Kotak General Health Premier Insurance

Eligibility Criteria of Kotak General Health Premier Insurance

• Entry Age
  • 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%

Sum Insured Options : From ₹3 lacs to ₹25 lacs

Key Benefits of Kotak General Health Premier Insurance

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 free health check-up for each Insured Person above 18 years of age for specified tests. Availing the free 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 CoverPolicy 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 (available under select plans only) (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 Optional Covers
Critical Illness 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.

Coverages of Kotak General Health Premier Insurance Policy

• 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
• 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 free health check-up for each Insured Person above 18 years of age for specified tests. Availing the free 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
• Organ Donor Cover :In-patient hospitalization expenses of the donor in case of an organ transplant will be covered.
• Domiciliary Hospitalization :Policy covers medical expenses for treatment taken at home on the advice of the medical practitioner
• 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.
• Air Ambulance Cover :It will cover expenses for ambulance transportation in an airplane or helicopter for emergency life threatening situations.
• 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

Exclusions of Kotak General Health Premier 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

Disclaimer: “For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”)