Comprehensive Health Insurance - Kotak Health Premier Plan

A comprehensive health insurance policy that comes with protection plus rewards and value added benefits to help you stay fit.

Key benefits

In-patient Treatment
Medical expenses like room rent, ICU charges, operation theatre charges, doctor’s fees, etc. arising out of minimum 24 hours of hospitalization will be covered

Day Care Treatment
Medical expenses incurred for listed 405 day care procedures will be covered which require less than 24 hours hospitalization

Pre and Post-Hospitalization Medical Expenses
Pre & post hospitalization medical expenses upto specified number of days prior to and after discharge based on the plan opted will be covered.

Restoration Benefit
There will be a 100% restoration of the Base Sum Insured once in a policy year in case the Base Sum Insured and Cumulative bonus is insufficient due to previous claims. In case of accident related claims, restoration will be applicable from first claim onwards. This restored amount can be used for all future claims not related to the same illness for which a claim has been for the same Insured Person.

Cumulative Bonus
Cumulative Bonus can be earned upto 50%/ 100% of the sum insured as per plan opted in case of a claim free year at 10% per year. There will be no reduction in Cumulative Bonus in case of a claim.

Annual Health Check-up
The policy includes one health check-up for each Insured Person above 18 years of age for specified tests at no additional cost. Availing the health check-up will not impact the Base Sum Insured or the Cumulative Bonus. This will be offered regardless of any claim in the Policy.

Second E-Opinion Cover
Policy will facilitate to avail of Second E-Opinion on medical condition occurring during policy period. The opinion can be availed multiple times during the policy period

Ambulance Cover
Policy will cover ambulance expenses for transportation to the hospital in case of an emergency.

Organ Donor Cover
In-patient hospitalization expenses of the donor in case of an organ transplant will be covered.

Alternative Treatment
Policy covers in-patient medical expenses related to Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy systems.

Domiciliary Hospitalization
Policy covers medical expenses for treatment taken at home on the advice of the medical practitioner

Other Covers

The policy comes with a host of other covers which are in built or available as an optional cover (on payment of additional premium) depending on the plan chosen.

Hospital Daily cash: It will pay a specified daily cash amount from day one in case the hospitalisation extends for at least 3 consecutive days.

Convalescence Benefit: This benefit pays a lumpsum specified amount in case the hospitalisation exceeds for a minimum period of 10 consecutive days.

Home Nursing Benefit: This cover pays for the services of a qualified nurse at the residence of the insured after discharge from hospital.

Daily Cash for Accompanying an Insured Child: It will pay a specified daily cash amount from day one in case the hospitalization of an Insured child extends for at least 3 consecutive days.

Compassionate Visit: This benefit pays for the cost of return journey of Insured’s immediate relative from place of residence to hospital.

Air Ambulance Cover: It will cover expenses for ambulance transportation in an airplane or helicopter for emergency life threatening situations.

Maternity Covers  (All the below 3 covers need to be taken together)

  • Maternity Benefit: It covers medical expenses for the delivery of insured’s child or lawful termination of pregnancy. Cover is available for 2 deliveries across all policy years. Pre and post-natal expenses are covered.
  • New Born Baby Cover: It covers medical expenses incurred on the insured’s new born baby.
  • Vaccination Expenses: It will cover the vaccination expenses incurred on the new born baby. The expenses will be covered from the birth till the baby completes 2 years

Product UIN: KOTHLIP21065V032021

Features

Eligibility
Entry Age - 91 Days for Child and 18 Years for Adult
Maximum Entry Age for Adult - 65 Years
Maximum Entry Age for Child - 25 Years, after which the Child will be considered as an Adult
Exit Age/Renewal - The Policy provides for life-long renewal
Policy Period - 1/2/3 Years
Policy Type - Individual/Family Floater

Relationships covered
Self, Spouse, natural or adopted dependent children, parents, parents-in-law and siblings, Employer-Employee. Natural/Appointed Guardian can also take insurance for minor under their guardianship.
A Family Floater policy can cover a maximum of 2 adults and 3 dependent children under a single policy.

Waiting period for Pre-existing Diseases - As per Plan opted

Key Discounts

  • Long Term Discount
    • 2 year policy - 2.5%
    • 3 year policy - 5%
  • Family Discount (Not applicable for Floater Policies)
    • 2 eligible members - 2.5%
    • More than 2 members - 5%
  • Cross Sell Discount(Applicable if the policyholder has one live policy) – 10%

Pre-policy Medical check-up

The customer might have to undergo Medical tests based on the underwriting guidelines issued by the company from time to time. Medical tests will be facilitated by us and conducted at our network of diagnostic centers. The validity of such tests will be up to 30 days. The details of the medical test and the center at which such tests shall be conducted will be informed to you before the medical examination.

