Frequently asked questions

ABOUT GOQii INSURE+

GOQii Insure+ India’s first ‘outcome based health and life insurance program’ that enables you to get a Health Insurance cover for up to ₹5 lakhs and Life Insurance cover of up to ₹1 lakh by getting healthier on the GOQii App.

Kotak General Insurance is the health insurance provider. Kotak Life Insurance is the life insurance provider.

You can get healthier on the GOQii App by logging in your daily habits such as steps, food intake, water logs, sleep, exercises and others (set by your personal coach) and achieving your daily health targets. This in turn helps you improve your S.A.F.E. score on the GOQii app and enables you to get healthier in the process.

On activating GOQii personal care subscription, you automatically activate the GOQii Insure+ plan of Health Insurance and Life Insurance covers. Every GOQii player (user) that activates their Insure+ plan starts their health journey on the lowest tier of the SAFE score i.e. Sedentary. At this level, you are eligible for a Health Insurance cover of ₹1 Lakh & a Life Insurance cover of ₹1 Lakh. By leading a healthy lifestyle and engaging on the GOQii App, players can improve their SAFE score and progress to Active, Fit and Elite to increase the value of their health insurance cover. On reaching Elite, players are eligible for up to ₹5 lakh Health Insurance + ₹1 lakh Life Insurance Cover.

Refer to the below table to understand the tiers in the SAFE Score.

GOQii SAFE SCORE ELIGIBLE INSURANCE COVER
Sedentary Up to ₹1 lakh Health Insurance + ₹1 lakh Life Insurance Cover
Active Up to ₹2 lakh Health Insurance + ₹1 lakh Life Insurance Cover
Fit Up to ₹3 lakh Health Insurance + ₹1 lakh Life Insurance Cover
Elite Up to ₹5 lakh Health Insurance + ₹1 lakh Life Insurance Cover

If you are unable to maintain your SAFE Score, you will drop down 1 level from your existing tier and will be eligible for the insurance cover under the tier you fall in. (For e.g. If you belong to the Elite Tier and are unable to maintain the minimum SAFE score, you will drop down to the Fit level and will be eligible for health insurance cover of ₹3 lakh Health Insurance + ₹1 lakh Life Insurance Cover at the time of claim).

In case if you are sedentary for more than 60 days, on the GOQii App, you will lose the GOQii Insurance Cover.

At present, Health and life insurance covers are provided to users who have purchased GOQii Smart Vital 2.0 & GOQii Smart Vital 2.0 Max devices under GOQii Insure+ and have activated the coaching subscription plan on the GOQii app.

You can buy GOQii Smart Vital 2.0 & GOQii Smart Vital 2.0 Max from the GOQii Website/Mobile App / Retail Stores such as Croma, Vijay Sales, etc. Online platforms like Amazon, Flipkart, etc.

  • For new GOQii Players who have purchased the new GOQii Smart Vital 2.0 & GOQii Smart Vital 2.0 Max devices, they get a 12 month personal care subscription
  • Existing GOQii Players can avail the GOQii Insure+ program on renewing or purchasing a 12 month insure+ subscription

A 12 month GOQii Insure+ plan includes a personal health coach, certified health experts, tele-consultations with doctors, interactive video coaching, GOQii Cash Rewards, Challenges, GOQii Health Store, and much more.

ACTIVATION & ELIGIBILITY

For new GOQii players

  • Download the GOQii App from the Google Play Store or Apple App Store
  • Login to the GOQii App using your mobile number and the activation code received along with the GOQii Smart Vital 2.0 or GOQii Smart Vital 2.0 Max Kit
  • Insurance plan will be activated automatically post successful activation

For existing GOQii players

  • Go to the ‘my subscriptions’ tab on the GOQii app
  • Tap on the ‘Change Plan’ option
  • Scroll to the ‘Annual’ section and subscribe to the GOQii Personal Care Plan

The Insurance cover is applicable for the age group between 18 to 60 years. Currently, it is available only for Indian citizens.

No. This is an individual plan only available to GOQii players who activate the personal coaching subscription on the GOQii App.

