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About Kotak Health Premier - a comprehensive health insurance policy

A comprehensive medical insurance policy also known as comprehensive health insurance that comes with protection plus rewards and value added benefits to help you stay fit. Get access to wide range of health insurance plans as well as multiple benefits on your health insurance policy like In-patient Treatment, Day Care Treatment, Pre and Post-Hospitalization Medical Expenses, Restoration Benefits, Cumulative Bonus, Annual Health Check-up, Ambulance Cover, Hospital Daily Cash, Ambulance Cover and many more.

Refer policy wordings for more information.

Coverage Details

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. The complete list is available on our website www.kotakgeneral.com.

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 made 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 free health check-up for each Insured Person above 18 years of age for specified tests. 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 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. The policy comes with a host of other covers which are either inbuilt 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 hospitalization extends for at least 3 consecutive days.

Convalescence Benefit
This benefit pays a lumpsum specified amount in case the hospitalization 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 Accompanyingan 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.

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.
Note: All the above 3 covers need to be taken

CriticalIllness Cover
This is a benefit cover which provides lumpsum benefit in the event of happening of 18 listed critical illnesses. Benefit is available over and above the Base Sum Insured.

Personal Accident Cover
This is a Benefit cover which provides lumpsum benefit in the event of Accidental Death/ Permanent Total Disablement Benefit is available over and above the Base Sum Insured.

Cap on Room Rent
Policy holder can opt for a capping of room rent and will be entitled for a discount in premium. Claim will be paid based on a rateable proportion based on the actual and eligible room rent.

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 the 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 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, Claims related to breach of law with criminal intent.

For a complete list of permanent exclusions, please refer to the policy wordings.

How to Claim?

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, subject to fulfilling cashless claims criteria.

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.kotakgeneral.com

Note: All claims will be processed subject to Policy terms & conditions available in the Policy wordings.