – On the left side drop down Menu)
Escalation Matrix
Levels Contact Person
Contact nos Email ids
First point Saveena Hegde
022-66197508
Escalation Dr. Rashmi Sachdev
7738395815 [email protected]
Ajay Kurup 7738257002 [email protected]
All other queries: [email protected]: 022 -67402418/ 419 / 420Cell: 918451914209
For any other issues/queries please call on the below Nos:Cashless: 020 -30305858 or send an emai to: [email protected] queries on e-cards – email to: [email protected]