Yes, you can view your insurance details in the GOQii App and also track your SAFE Score based on your healthy habits and engagement with the GOQii app.

Yes, you can view your Health Card in the GOQii App.

The Insurance plans will be valid for a period of 12 months from the date of activation of your personal care subscription.

You can renew the insurance plan by purchasing the 12-month GOQii Personal Care Subscription Plan from the GOQii Mobile App.

There is a 30-day waiting period from the policy start date.

HEALTH INSURANCE: CLAIM PROCESS & REIMBURSEMENT

You can avail a cashless facility for your health insurance claim across 7500+ network hospitals in India.

Yes, under the insurance section in the GOQii App, click on Hospital List and search the network hospital basis city & pincode

In case of reimbursement, you must notify about your hospitalization directly in the GOQii App. However, in case of cashless, you can directly get in touch with the onsite TPA stationed at the network hospital.

PRE-HOSPITALISATION: Medical Expenses covered up to a period of 30 days
Pre-hospitalisation expenses are medical expenses that are incurred in 30 days before hospitalisation of the patient.

POST-HOSPITALISATION: Medical Expenses covered up to a period of 60 days
Post-hospitalisation expenses are medical expenses that are incurred in 60 days after the patient is discharged from the hospital.

Day Care Treatment Covered
Day-care involves medical treatment, operation and surgeries for patients that require hospitalisation for less than 24-hours.

Emergency Ambulance Covered up to ₹2000/claim
Emergency Ambulance covers the ambulance expenses for transportation to the hospital in case of an emergency.

No Room Rent Limit for Fit and Elite GOQii Players
For Sedentary & Active GOQii Players, Room Rent Capping is applicable.
Normal Rooms – ₹2,000/day | ICU Rooms – ₹4,000/day.

If the room rent exceeds the limit prescribed, the medical expenses payable will be on a pro-rata basis. This is not applicable for medicines/pharmacy, medical consumables and medical implants, which will be payable in actuals.

Donor expenses covered
Any expenses that refer to the organ transplant which is recommended and approved as part of the medical expenses for the policyholder.

Inpatient treatment covered
Any expenses that refer to the organ transplant which is recommended and approved as part of the medical expenses for the policyholder.

  • Specified disease/ procedure waiting period (Code – Excl02)
  • Sub-Limits: Cataract – Per eye ₹20,000/-
  • In Patient Treatment covered

Pre-Existing diseases are covered only after 24 months
There is a 24 months waiting period for pre existing diseases to be covered. This means, any claim of a pre-existing illness won’t be covered before 24 months since the start of the policy issued.

Expenses and direct complications related to the treatment of a pre-existing Disease (PED) shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with the insurer.

30 Day Waiting Period
There is a 30 Day Waiting Period from the policy start date.

Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.

Only 12 months of waiting for specific diseases / procedure
Expenses related to the treatment of the listed conditions/ surgeries/treatments shall be excluded until the expiry of 12 months of continuous coverage after the date of inception of the first policy.

This exclusion shall not be applicable for claims arising due to an accident. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases, then the longer of the two waiting periods shall apply.

List of excluded diseases/procedures

  • Cataract
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • All types of Hernia, Hydrocele
  • Fissures and/or Fistula in anus, hemorrhoids/piles
  • Arthritis, gout, rheumatism and spinal disorders
  • Joint replacements unless due to Accident
  • Sinusitis and related disorders
  • Stones in the urinary and biliary systems
  • Dilatation and curettage, Endometriosis
  • All types of skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant
  • Dialysis required for chronic renal failure
  • Tonsillitis, adenoids and sinuses
  • Gastric and duodenal erosions and ulcers
  • Deviated nasal septum
  • Varicose Veins/ Varicose Ulcers

Tap to find out the list of permanent exclusions from the policy.

