Kotak Mahindra Health Insurance Claim Settlement

Kotak Mahindra Health Insurance

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Highlights

4,000+ Network Hospitals

3,49,931 Policies Issued

47% Incurred Claim Ratio

Lifelong Renewability

55.74% Claim Settlement Ratio

In-House Claim Settlement

Claim Settlement of Kotak Mahindra Health Insurance

The claim settlement process of Kotak General Insurance is smooth and fast. The process is quite easy and doesn’t put a policyholder in inconvenience. Backed by a vast number of healthcare facilities, the insurer is known to have settled multiple numbers through its fast-paced and simple claim procedure. When it comes to Kotak General Health Insurance, the two scenarios include, Cashless and Reimbursement. 

  • Claim Process for Cashless Treatment

    Kotak General Health Insurance provides cashless hospitalisation at more than 4000 network hospitals across the country. Any policyholder can opt for cashless settlement of claims at their nearest network hospital. The steps of the claim settlement process include- 

    • First of all, find a Kotak General network hospital in the city where you want to avail cashless treatment
    • Intimate Kotak General within 24 hours in case of an emergency hospitalisation and 48 hours before admission in case of planned hospitalisation
    • While visiting the chosen network hospital, do remember to carry the cashless treatment card or the policy number and member ID
    • Show the card/policy number of the member ID at the insurance desk of the Kotak General network hospital 
    • Duly fill the pre-authorisation form available at the hospital
    • After you have informed the insurer and filled the form, the pre-authorisation form will be sent to Kotak General Health Insurance
    • After the claim details are examined and reviewed, Kotak General Health Insurance team will inform the policyholder and hospital regarding the claim approval or rejection
    • In case the claim is approved, the medical expenses will be borne by Kotak General Health Insurance directly. But, if the claim is rejected, the policyholder will be required to pay the bills
  • Reimbursement Treatment

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

    • In the case of planned hospitalisation, the Kotak General should be informed before 48 hours of admission
    • In case of an emergency hospitalisation, the intimation should be given within 24 hours of hospitalisation 
    • The policyholder is required to submit a claim form with the relevant documents within 30 days of discharge from the hospital 
    • After the investigation of the documents and claim form details is conducted, the letter of approval will be sent to the policyholder by the claim management team of Kotak General Health Insurance to confirm the approval. After verification, the claim will be settled within 15 days
    • In case of rejection, the insured individual is required to respond to the query raised by the insurer or insured to uncover the reason for rejection
  • Documents Needed

    The list of documents required for claim settlement at Kotak General Health Insurance include- 

    • Valid photo ID proof
    • Original investigation reports
    • Post-mortem report (if applicable)
    • Original hospital bills and receipts
    • Pharmacy bills along with the prescription
    • Indoor case papers and duly-filled claim form
    • Treating doctor's report and original consultation notes
    • Nature of operation performed and surgeon's bill and receipt
    • Discharge report

    In case, you have any query, initiate contact at InsuranceDekho at 1800-1205-698. 

  • Incurred Claim Ratio (ICR) of Kotak Mahindra Health Insurance

    The Incurred Claim Ratio or ICR refers to the net claims paid by a health insurer as against the net premiums earned. It is a highly effective approach to find how viable and reliable a health insurer is. ICR reveals the pace of claim procedure and the productivity of the insurance firm in terms of revenue. The incurred claim ratio of Kotak General Health Insurance is 47%, which showcases that it has an ample amount of assets in hand and executing claim process quite smoothly.

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