Frequently Asked Questions

Frequently Asked Questions

How to file a health claim?

Bharti AXA General Insurance offers both Cashless services and Non-cashless (reimbursement) facilities for its customers. You can find our empanelled list of cashless hospitals where claims are managed by Third Party Administrators (TPAs) to offer claims service during hospitalization. 

To service your claims, reach out to the TPAs in your zone: 

North Zone: Paramount Health Services, Emeditek Solutions, & FamilyHealth Plan: For locations of Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Uttar Pradesh, Delhi, Chandigarh, Uttarakhand, Rajasthan and Chhattisgarh. Toll free number: 1800-22-66-55 & 1800-102-3242

South Zone: Paramount Health Services, Emeditek Solutions, & FamilyHealth Plan: For locations of Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Pondicherry, Andaman and Nicobar Islands and Lakshadweep. Toll free number: 1800-425-9449 & 1800-425-4033

West Zone: Paramount Health Services, Emeditek Solutions, & FamilyHealth Plan: For locations of Gujarat, Maharashtra, Goa, Madhya Pradesh, Dadra and Nagar Haveli, Daman and Diu. Toll free number: 1800-425-9449 & 1800-102-3242

East Zone: Paramount Health Services, Emeditek Solutions, & FamilyHealth Plan: For locations of Bihar, West Bengal, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya, Orissa, Tripura, Jharkhand, Sikkim. Toll free number: 1800-425-4033 & 1800-102-3242
 

How to avail cashless hospitalization facility?

In case of Emergency Hospitalization in Network Hospitals:

  • Patient takes admission in the hospital by showing Health ID card
  • Cashless claim request form to be filled by the hospital and faxed to TPA or submitted to insurance help desk at the hospital
  • TPA will review the claim
  • TPA will inform the insured and the hospital with the status via SMS, email or fax notification usually within 6 hours of submission of request
  • TPA will approve only the medical expenses covered under the policy. 
  • These expenses will be settled by Bharti AXA General Insurance directly.
How many claims are allowed over a year?

Any number of claims can be made during the policy period subject to the maximum limit mentioned under the policy.

How to avail reimbursement facility?
  • Insured gets admitted to the hospital
  • Takes treatment and pays hospital bills.
  • Gets back all original documents from the hospital.
  • Submits all original and necessary documents to the TPA along with duly filled claim form.
  • TPA will review the documents and effect payment within 21 days of receiving the complete documents.
  • If the claim is rejected, a letter will be sent along with the reasons of rejection.
What is claim settlement ratio? What are the reasons for denial of claim for health insurance?

Claim Settlement ratio is the ratio of claims settled against claims reported during the year. Bharti AXA Health Insurance Claim settlement ratio is 94% for 2012.

The major reasons for refusal of claims for health insurance are:

  • Related to Maternity
  • Related to PED
  • Related to waiting Period
  • Hospitalization not justified
  • Diagnostic/Investigation purpose
  • Period of Hospitalization - Less than 24 hrs
  • Other Exclusion Clauses of the policy
  • Misrepresentation/Fraud
  • Experimental/Unproven Treatment
How can I renew my health insurance policy after one year?

Kindly call our customer support help desk at 1800-103-2292 (Toll free) to renew your health insurance policy.

How is premium calculated for Health Insurance?

The premium payable on your policy is based on the following factors:

  • Sum Insured option chosen
  • The number of family members to be covered
  • The age of the senior most person in the family to be covered
  • The type of policy you opt for - Basic, Premium or Optimum
Can I decide the amount of insurance I require or does the insurance company decide it?

You can decide the amount of insurance on your own. We have a variety of sum insured options for you to choose from. You can decide on the amount based on the number of family members to be covered under the policy, the age of family members, the expected costs of treatment and the amount of premium you are willing to pay. 

What are the minimum and maximum amount of sum insured that I can opt for?

The minimum amount of sum insured is Rs. 2 lakhs and the maximum amount is Rs. 5 lakhs.

What is cashless facility?

Cashless claims is a facility that is available in our network of tied-up hospital where we settle claims directly with the hospital or nursing home without you having to pay any amount to the hospital. In the case of a pre-planned hospitalization, if the chosen hospital is included in our network of cashless hospitals, all that you need to do is request the hospital to send us a claim form along with certification from the doctor about the nature of the illness and treatment.

Once our Third Party Administrator receives the information, and if the claim is admissible, the TPA sends you a pre-authorization in a few hours, for the cashless claim. We have an extensive network of more than 4,300+ network hospitals all over India where you can avail this facility.