Following things are not excluded in this policy:

  • Cataract
  • Investigation & Evaluation
  • Rest Cure, rehabilitation and respite care
  • Obesity/ Weight Control
  • Change-of- Gender treatments
  • Cosmetic or plastic Surgery
  • Hazardous or Adventure sports
  • Breach of law
  • Excluded Providers: Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible.
  • Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
  • Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons
  • Dietary supplements and substances that can be purchased without prescription
  • Refractive Error: Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters
  • Unproven Treatments
  • Sterility and Infertility
  • Maternity
  • Costs of routine medical, eye or ear examinations preventive health check-ups, spectacles, laser surgery for correction of refractive errors, contact lenses, hearing aids, dentures or artificial teeth;
  • Any expenses incurred on prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, crutches, instruments used in treatment of sleep apnoea syndrome or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for bronchial asthmatic condition, cost of cochlear implant(s) unless necessitated by an Accident or required intra-operatively
  • Expenses incurred on all dental treatment unless necessitated due to an Accident
  • Any expenses incurred on personal comfort, cosmetics, convenience and hygiene related items and services
  • Any acupressure, acupuncture, magnetic and such other therapies
  • Circumcision unless necessary for treatment of an Illness or necessitated due to an Accident
  • Vaccination or inoculation of any kind, unless it is post animal bite
  • Intentional self-injury (whether arising from an attempt to commit suicide or otherwise)
  • Treatment relating to Congenital external Anomalies
  • Any treatment related to sleep disorder or sleep apnoea syndrome, general debility, convalescence, run-down condition
  • Costs incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for employment or travel or any other such purpose
  • Any treatment taken outside India
  • Any treatment taken from anyone not falling within the scope of definition of Medical Practitioner. Any treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council
  • Non-allopathic treatment; unless covered under ‘Alternative treatment’
  • Any consequential or indirect loss arising out of or related to Hospitalization
  • Any Injury or Illness directly or indirectly caused by or arising from or attributable to war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority
  • Any Illness or Injury directly or indirectly caused by or contributed to by nuclear weapons/materials or contributed to by or arising from ionising radiation or contamination by radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel
  • All non-medical expenses listed in Annexure III (List I) of the Policy
  • Any OPD treatment will not be covered
  • Medical supplies including elastic stockings, diabetic test strips, and similar products.
  • Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities
  • Treatment such as External CounterPulsation (ECP), Enhanced External CounterPulsation (EECP), Hyperbaric Oxygen Therapy will not be covered unless it forms a part of in-patient treatment in case of hospitalization or part of discharge advice up to the Post hospitalization period as specified in the policy Schedule/ Certificate of Insurance
  • Any physical, medical condition or treatment that is specifically excluded in the Policy Schedule under Important Condition

Claims can be of 2 types

  • 1. Cashless

    Hasslefree and quick

    Cashless claims in health insurance is a mode of claim settlement where the policy holder does not have to pay cash for treatment and the settlement of the bills is taken care of directly between the hospital and the insurance company. To avail cashless facility of up to ₹5 Lakhs (depending on your S.A.F.E. Score), the policy holder must be hospitalised in any of GOQii’s network hospitals.

  • 2. Reimbursement

    Pay yourself first and get it reimbursed later

    Reimbursement claim in health insurance is a mode of claim settlement where the policyholder pays first to the hospital for medical/hospitalisation bills for the availed medical treatment. Then the policy holder can reach out to the insurer and claim reimbursement for the amount paid.

FOR CASHLESS CLAIMS:

In case of cashless, policy holder will have to connect with the onsite TPA stationed in the network hospital at the time of admission

  • Select a network hospital
    Select a networked hospital from the designated network hospital list

  • Connect with onsite TPA
    Connect with the onsite TPA and get yourself admitted to selected hospital

  • Hassle free experience
    Get your treatment done without any hassles

FOR REIMBURSEMENT CLAIMS:

  • 1. Navigate to claims on GOQii App: In case of claims if any, policy holder can go to the Claims Section

  • 2. Fill claim form: In case of a reimbursement claim, policy holder has to fill Claim Forms A & B and upload the required documents in the GOQii App

  • 3. Submit the documents: Additionally in case of reimbursement claim, policy holder will have to mandatorily courier original documents of hospitalization & medical expenses to the Kotak General/TPA address for authentication & processing the claims (Address: Family Health Plan (TPA) Limited, Gr. Floor, Srinilaya Cyber Spazio, Road No. 2, Banjara Hills, Hyderabad, Telangana – 500034; Toll Free – 1800 2664545; Email: care@kotak.com)

