Kotak General Secure Shield Insurance

Kotak General India health insurance

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Kotak General Insurance is a 100% subsidiary of India’s fastest growing bank, Kotak Mahindra Bank Ltd and was established to service the growing non-life insurance segment in India. At Kotak Mahindra General Insurance, they value customer service, quality and innovation above everything else. The company aims to cater to a wide range of customer segment & geographies offering an array of non-life insurance products like Motor, Health, etc.

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 Insurance has a national footprint of 13 branches spread across India (as on 31st Dec 2017) and an employee base of 354 professionals. (as of 31st Dec 2017) As a practice, the company seeks to provide a differentiated value proposition through customized products & services leveraging state of art technology & digital infrastructure.

Health Premier is a Comprehensive Health Insurance policy that comes with protection plus rewards and value added benefits to help one stay fit. In today's stressful world, critical illnesses are becoming more and more common. With Kotak Secure Shield, you can protect yourself and your family against the expenses that come with treating these illnesses, without having to compromise on the quality of healthcare.

How to Claim Under the Policy

Toll Free Call at : 1800 266 4545 (Toll free)
E-Mail at : care@kotak.com
Website Address : www.kotakgeneralinsurance.com
Write at : Kotak General Insurance Co Ltd, 8th Floor, Zone IV, Kotak Infinity, Bldg. 21, Infinity IT Park, Off WEH, Gen. AK Vaidya Marg, Dindoshi, Malad (E), Mumbai – 400097. India

Cashless Claim

  • Take a pre-authorization in case of a planned hospitalization by informing Kotak 48 hours prior to admission
  • In case of unplanned hospitalization, intimate Kotak about your claim by calling 1800 266 4545 within 24 hours of admission
  • Visit any of the network hospitals & use our Policy Certificate to avail cashless facility, subject to fulfilling cashless claims criteria

Re-imbursement Claim

  • Intimate Kotak by calling immediately on hospitalization 1800 266 4545
  • Settle bills directly in the hospital & collect all relevant documents
  • Submit all original documents to Kotak within 30 days of discharge
Feature Highlight Remarks USP
Product Room rent capping No Additional discount can be given if one opts for room rent cap
Co-Payment No  
Restoration Benefit (100% of Sum Insured)
No additional premium
No endorsement request
Auto Trigger of benefit in below scenarios:
Applicable from 1st Accidental claim
Applicable from 2nd non-Accidental claim
Annual Health Check Up 1 free Health Check Up for each adult in each policy year Facility provided regardless of any claim in current policy or previous year KGI policy
Organ Donor Cover up to Sum Insured Expenses covered of Donor and Receipient
Ambulance Cover 20k and 50k per annum for Sum Insured up to 20lacs and higher respectively Ambulance cover (amount) is on per annum basis and not per claim thereby covering any single instance where Ambulance cost is high
Cumulative Bonus 10% every year - 50% & 100% of base policy for Sum Insured up to 20lacs & 100% respectively No reduction in Cumulative Bonus in case of a claim
Additional Discounts Distributors authority
No dependency on Insurance co.
1. Cross-sell discount (using any live KGI policy) - 10%
2. Applying Room Rent Capping - 5%
3. Long Term Policy tenure - 2.5% and 5% for 2 and 3 years
Pre-policy Medical test No medicals upto 65 years Subject to:
Sum Insured not more than 25lacs and
No PED is declared by the prospect in Proposal Form
Clear UW guidelines No loading on proposals basis medical conditions Either a proposal is accepted or declined - but no Loading
Highly Competitive Pricing for age group 20-45yrs and Sum Insured more than 7.5lacs in all combinations
High BMI range allowed up to 39 it is up to 30 in most insurers
Add this with no loading policy - gives you more range of customers at no higher premium Systems
Operational Support Quote generation
Sharing quote on Whatsapp/Message
Digitial payment link generation
Online policy issuance
No Proposal form required
Agent Portal and BPOS has all these feature

