Kotak General Health Care Insurance

Kotak General Health Care Insurance benefits

• Eligibility Criteria of Kotak General Health Care Insurance

  • Entry Age
    • Min 5 years & Max. 65 years (Individual)
    • Min 91 days & Max. 65 years (Floater)
    • Max. 25 years for dependent children
  • Exit Age Lifetime renewability
  • Policy Tenure 1, 2 & 3 years
  • Relationships Covered Self, Spouse, Dependent Children & Dependent Parents
  • Free-look Period 15 days from the date of receipt of the policy
  • Grace Period 30 days for renewals

• Benefits	Excel	Premium	Prime
  Base Sum Insured	2 lakhs, 3 lakhs, or 4 lakhs	5 lakhs, 10 lakhs, 15 lakhs, 20 lakhs, or 25 lakhs	10 lakhs, 15 lakhs, 20 lakhs, 25 lakhs, 50 lakhs, 75 lakhs, or 100 lakhs
  Basic Covers	Inpatient Hospitalization Up to 60 days post hospitalization Ambulance Cover up to `1500	Up to 30 days pre hospitalization 150 named day-care procedures Free Health Check-up Cumulative Bonus	Inpatient Hospitalization Pre-hospitalisation up to 30 days Pre-hospitalisation up to 30 days 150 Named Day-care Surgeries & Procedures Ambulance Cover of INR 1500 Free Health Check-up - for each Insured Person above 18 years of Age, each Policy Year for the specified tests Cumulative Bonus - 10% of the Sum Insured for each claim free year, upto a maximum of 50%"
  Optional Covers (Add-Ons)	Pack 1: Hospital Daily Cash + Convalescence Benefit + Donor Expenses Pack 2: Critical Illness Cover + Double Sum Insured Pack 3: Cap on Room Rent	Pack 1: Hospital Daily Cash + Convalescence Benefit + Donor Expenses Pack 2: Critical Illness Cover + Double Sum Insured	Option 1: Hospital Daily Cash Option 2: Convalescence Benefit Option 3: Donor Expense Option 4: Critical Illness Cover Option 5: Double Sum Insured Option 6: Domiciliary Hospitalisation Cover Option 7: Alternative Treatment Option 8: Maternity Benefit: INR 50,000 Option 9: New Born Baby Cover Option 10: Compassionate Visit: INR 10,000 Option 11: Restoration of Sum Insured
  Individual/Floater	Individual: Available for all Sum Insured Floater: Available for 3 lakhs and 4 lakhs only	Both Available	Both Available
  Mandatory Medical Check-Ups	-	For Individuals > 45 years	10/ 15/ 20/ 25 lacs - Every individual member greater than 55 years 50/ 75/ 100 lacs – All ages
  Waiting Period: Pre-Existing Disease	-	4 Years (for all age groups)	-
  Policy Tenure	-	1, 2, & 3 years	-
  Relationships Covered	-	Self, Spouse, Dependent Children, Dependent Parents	-
  Tax Benefit	-	Under Sec. 80D of IT Act 1961	-
  Free-Look Period	-	15 days from the date of receipt of the policy	One free health check-up for each insured person that is above 18 years of Age for the specified tests

• Coverages of Kotak General Health Premier Insurance Policy

  Cashless benefit:

  Besides reimbursement of medical bills, you would also get the benefit of cashless settlement. Therefore, you need not worry about making any huge expenses, as we settle the bill directly with over 4000 hospitals in our hospital network.

  Pre-Hospitalisation Medical Expenses and Post-Hospitalisation Medical Expenses:

  In the event of a hospitalisation, focus only on getting better and not on the costs. Medical expenses incurred 30 days before a hospitalisation, and 60 days after a hospitalisation will be covered under Kotak Health Care.

  Day Care Treatments:

  If medical expenses are incurred for specified treatments or procedures that do not require you to be hospitalised for more than 24-hours, Kotak Health Care will cover the cost of these procedures. Enjoy cover for up to 150 specified procedures and treatments. For a complete list of Day Care Treatments covered, please click here.

