Kotak Mahindra Health Insurance Claim Settlement

Kotak General Insurance’s claim settlement process is simple and quick. The procedure is simple and does not cause any inconvenience to the customer. The insurer is known to have satisfied countless numbers through its fast-paced and easy claim procedures, which is backed by a large number of healthcare facilities. You can file a cashless or reimbursement claim under Kotak General Insurance coverage. The health claim settlement ratio for the insurer is 93 per cent, which is quite good. The claim settlement method that the insurance follows is simple and convenient for policyholders.

Kotak Mahindra Health Insurance

Kotak Mahindra General Insurance is a wholly-owned subsidiary of India’s fastest growing bank, Kotak Mahindra Bank Ltd. The insurance firm was founded in 1985 to satisfy the needs of people in India’s rapidly developing non-life insurance segment. Quality, client service, and innovation are valued above all else at Kotak Mahindra General Insurance. \

Health insurance plans, auto insurance plans, bike insurance plans, house insurance plans, and business insurance plans are among the non-life insurance products offered by the general insurance company, which strives to serve a wide range of customer segments and geographies. Kotak Mahindra General Insurance aims to provide a differentiated value proposition to its tailored policies when it comes to health insurance. Its health insurance plans are specifically intended to meet the diverse needs of all segments of society and provide comprehensive coverage at affordable costs.

Kotak Mahindra Health Insurance Claim Process

A request for payment of medical expenses incurred during the policy term is referred to as a health insurance claim. Payments to the hospital might also be made directly by the insurance company. The insured must submit a claim request to receive health insurance benefits and compensation for medical expenses. We’ve covered both the cashless and reimbursement processes in-depth here.

Claim Process for Cashless Treatment

In more than 6,700+ network hospitals across the country, Kotak General Health Insurance provides cashless hospitalisation. Any policyholder can choose to have their claims paid in cash at a network hospital near them. The following are the steps involved in settling a claim:

• To begin, locate a Kotak General network hospital in the city where you wish to receive cashless services. 
• In case of emergency hospitalisation, notify Kotak General within 24 hours; in case of planned hospitalisation, notify Kotak General 48 hours ahead of time. 
• Remember to bring the cashless treatment card or the policy number and member ID with you when you visit the specified network hospital.
• Show the member ID card/policy number at the Kotak General network hospital’s insurance desk. 
• Fill out the pre-authorization form provided by the hospital. 
• The pre-authorisation form will be forwarded to Kotak General Health Insurance after you have informed the insurer and filled out the form.
• Following an examination and evaluation of the claim details, the Kotak General Health Insurance team will notify the policyholder and hospital of the claim approval or denial. 
• If the claim is approved, Kotak General Health Insurance will cover the medical charges directly. 
• However, if the claim is denied, the policyholder is responsible for paying the expenditures.

Reimbursement Treatment

A policyholder can file a reimbursement claim at both, network and non-network hospitals. The steps in the reimbursement claim process include- 

• The Kotak General should be notified of any scheduled hospitalisation 48 hours before admission. 
• In the event of emergency hospitalisation, the notification must be given within 24 hours of admission. 
• Within 30 days of discharge from the hospital, the policyholder must submit a claim form together with all supporting documentation.
• The claim management team of Kotak General Health Insurance will provide the policyholder with a letter of approval to confirm the approval after conducting an examination of the documents and claim form details.
• The claim will be settled within 15 days after verification. 
• In the event of rejection, the insured person must respond to the insurer’s or insured’s inquiry in order to learn the reason for rejection.

Documents Required for Filing a Claim

• Investigation reports (original)
•  Hospital discharge summary
•  Original bills and receipts 
•  Valid photo ID proof
•  Nature of operation performed mentioned on reports 
•  Test reports along with attending Doctor’s reports 
•  Report of FIR or post mortem, if applicable

Kotak Mahindra Health Insurance Claim Settlement Ratio

The Claim Settlement Ratio is a percentage of the total number of health insurance claims received by an insurance provider during a financial year divided by the number of claims settled. The Claim Settlement Ratio of Kotak General Insurance for FY 2019-20 is 75.45%.

Reviews and Ratings

The policy has an impressive rating of 4.5/5 based on 11 reviews from Policy Bazaar. Insurance Dekho has given the policy a rating of 3.9/5 based on 41 reviews. 

Namita – Kotak is a good insurance company and sells some of the best insurance products on the market. I purchased the Kotak Secure Shield plan last year and till now I’ve not faced any problem with it.

Priyamvada – My friend told me to buy insurance from Kotak and I am grateful to her for giving me this advice. I made the right choice by buying this plan because it offers a large cover at less premium.