Zone Classification

Now the premium you pay and co-pay option is determined based on the city where you reside.

Applicable Zone Treatment Taken at Co-payment applicable
Zone II Zone I 10%
Zone III Zone I 20%
Zone III Zone II 10%

 

  • Zone Classification:
    • Zone I: Mumbai (including Thane and Navi Mumbai) and Delhi (including NCR areas).
    • Zone II: Kolkata, Hyderabad, Chennai, Pune, Bangalore and Gujarat.
    • Zone III: Rest of India excluding the locations mentioned under Zone I & Zone II.
    • Identification of Zone will be based on the city of the Proposer
    • A single zone shall be applicable to all members covered under the Policy
    • Customer can also select a Zone higher than that of the actual Zone on payment of relevant premium at the time of buying the Policy or at the time of Renewal


    Note:

    • Dependent Child under family floater policies after completion of 25 Years shall be considered as adult for premium computation.
    • Avail tax benefit up to ₹ 25,000 for people below 60 years and ₹ 30,000 for senior citizens u/s 80D*.
    • In case of multi-year health insurance policies, i.e. policies having tenure of more than one year, the deduction u/s 80D shall be allowed on proportionate basis for the number of years for which health insurance cover is provided, subject to the specified limits.
    • 80D benefit will not be available if any member other than self, spouse, dependent children, parents covered under Family Floater Policy.
    • In case of Individual Policy, if any member other than self, spouse, dependent children, parents are covered then 80D benefit will not be available to these members.

     

    * Tax Benefit mentioned herein is subject to the fulfilment of conditions mentioned in the Income Tax Act, 1961

Health & rewards

Now get rewarded for taking care of your health/ fitness through regular preventative and fitness habits. You can earn reward points for the activities mentioned below. These points can be redeemed in accordance with the redemption terms and conditions.

List of Wellness Activities
Sr. No. Activities Points per Insured Points per Floater Policy
1 Health Risk Assessment(HRA) 250/ policy year 500/ policy year
2 Health Check-Up 500/ policy year 1500/ policy year
3 Preventive Health Check-Up 250/ per test 1500/ policy year
List of Fitness Activities
Sr. No. Activities Reward Points
A Participation in Professional sporting events like Marathon/ Swimathon/Triathlon, etc. 500 Points/Event and 1000 Points/Policy Year
B Gym/Yoga Membership for 1 Year 1000 Points/Policy Year
C Sports Activity Membership (Swimming/Tennis/Badminton) for 1 Year 1000 Points/Policy Year
D Share your Fitness story 250 Points/Policy Year
E Winning Health Quiz/ Contests organized by the company 250 Points/Event and 500Points/Policy Year

Note:

1.    Health Risk Assessment (HRA): Insured person should be above 18 Years of age.

2.    Health Check-up: The Insured needs to undergo the check up as per Annual Health Check Up cover. If the results are within normal limit, additional 500/ 1500 points will be awarded.

3.    Preventive Health Check-up: If the results are within normal limit, additional 250 points per test and a maximum of 1500 points per family will be awarded.

Redemption of Reward Points:

a) Each Reward Point will be equivalent to Rs. 0.25.

b) These reward points can be redeemed against any of the following options:

    i) Outpatient medical expenses like consultation charges, medicine & drugs, dental expenses, wellness & preventive care.

    ii) Diagnostic expenses and health check-ups through our Network providers.

    iii) In-patient Treatment and Day Care Treatment claims

    iv) Payment of Co-payment

    v) List of Non-medical expenses

    For more details on wellness/fitness activities and terms of redemption please refer to the policy wordings

 

Reward point accumulation table(Individual Policy)
Activities Points Bonus # Total
HRA 250 NA 250
Annual Health Checkup 500 500 1000
Preventive health checkup – Test 1 250 250 500
Preventive health checkup – Test 2 250 - 250
Fitness Activities* 3000 NA 3000
  Total Points 5000
  Total conversion @ Re 0.25/point 1250
Note: # Awarded if all medical test parameters are within normal limit
Note: Please refer policy wordings for list of eligible preventive health checkup tests

Activities
Reward points Maximum Eligible Total
Marathon 8 runs 4000 1000 1000
Gym Membership 1000 1000 1000
Yoga Membership 1000
Swimming 1000 1000 1000
Tennis 1000
Total 8000 3000 3000

Note:

Maximum 5,000 reward points per Insured Person in case of Individual Policy and a maximum of 10,000 reward points per family in case of Floater Policy in a Policy Year can be earned.