    Customer to provide below mentioned Mandatory Claims Documents for smooth claim process:

    • Duly filled and signed Claim form A & B
    • Original Hospital discharge summary
    • Original Chemist bills and receipts
    • All original medical test reports
    • First consultation and follow up treatment papers
    • Canceled cheque with printed name on it of policy holder or pass book in support for claim pay-out is submitted
    • CKYC form, PAN Card and address proof is submitted for claims more than ₹1 lakh
    • Mention email address (registered & alternate) and mobile number in claim form for any claim update communication (email/SMS) from Kotak GI

  • 4. Submit the claim: On successful submission of the claims form & documents, policy holder will be able to see the real-time claim status and queries. In case of any queries, policy holder will have to resolve the same directly with Kotak General & TPA

  • 5. Track status:Customers will be able to see claim status as below:

    • Claim Registered
    • Under Adjudication process
    • Under Investigation
    • Under Query
    • Insurer Approval Awaited
    • Claim Approved
    • Claim Rejected
    • Settlement In Process
    • Payment Processed

  • 6. Payment processed: Get claim amount reimbursed on successful approval

Policyholder will have to directly contact Kotak General Insurance Toll Free Helpline on 1800 2664545 or email: care@kotak.com to resolve their queries.

LIFE INSURANCE: CLAIM PROCESS & REIMBURSEMENT

  • Life Insurance worth ₹1 Lakh is provided to users who have purchased GOQii Smart Vital 2.0 & GOQii Smart Vital 2.0 Max devices under GOQii Insure+ and have activated the subscription plan on the GOQii App.
  • This Life Insurance cover is applicable for age group of 18-60 years
  • In case of death or demise, the sum assured payable is ₹1 Lakh to the nominee of the policy holder.
  • Under this policy, death due to any reason (Natural/Accident) except suicide is covered

For existing GOQii players

  • Go to the ‘my subscriptions’ tab on the GOQii app
  • Tap on the ‘Change Plan’ option
  • Scroll to the ‘Annual’ section and subscribe to the GOQii Personal Care Plan

Register your claim request

  • In the unfortunate event of a policy holder’s death, the death benefit is payable to the nominee of the policy holder.
  • Nominee of the Policy Holders have to contact Kotak Life Insurance Toll Free Helpline on 1800 209 8800 or email kli.claimsmitra@kotak.com
  • All claims must be notified to the Kotak Life Insurance Claims department in writing within 90 days of the date of the death of the member along with the specified documents.

Submit mandatory documents

To process claims smoothly, the nominee will first need to fill the Death Claim form and intimate the Kotak Life Insurance Claims Team. After which, you need to to submit the following list of documents:

  • Original death certificate and related documents based on death
  • Age Proof of Life insured
  • Nominee identity proof and photograph and bank account details
  • Last attending doctor’s certificate and hospital papers (upload through GCP)
  • If the death is due to an accident or any other unnatural cause: (upload through GCP)
    • A certified copy of the FIR filed with the Police authorities
    • A certified copy of the Post Mortem Report/Autopsy Report
    • A certified copy of the Driving License, if death occurred while driving

Claims resulting from suicide within the first year of cover under the policy for all policyholder’s will be disallowed

Suicide within first year

If a member joins the service of the policy holder on or after the date of commencement of the policy, any claim arising as a result of the member committing suicide (whether sane or insane) within first 12 months from the date of commencement of the cover risk under the policy the nominee or the beneficiary of the insured person shall be paid 80% of the total premiums paid till the date of death or the surrender value available as on the date of death whichever is higher, provided the policy is in force.

Foreign Nationals or members working overseas cover subject to underwriting

For Foreign Nationals or members working overseas (including on secondment/deputation) cover will be provided subject to underwriting. Kindly provide details as under:

  • Nationality
  • Current location
  • Whether on payroll of the proposer Company?
  • Whether covered under group insurance plan by the parent company?

If more than 5% members are deputed in non-standard countries for more than 30 consecutive days, the entire cover for these members will be subject to underwriting.