Kotak Arogya Sanjeevani Policy Coverage

Kotak Arogya Sanjeevani Policy Coverage

Kotak Mahindra General Insurance Co. Ltd. provides Arogya Sanjeevani health insurance policy with comprehensive coverage benefits. From daycare treatments to modern procedures like oral chemotherapy are covered. The policy criteria, features, and coverage details are given below:

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The policy offers health insurance coverage for pre and post-hospitalization expenses, in-patient hospitalization charges like room rent and ICU/ICCU, AYUSH treatments, daycare treatments, and ambulance charges. Moreover, the policy offers a cumulative bonus of 5% to 50%, a free look period of 15 days, and portability benefits.

Eligibility Criteria

Key Features of Kotak Arogya Sanjeevani Policy

Kotak Arogya Sanjeevani policy offers the following features and benefits to the insured:

• The coverage is provided on both individual and family floater basis
• Modern treatments and daycare procedures are claimable under this standard health insurance scheme
• The policy coverage is extendible to spouse, children, and parents
• Cumulative bonus for claim-free years range from 5% to 50%
• Policy cancellation is possible by giving 15-days’ notice to the insurer
• Tax benefits on the premium paid as per the Section 80D of the Income Tax Act

Inclusions of Kotak Arogya Sanjeevani Policy

Kotak Arogya Sanjeevani policy offers the following features and benefits to the insured:

• Ayush Hospitalization coverage limit is up to the sum insured with no sub-limits
• Modern/technologically advanced treatments are covered up to 50% of the sum insured
• In-patient Ayush hospitalization cover for Ayurveda, Unani, Yoga, Naturopathy, Siddha and Homeopathy systems
• The policyholder can file a claim for any daycare procedure where 24-hours hospitalization is not required
• Pre and post hospitalization treatment charges are reimbursed for 30 days and 60 days respectively
• Ambulance charges up to Rs 2000 for every hospitalization
• The policy coverage also includes cataract surgery for Rs 40,000 or 25% of the sum insured. It is applicable on one eye during a policy term

Exclusions of Kotak Arogya Sanjeevani Policy

The list of exclusions under the Kotak Arogya Sanjeevani policy is given below:

• Claim for pre-existing diseases cannot be filed until 4-years of the continuous policy term
• However, some specific illnesses can be claimed once  24 months of the waiting period is over
• Unproven treatments cannot be claimed
• Any treatment outside India is not permissible  for claims
• War-related medical emergencies remain excluded
• The policy does not cover claims for OPD charges and home treatment expenses
• Some other limitations are fertility and obesity treatments
• Adventure sports-related injuries also cannot be claimed

Claim Process

The process to file Kotak Arogya Sanjeevani health claims for both cashless and reimbursement processes is given below:

Claim Reimbursement

• Inform within 30-days of hospital discharge for pre-hospitalization, daycare medical procedures, and  hospitalization expenses
• Inform within 15-days of hospital discharge for post-hospitalization expenses

Cashless Claim Procedure

You can file a cashless claim for treatments taken in a network hospital. All the medical insurance claims are subjected to TPA or the Insurer’s authorization approval:

• To get authorization the policyholder needs to take the claim form from the TPA and send it to the Insurer/ TPA
• When you send this form, the TPA/Company issues a pre-authorization letter to the hospital once the verification is completed
• As a part of the discharge procedure, you also need to sign and verify the hospital discharge papers  and pay off any extra medical expenses charged by the hospital
• Once the documentation is completed and the authorization is provided you can avail cashless hospitalization services, else you can avail of the treatment and get claim reimbursement for expenses later on
• If all the documents and details provided as per the process your cashless claim will be processed else you can also file  for reimbursement

Documents Required for Claims

The insurer may ask for the following documents at the time of claim settlement:

• Signed and filled claim form
• ID proof of the insured patient/medical bills in original/ medical practitioner’s prescription advising hospitalization
• Operation theatre notes/discharge summary/Invoice of the implants
• Payment receipts and all the diagnostic reports
• Medico-legal report ( if asked by the insurer)
• Bank NEFT Details for money transfer
• KYC details of the customer
• More documents as per the case, if need be

For any queries and further claim assistance, you can email us at care@policybazaar.com or call us at 1800-708-8787.

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