Kotak General Arogya Sanjeevani Policy

Kotak General Arogya Sanjeevani Policy

  • Individual
  • Family
Kotak General Arogya Sanjeevani Individual Quotes

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Kotak General Arogya Sanjeevani Quotes for Family

Kotak General Arogya Sanjeevani Family health insurance plans provide coverage for the entire family within the scope of a single health plan. find quotes, compare & buy Kotak General Arogya Sanjeevani Quotes for Family

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Highlights of Kotak General Arogya Sanjeevani Policy

  • The minimum sum insured isRs.1 Lac and maximum sum insured isRs.5 Lacs (in multiples ofRs.50,000)
  • On Individual basis – Sum Insured shall apply to each individual family member
  • On Floater basis – Sum Insured shall apply to the entire family

Kotak General Health Insurance Review

Kotak General Health Care Insurance
Kotak General Insurance sum insured
2 lac - 25 lacs
Incurred Claims Ratio *
47.00%
Kotak General Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio **
100.00%
List of network hospitals
3900+ hospitals
Number of policies issued *
349,931
Maximum family floater coverage
Self, Spouse + dependent children + parents
Number of lives covered *
4,39,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Kotak General Arogya Sanjeevani Policy benefits

  • Eligibility
  • Coverages
  • Exclusions

Eligibility Criteria of Kotak General Arogya Sanjeevani Policy

  • The minimum entry age is 18 years and the maximum entry age is 65 years.
  • Persons Covered:
    Policy can be availed for Self and the following family members
    legally wedded spouse.
    Parents and Parents-in-law.
    Dependent Children (i.e. natural or legally adopted) between the ages 3 months to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals
  • Policy Period :1 year
  • Portability :Offers portability option to other health insurance policies

Coverages of Kotak General Arogya Sanjeevani Policy

  • Hospitalisation & Day Care Treatments :In-patient Hospitalisation and Day Care Treatments are covered upto the opted Sum Insured subject to the sub-limits mentioned below.
  • Pre and Post-Hospitalization Medical Expenses :Pre & post hospitalization medical expenses upto specified number of days prior to and after discharge based on the plan opted will be covered.
  • Ambulance Charges :MaxRs.2000 per hospitalization
  • Pre & post Hospitalization :30 days Pre Hospitalization & 60 days Post Hospitalization expenses
  • AYUSH Benefit :Expenses incurred on hospitalisation under AYUSH treatment
  • Cumulative Bonus :Cumulative Bonus of 5% of the Sum Insured, upto a maximum of 50% will be provided for each claim free year, It will get reduced in case of Claim at the same rate.
  • Sub Limits:
    Sublimit for room/doctors fee:
    For hospitalization expenses like room, boarding, nursing expenses up to 2% of Sum Insuredor a maximum ofRs.5,000 per day.
    ICU/ICCU expenses will also be provided up to 5% of sum insuredor a maximum of Rs.10,000 per day.
    Sub-limit for cataract surgery - 25% sum insuredorRs.40,000/- , whichever is lower per eye, under one policy year.
    Modern treatment methods and Advancements in technology: Up to 50% of the Sum insured.

Exclusions of Kotak General Arogya Sanjeevani Policy

  • Waiting Periods :Pre-Existing Diseases will be covered after a waiting period of forty eight (48) months of continuous coverage
    Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident.
    Specified surgeries/treatments/diseases are covered after specific waiting period of 24 months/ 48 months
    Please refer to the policy wordings for complete details on the waiting period
  • Admission primarily for investigation & evaluation
  • Admission primarily for rest Cure, rehabilitation and respite care
  • Expenses related to the surgical treatment of obesity that do not fulfill certain conditions
  • Change-of-Gender treatments
  • Expenses for cosmetic or plastic surgery

Kotak General Health Insurance FAQ’s

Cashless/Reimbursement requests can be turned down under the following circumstances:

  • If the information provided at the time of cashless request is insufficient to judge the admissibility of the possible claim
  • If the hospitalisation is in a non-network hospital,
  • If the claim attracts any of the standard exclusions of the policy including the pre-existing and waiting period clauses
  • If there is a violation of terms and conditions of the Policy
  • Policy invalid at the time of claim or sum insured exhausted due to previous claims under the Policy.

In such a case, the hospital will request the Insurance Company to increase the amount approved if needed during the treatment. The request will be assessed by the Insurance Company and additional approval will be given subject to terms and conditions of the Policy and availability of the sum insured.

The following information should be provided while intimating a reimbursement claim:

  • The policy number
  • Name of the policyholder
  • Name and address of the insured person in respect of whom the request is being made
  • Nature of illness or injury, and the treatment / surgery taken
  • Name and address of the attending medical practitioner
  • Hospital where treatment/surgery was taken
  • Date of admission and date of discharge
  • Any other information that may be relevant to the illness / injury / hospitalisation

The claim documents, duly completed, should be submitted at the following address as early as possible, but no later than 30 days from the date of discharge. Health claims department address:
Family Health Plan Insurance TPA Limited,
Srinilaya – Cyber Spazio, Suite # 101,102,109&110,
Ground Floor,Road No. 2, Banjara Hills,
Hyderabad : 500034, Telangana , India.

Brochure

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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