Bajaj Allianz Health Insurance Claim Settlement Ratio

Over the past couple of decades, there has been an increased awareness of healthcare services. From healthy eating habits to the practice of stay-fit activities - everything is “in trend”. Unfortunately, while such practices may put you on the track to staying healthy, you can't always avoid certain lifestyle ailments or the sudden outbreak of pandemics like COVID-19. Additionally, there is the issue of rising medical inflation. All of these combined have given rise to several health insurance providers and innovative health insurance plans.

As potential policyholders seeking a value-worthy plan, you need an insurer with an extensive track record offering customised plans to cater to policyholders' tailored financial bandwidth and medical requirements. Bajaj Allianz Health Insurance checks all these boxes: the insurer fetches the industry experience from the Allianz group and knowledge of the industry’s financial requirements and goals from the seasoned Bajaj Finserv company.

Accordingly, Bajaj Allianz offers a long list of health insurance products that can be customised thoroughly, as well as value-worthy health insurance add-ons and coverage for critical ailments like cancer. Unfortunately, the brand’s health insurance policies are not comprehensive and are often too expensive as compared to other plans from its categories. However, before you start looking into the health insurance plans from this brand, you need to analyse its credibility.

Let’s start with the Bajaj Allianz Health Insurance Claim Settlement Ratio 2024!

What is the Claim Settlement Ratio?

When analysing a health insurance provider's credibility, the first parameter to consider is the Claim Settlement Ratio or CSR, which is given by -

(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100

This ratio reflects the health insurer's claim settlement track record, and the ideal range is above 90 and below 100. If you have approached a health insurance provider with a CSR between this range, you can purchase a plan from the insurer (provided it performs equally well across the other parameters involved in measuring the brand’s credibility).

On the other hand, if you encounter a health insurance provider with a CSR of below 80 or above 100, steer clear of it and seek a better brand.

What is the Bajaj Allianz Health Insurance Settlement Ratio for 2024?

(If you are searching for the Bajaj Allianz Health Insurance Claim Settlement Ratio 2024, you must first analyse Bajaj Allianz’s CSR data for 2022 – 2023, the last financial year. However, a single year's data won’t give you the much-required insight into the consistency of the insurer’s claim settlement track record. Hence, we have taken the CSR data from the last 3 years, drawn an average of these years and tallied them against the industry’s average.)

Overview of Bajaj Allianz Health Insurance

What is the significance of Bajaj Allianz Health Insurance Claim Settlement Ratio 2024?

Across the last 3 years, the Bajaj Allianz Health Insurance Claim Settlement Ratio has witnessed a few ups and downs. What does this translate to for its potential and existing policyholders? Let’s find out!

1. Consistency: While it’s true that the CSR numbers for Bajaj Allianz Health Insurance across 2020 to 2023 have gone through some ups and downs, they have never dropped below 90. This is a great sign for its policyholders and speaks volumes about its consistency in claim settlement.
2. Overall Performance: Bajaj Allianz Health Insurance exceeds the industry average year on year and as an overall number for 3 years. This and the insurer’s consistent CSR numbers that stay above 90 indicate that the brand is on the right path to be a credible health insurance provider.

Why is the Claim Settlement Ratio important?

When purchasing a health insurance policy, you need to check two aspects: the plan's features and the provider's credibility. In the latter case, the Claim Settlement Ratio is one of the multiple parameters involved.

An insurer’s CSR reflects its claim settlement track record and thus offers a surface insight into the provider’s reliability. Hence, it is often the first parameter that potential policyholders check before approaching an insurer.

However, please remember that CSR can’t be the sole parameter when deciding upon a health insurance provider. CSR fails to show the time required to settle a claim and whether the claim has been settled in full or partially. It also doesn’t say much about the insurer’s future sustainability, claim settlement potential, or overall operational proficiency. Hence, you must look into the Incurred Claim Ratio, complaint volume, and the number of network hospitals of a health insurance provider before availing of a policy from this brand.

What is the Claim Settlement Process for Bajaj Allianz Health Insurance?

1. CASHLESS

STEP 1: Contact Bajaj Allianz Health 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.

STEP 2: Submit the required documents (as mentioned below).

STEP 3: The hospital will request the insurer for their pre-authorisation approval.

STEP 4: The insurer approves the treatment, and you can go ahead with a cashless mode of claim settlement, which will be covered by your insurer when you are discharged.

(Please note that if your cashless request is denied, you can still proceed with the treatment. You will need to pay the bill from your pocket initially and can later file for a reimbursement claim settlement. The process for this is mentioned below.)

2. REIMBURSEMENT

STEP 1: You can register your claim online by visiting the official link and downloading the reimbursement form

STEP 2: Complete the claim form and submit it with the required documents (as listed below) online or at the nearest branch.

STEP 3: After cross-verification of your documents and the hospital desk, the insurer will disburse your claim amount to your bank account.

You can also receive guidance on your claim settlement by calling their helpline number - 1800-209-5858 or mailing to bagichelp@bajajallianz.co.in for assistance.

What are the documents required to settle claims for Bajaj Allianz Health Insurance?

When planning to file a claim to Bajaj Allianz Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy -

1. CASHLESS

• Policy number (health insurance card)
• Copy of ID proof

2. REIMBURSEMENT

• Hospitalisation Claim
• Hospitalization Claim Claim form duly filled and signed by the insured
• Original Discharge summary document
• Original hospital bill with detailed cost breakup
• Original paid receipts
• All Lab and test reports
• Copy of Invoice/Stickers/barcode in case of implants
• The first consultation letter from the doctor
• KYC form
• Filled and signed NEFT form by Policy Holder/proposer
• Hospitalisation Death Claim
• Claim form duly filled and signed by the insured
• Original Death summary document
• Original hospital bill with detailed cost breakup
• Original paid receipts
• All Lab and test reports
• Copy of Invoice/Stickers/barcode in case of implants
• The first consultation letter from the doctor
• KYC form
• Legal heir certificate containing affidavit and indemnity bond
• Filled and signed NEFT form by  Policy Holder/proposer.

Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.

Conclusion

Bajaj Allianz Health Insurance holds a good name across the market owing to its brand equity. As a health insurance provider, its credibility metrics are exceptional. However, regarding health insurance plans, the policies still need a more comprehensive touch, and the pricey premiums aren’t an encouraging sign either. But, if you are a brand loyalist and don’t mind the spike in premiums, you may take a look at Health Care Supreme and Health Guard Gold.