  Cumulative Bonus:

  Enjoy special no-claim benefits on your policy. Receive a cumulative bonus of 10% on your Base Annual Sum Insured on renewal of your health insurance, provided there has been no claim throughout the policy period, up to a maximum of 50% of the Base Annual Sum Insured. If any claim is made under the policy after a Cumulative Bonus has been applied, then the accrued Cumulative Bonus under the policy will reduced by 10% on the commencement of the next policy year or the next renewal of the policy as applicable.

  Tax Benefit:

  Under Sec. 80D of Income Tax Act 1961

  Discount:

  2 year policy – 5% and 3 year policy – 10%

  Optional Covers

  Hospital Daily Cash / Convalescence Benefit / Donor Expenses / Critical Illness Cover / Double Sum Insured Cap on Room Rent

• 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 Certifi¬cate 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

• Exclusions of Kotak General Health Care Insurance

  Below is a list of our permanent exclusions, 30-days exclusions, 2-year exclusions, and 4-year exclusions:

  • Permanent Exclusions: Certain specified illnesses, procedures or treatments like routine health check-ups, dental treatments, aesthetic or cosmetic surgeries, injury or illness due to abuse of intoxicating substances, etc., are permanently excluded from the scope of coverage.
  • 30-Day Exclusions: This includes any illness contracted or medical expenses incurred within 30 days of commencement of the policy unless due to an accident. This exclusion doesn't apply to the renewal of a policy with us or to anyone whose policy has been accepted under the portability benefit.
  • 2-Year Exclusions: This exclusion 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. The following illnesses/medical conditions shall fall under 2-year exclusions: Cataract; Benign Prostatic Hypertrophy; Myomectomy, Hysterectomy unless because of malignancy; All types of Hernia, Hydrocele; Fissures and/or Fistula in anus, haemorrhoids/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 tumours/cysts/nodules/polyps of any kind including breast lumps unless malignant; Dialysis required for chronic renal failure; Surgery on tonsillitis, adenoids and sinuses; Gastric and duodenal erosions and ulcers; Deviated nasal septum; Varicose Veins/Varicose Ulcers.
  • 4-Year Exclusions: This exclusion applies to any pre-existing disease at the time of buying the policy. Any such pre-existing disease will not be covered for a period of 48 months of continuous coverage.
  • Costs of routine medical, eye or ear examinations preventive health check-ups, spectacles, laser surgery for correction of refractory 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
  • Expenses incurred on all dental treatment unless necessitated due to an Accident
  • Any naturopathy treatment, acupressure, acupuncture, magnetic and such other therapies
  • Circumcision unless necessary for treatment of an Illness or necessitated due to an Accident
  • Sterility, venereal disease or any sexually transmitted disease;
  • Intentional self-injury (whether arising from an attempt to commit suicide or otherwise) and Injury or Illness due to use, misuse or abuse of intoxicating drugs or alcohol
  • Any expenses incurred on treatment of mental Illness, stress, psychiatric or psychological disorders;
  • Any aesthetic treatment, cosmetic surgery or plastic surgery including any complications arising out of or attributable to these, unless necessitated due to Accident or as a part of any Illness;
  • Any expenses incurred on treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy, childbirth, miscarriage, abortion or complications of any of these, including caesarean section) and any fertility, infertility, sub fertility or assisted conception treatment or sterilization or procedure, birth control procedures and hormone replacement therapy. However, this exclusion does not apply to ectopic pregnancy proved by diagnostic means and which is certified to be life threatening by the Medical Practitioner
  • Treatment relating to Congenital External Anomalies
  • All expenses arising out of any condition directly or indirectly caused to or associated with Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants
  • Expenses on supplements, vitamins and tonics unless forming part of treatment for Injury or Illness as certified by the attending Medical Practitioner
  • 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 Claim directly or indirectly related to criminal acts
  • 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 licence or registration granted to him by any medical council
  • Non- allopathic treatment; unless covered under extension ‘Alternative treatment’
  • 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