List of Bharti AXA health insurance policies

Key Features:
  • Kotak Health Care comes to you in the form of three options; Excel, Premium and Prime.
  • Waiting Period: Pre-Existing Disease :4 Years (for all age groups)
Key Features:
  • Entry Age : 91 Days for Child and 18 Years for Adult
    Maximum Entry Age for Adult - 65 Years
    Maximum Entry Age for Child - 25 Years, after which the Child will be considered as an Adult
Key Features:
  • Ambulance Charges: MaxRs.2000 per hospitalization.
  • AYUSH Benefit :Expenses incurred on hospitalisation under AYUSH treatment.
Key Features:
  • Day care Treatment: Covers medical expenses arising out of listed 405 day care procedures
  • In Patient Treatment :Covers medical expenses arising out of minimum 24hrs of hospitalization
Key Features:
  • Entry Age : Minimum: 18 years Maximum: 65 years.
  • Policy Period : 1, 2 & 3 years.
Key Features:
  • Policy can be availed by persons between the age of 18 years up to 65 years as Proposer.
Key Features:
  • Individuals between the age of 18 yrs to 65 yrs

Kotak General Health Insurance FAQ’s

The pre-authorisation form is the form that is sent to the insurance company to avail of cashless service, after being duly filled by the insured and the attending doctor. This form is available at the insurance helpdesk/cashless counter in the hospital.

Network hospital refers to all such hospitals/nursing homes in which the cashless facility may be availed by the insured for treatment as provided herein. The list of network hospitals is subject to amendment from time to time and shall be available with the Company.

Yes, you are eligible to lodge he claim with us. Please note, the hospital/nursing home should meet the criteria as defined in the Policy. Your claims will be assessed on reimbursement basis subject to other terms and conditions of the Policy.

The health policy covers medical expenses incurred towards the ailment, subject to the condition that the ailment is admissible under the Policy. Following are the broad heads of expense:

  • Hospital (room & boarding and operation theatre) charges
  • Fees of surgeon, anaesthetist, nurse, specialists
  • Cost of diagnostic tests, medicines, blood, and oxygen; as long as these are medically necessary

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.

The pre-hospitalisation claim documents duly completed should be submitted at the following address within 15 days from the date of discharge. All post-hospitalisation claim documents should be submitted within 30 days from the date of completion of treatment, or expiry of the post-hospitalisation period as per the Policy, whichever is earlier.

The following documents are required for the processing of reimbursement claims:

  • Claim form duly filled and signed by the insured and attending doctor
  • All treatment papers of current ailment mentioning first symptoms and date of occurrence of the ailment, previous treatment papers (if any)
  • Discharge card from the hospital
  • All original medical investigation reports (viz. X-ray, ECG, blood test, etc.)
  • Original hospital bills and receipts
  • Original bills of chemist, medical practitioner, medical investigation, etc. supported by prescriptions
  • NEFT details: Cancelled cheque of policy holder, copy of blank passbook/statement of policy holder if cancelled cheque does not contain name of the policy holder, and copy of the PAN card of the policy holder
  • Know Your Customer (KYC) details viz. address proof, photo ID, and 2 recent passport size photographs (applicable for claim amounts overRs.1 lakh)

You need to submit the original documents to one of the insurance companies. After settlement of the claim, you need to obtain certified true copies of the documents along with a settlement letter and submit the same to the other insurer for the claim.

  • Reimbursement Claim: These claims shall be processed within 15 working days from the receipt of complete documents. Complete documents means submission of all medical documents as mentioned in the claim procedure along with all previous treatment papers (if any).
  • Cashless Claims: We shall convey our decision on the cashless mode within 6 business hours from the receipt of complete details. Complete details means submission of pre-authorisation form with information viz. provisional / final diagnosis, estimated treatment expense, length of stay & past medical history (if any) and duly signed by the treating doctor.

It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.

Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs

A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.

Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.

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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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