Value Added Benefits
The benefits listed below will be applicable as per the plan opted for.

VA 1 VA 2 VA 3
Online customer profile Online customer profile Online customer profile
Doctor directory Doctor directory Doctor directory
Doctor appointment Doctor appointment Doctor appointment
Online Pharmacy/ Online Diagnostics
tests booking
Online Pharmacy/ Online Diagnostics
tests booking
Online Pharmacy/ Online Diagnostics
tests booking
Health tips/ articles Health tips/ articles Health tips/ articles
Home health Home health Home health
  E-consultation E-consultation
    Dietician/ Nutritionist opinion

Note: The activities may attract additional charges payable directly to the vendor.
Availing the said value added benefits will not impact the Sum Insured or the eligibility for Cumulative Bonus.

Optional Covers

Advantage Plan:

  • Home Nursing Benefit
  • Daily Cash for Accompanying an Insured Child
  • Compassionate Visit
  • Critical Illness Cover (Available for Age 18 years and above)
  • Personal Accident Cover
  • Cap on Room Rent

 

Edge and Elite Plans:

  • Compassionate Visit
  • Maternity Benefit* (with 3 year waiting period)
  • New Born Baby Cover* ( with 3 year waiting period)
  • Vaccination Expenses* ( with 3 year waiting period)
  • Air Ambulance Cover
  • Critical Illness Cover (Available for Age 18 years and above)
  • Personal Accident Cover

Register a Claim/Claim Process

Cashless Claim

  • Take a pre-authorization in case of a planned hospitalization by informing us 48 hours prior to admission.
  • In case of unplanned hospitalization, intimate us about your claim by calling 1800 266 4545 within 24 hours of admission
  • Visit any of our network hospitals & use our Policy Certificate to avail cashless facility.

Re-imbursement Claim

  • Intimate us by calling 1800 266 4545 immediately on hospitalization.
  • Settle bills directly in the hospital & collect all relevant documents.
  • Submit all original documents to us within 30 days of discharge. List of applicable documents is available on our website: www.kotakgeneralinsurance.com

Note: All claims will be processed subject to Policy terms & conditions available in the Policy wordings
Reward Points Accumulation
Collect the relevant reports/ bills/ certificates after undergoing the tests or undertaking the activity.
Send us the relevant reports for the tests and/ or receipts/ bills for the specific activities which you have undergone.
To track your reward points, call us on 1800 266 4545 or email us at care@kotak.com
Reward Points Redemption

  • Send the original bills, test reports if any along with the duly completed redemption form to Kotak Mahindra General Insurance Company Ltd., 8th Floor, Zone IV, Kotak Infiniti, Bldg. 21, Infinity IT Park, Off WEH, Gen. AK Vaidya Marg, Dindoshi, Malad (E), Mumbai – 400097. India.
  • To track the redemption status, call us on1800 266 4545 or email us at care@kotak.com

Waiting Period/Exclusions

For a smooth and hassle-free claims experience, it is important to understand the exclusions/ waiting period in your policy.

30 Day Waiting Period
Expenses related to treatment of  any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident. This exclusion also doesn’t apply if the Insured Person has continuous coverage for more than twelve months.

Specified disease/ procedure Waiting Period
This includes medical expenses incurred for certain specified illnesses or conditions like Hernia, Fissures/Fistula, Arthritis, Gout etc. during the first 2 consecutive years of the commencement of the policy.

Pre-existing Disease Waiting Period
Any Pre-Existing Disease will not be covered until waiting period as per Plan opted for as elapsed.

Permanent Exclusions
Treatment for alcoholism, drug or substance abuse; intentional self-injury; cosmetic surgery; Expenses related to any, unproven treatment; Expenses related to sterility and infertility, claim related to breach of law with criminal.
For a complete list of permanent exclusions, please refer to the policy wordings on our website.

Terms of Cancellation

  • The policyholder may cancel this policy by giving 15days' written notice. For Policyholder’s initiated cancellation, the Company would compute refund amount as pro-rata (for the unexpired duration) premium. This would further be deducted by 25% of computed refundable premium.
    No refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the insured person under the policy.
  • The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of material facts, fraud by the insured person by giving 15 days' written notice and there would be no refund of premium.