Kotak Arogya Sanjeevani Policy Coverage

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      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

      Criteria

      Specifications

      Sum Insured

      Rs 1 lakh to Rs 5  lakh

      Entry Age Criteria

      18-65 years

      Dependent Children

      3 months-25 years

      Co-pay

      5%

      ICU/ICCU Charges

      Covered

      Cataract Surgery

      Covered

      Pre-existing diseases

      48 months/4-years

      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.

      FAQs

      Policybazaar exclusive benefits
      • 30 minutes claim support*(In 120+ cities)
      • Relationship manager For every customer
      • 24*7 claims assistance In 30 mins. guaranteed*
      • Instant policy issuance No medical tests*
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      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30-minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881. Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. As per the Insurance guidelines, you are allowed to cancel the policy with-in 15 days from the date of Issuance of policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

      ~Source: Google Review Rating available on:- http://bit.ly/3J20bXZ

      ##On ground claim assistance is available in 114 cities

      Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

      STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.

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      Policybazaar Insurance Brokers Private Limited | CIN: U74999HR2014PTC053454 | Registered Office - Plot No.119, Sector - 44, Gurgaon, Haryana - 122001 Contact Us | Legal and Admin Policies

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