Group Insurance 406 views July 10, 2021

Kotak Corona Kavach Group Policy

Kotak Corona Kavach Group Policy provides you financial protection against the medical expenses arising out of COVID-19. This policy provides your coverage for 3 ½ months, 6 ½ months and 9 ½ months. You can choose your policy period as per your preference. Kotak Corona Kavach Group Policy sum insured ranges from INR 50,000  to INR 5,00,000. Read this page further and know more about the Kotak Corona Kavach Group Policy coverage.

Kotak Corona Kavach Group Policy Covid Hospitalization Cover

Under this policy, any medical expenses incurred for the treatment of COVID shall be covered. COVID diagnosis must be done in a government-authorized diagnostic center. The insurer shall also cover the expenses incurred on the treatment of any comorbidity along with the treatment for COVID, up to the sum insured as specified in the policy schedule. The coverage includes:

  1. Room Rent, Boarding, Nursing Expenses
  2. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses
  3. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees
  4. Cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, diagnostic imaging modalities, PPE Kit, gloves, mask and such similar other expenses
  5. Road ambulance expenses, subject to a maximum of INR 2,000 per hospitalization. This also includes the cost of the transportation from one hospital to another as prescribed by the Medical Practitioner

Note: Hospitalization expenses are admissible for the claim only if the stay is for a minimum of 24 hours.

Home Care Treatment Expenses: If you are receiving the COVID treatment at home upon positive diagnosis, which in normal course would require care and treatment at the hospital, the insurer shall cover such expenses. Home Care Treatment coverage is subject to the following conditions:

  1. Home Care Treatment is taken at home for up to 14 days
  2. The medical practitioner has advised you to undergo treatment at home
  3. There should be a continuous active line of treatment with the monitoring of the health status by a medical practitioner per day
  4. Daily monitoring charts including records of treatment must be administered and duly signed by the treating doctor
  5. Cashless or reimbursement facility is offered under Home Care Treatment
  6. In case you seek Home Care Treatment from a non-network provider, the claim shall be subject to prior approval from the insurer.

Under Home Care Treatment, the insurer shall cover the following:

  1. Diagnostic tests done at home or diagnostics center
  2. Medicines prescribed in writing
  3. Consultation charges of the medical practitioner
  4. Nursing charges
  5. Medical procedures limited to parenteral administration of medicines
  6. Cost of the Pulse oximeter, Oxygen cylinder and Nebulizer

AYUSH Treatment: The insurer shall cover the medical expenses incurred for in-patient treatment for COVID in a government- authorized AYUSH Hospital under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines.

Pre-Hospitalization: Any medical expenses incurred due to COVID or related to any admissible hospitalization/home care treatment shall be covered for a fixed period of 15 days before the date of admission to the hospital.

Post-Hospitalization The insurer shall indemnify post-hospitalization medical expenses for a fixed period of 30 days from the date of discharge from the hospital.

Kotak Corona Kavach Group Policy Optional cover

You can opt for the Hospital Daily Cash optional cover by paying an extra premium. If you opt for this additional coverage, the insurer shall pay you 0.5% of the sum insured per day for every 24 hours of continuous hospitalization. The benefit shall be payable to you for up to 15 days during a policy period in respect of every insured person.

Waiting Period

The insurer shall not make any payment under this policy till the expiry of the 15-day waiting period. So, any expenses related to the treatment of COVID shall not be covered within 15 days from the date of the policy commencement

Exclusions from Kotak Corona Kavach Group Policy

The insurer shall not make any payment under this policy, in respect of the following:

  1. Medical expenses related to any admission primarily for diagnostics and evaluation purposes
  2. Medical expenses related to any admission primarily for enforced bed rest and not for receiving treatment.
  3. Dietary supplements and substances that can be purchased without prescription
  4. Expenses related to any unproven treatment, services and supplies
  5. Expenses in relation to COVID where it has been diagnosed before the policy start date.
  6. Expenses incurred on Day Care and OPD treatment
  7. Diagnosis /Treatment outside the geographical limits of India
  8. Testing done at a diagnostic center not authorized by the Government

Note: All covers under this policy shall cease if you travel to any country placed under travel restriction by the Government of India.

Kotak Corona Kavach Group Policy Eligibility Criteria

You can purchase this policy if you meet the following age criterion:

  1. Minimum Age – 18 years
  2. Maximum Age – 99 years

If your age comes under the higher age criteria, you can purchase this policy for your family members without covering yourself. You can cover your spouse, parents, parents-in-law, dependent children (i.e. natural or legally adopted) between the age of 1 day to 25 years.

Note: Financially independent children with age of more than 18 years won’t be covered under this policy.

Kotak Corona Kavach Group Policy Claim Procedure

You can file a claim under Kotak Corona Kavach Group Policy if you follow the steps shown below:

Notify the Insurer

Call the helpline number and notify the insurer about the hospitalization. In case of an emergency hospitalization/cashless home care treatment, notify within 24 hours. Whereas, in case of a planned hospitalization, notify at least 48 hours before admission to a hospital.

Cashless Claim Process

  1. Visit any of the network hospitals
  2. Show your health card and ID proof to seek cashless medical treatment
  3. Fill in the cashless request form available and submit it to the hospital
  4. The network hospital shall send the cashless request form to the company/TPA for authorization.
  5. Upon getting the approval, the insurer will issue a pre-authorization letter to the hospital
  6. At the time of discharge, you need to verify and sign the discharge papers, pay for non-medical and inadmissible expenses

Reimbursement Process

In case of denial of a cashless claim, you can apply for reimbursement by submitting the following documents:

  1. Duly filled and signed claim form
  2. Copy of your passport, if available (All pages). Otherwise, submit any other photo identity if you do not own a passport
  3. Copy of Medical practitioner’s prescription advising admission
  4. Original bills with the itemized break-up
  5. Payment receipts in original
  6. Copy of discharge summary including complete medical history of the patient along with other details.
  7. Copy of investigation reports including test reports from the authorized diagnostic center for COVID
  8. Copy of OT notes or Surgeon’s certificate, if applicable
  9. NEFT Details (to enable direct credit of claim amount in the bank account) and a canceled cheque
  10. KYC proof, where the claim amount is above INR 1 Lakh
  11. Copy of PAN Card
  12. Legal heir/succession certificate, if applicable
  13. Any other relevant document required by insurer/TPA for assessment of the claim

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