Claim Process Kotak General Insurance

Cashless claim: “Cashless claim” means when insured gets hospitalized in a network hospital/nursing home, he or she, need not have to pay for the covered medical expenses, with the hospital/nursing home, up to the sum insured specified under the Policy, provided the claim is intimated and Insurance company has approved the request as per the terms and condition of the Policy. The Insurance Company, co-ordinates with the hospital/nursing home directly and settles the bill after the discharge of the patient. All non –medical expenses and/or co-payment or medical expenses over and above the sum insured has to be borne by insured at the time of discharge from hospital.

Reimbursement claim: “Reimbursement claim” means, insured gets hospitalized in any of the hospital/nursing home within India, which meets the hospital criteria as mentioned in the Policy, pays the medical expenses at the time of discharge and lodge the claim with insurance company for the amount due under the Policy. Insurance company would process the claim as per the terms of the Policy and reimburses the covered medical expenses to insured if the claim is admissible.

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 theater) charges
• Fees of surgeon, anesthetist, nurse, specialists
• Cost of diagnostic tests, medicines, blood, and oxygen; as long as these are medically necessary

Following information should be provided while intimating the 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/ Hospitalization.

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. However, if the insured chooses to submit the bills in part, the same is also accepted.
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