Kotak General Health Insurance
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KOTAK GENERAL HEALTH INSURANCE

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Kotak General Health Insurance

Overview
Kotak General Insurance Co Ltd is a leading health insurance organisation in India that has been operating since 2015. The company reported Rs. 6 Lacs of revenue from premium in 2015-16 and incurred claims of Rs. 21 Lacs, gathering an incurred claims ratio of 347.6%. It is a 100% subsidiary of the Kotak Bank Ltd and was established to provide non-life insurance products. Currently, the company provides health insurance and motor insurance.

Kotak General Health Insurance at a Glance
  • Cashless access to over 4000 network hospitals
  • Offers lifetime renewability
  • Option to choose sum insured level
  • The brand has an incurred claims ratio of 347.6% in 2015-16.

Documents needed to apply for Kotak General Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph

Why Kotak General Health Insurance?
Here are some reasons why Kotak General is the right insurance provider for you:

Features Description
Sum Insured Sum insured ranging from Rs. 5 Lacs to Rs. 25 Lacs available.
Cashless hospitalisation Kotak General provides access to over 4000 network hospitals across India where you can avail cashless facility.
Claim process Cashless access to over 4000 hospitals.
In-patient hospitalization/treatment Expenses incurred during hospitalisation for 24hours or more is covered by all Kotak General Health Insurance plans. In patients expenses include rent, boarding, ICU, Operation Theatre, medicine and consumables.
Pre-hospitalization Expenses Expenses incurred during 60 days post hospitalisation are covered.
Free Annual Health Check up Free annual health check up is provided for each person (above the age of 18yrs) covered in the policy and is irrespective of number of claims made in a year.
Ambulance charges Once your sum insured is exhausted during the year, the same is reinstated without any extra charges. The facility is available after a specified number of claim-free years.

Types of Kotak General Health Insurance Plans
Kotak General offers insurance coverage in the following options:

1: Kotak Health Care–This is Kotak General Insurance’s main health insurance product. The product is available in three variations – excel, premium and prime. The product attempts to provide comprehensive coverage on individual and floater basis depending upon needs.

2: Critical Illness Cover With Kotak Secure Shield– This policy is specifically geared towards those looking for financial protection against critical illness. The plan covers 18 different critical illness, surgical procedures and other events.

Kotak General Health Insurance Plans in detail
1: Kotak Health Care
Features Excel Premium Prime
Entry age 18 to 65 years (91 days to 25 years for children) 18 to 65 years (91 days to 25 years for children) 18 to 65 years (91 days to 25 years for children)
Type of Plan Individual / Floater Individual / Floater Individual / Floater
Sum Insured 2-4 lacs 5lacs, 10 lacs, 15lacs, 20lacs or 25lacs 10lacs, 15lacs, 20lacs, 25lacs, 50lacs, 75lacs, 100lacs
Coverage for Individual (available for all sum insured levels)
Family (available only for 3 and 4lacs)
Family means Spouse, Dependent Children, Dependent Parents
Individual and family
Family means Spouse, Dependent Children, Dependent Parents
Individual and family
Family means Spouse, Dependent Children, Dependent Parents
Policy term 1,2,3years 1,2,3years 1,2,3years

Inclusions, Benefits and Features
  • In-patient expenses – In-patient expenses during hospitalisation for more than 24 hours are covered.
  • Pre-hospitalisation – Up to 30days of expenses incurred for illness causing hospitalisation is covered.
  • Post-hospitalisation – Up to 60days of post hospitalisation expenses covered.
  • Ambulance expenses – Ambulance charges for emergency hospitalisation covered upto a specific limit.
  • Day-Care Procedures - The medical expenses for upto 150 day-care procedures, which do not necessarily require 24 hours of admittance, will also be covered.
  • Cumulative Bonus - A bonus of 10% of the basic sum insured is available after a claim free year, upto a maximum of 50%.

2: Critical Illness Cover with Kotak Secure Shield
Features Description
Entry age 18-65years
Type of Plan Individual
Renewal age Lifelong renewal
Policy term 1,2,3 years

Inclusions, Benefits and Features
  • Comprehensive Critical Illness Cover -In case there is diagnosis of any of the 18 critical illnesses covered, the insured will receive a one-time sum insured payment.
  • Personal Accident Benefit -In case of an accident resulting in death or permanent total disability, the cover provides financial stability to the insured.
  • Child Education Benefit -In case an accident results in death or permanent disability, this cover provides financial assistance for the education of the insured’s child.
  • Loss of Job Benefit –Provides financial support for the insured in case there is job loss resulting from illness.

Kotak General Exclusions:
  • Any pre-existing diseases will not be covered for a period of 48 months of Continues coverage under the policy, applicable only for critical illness.
  • In case of insured above 65 years of age only 1 year policy will be issued which can be renewed further on annual basis.
  • First occurrence of any medical condition or within 90 days of policy entry
  • Any claim arising or resulting from the Insured Person committing any breach of the law with criminal intent.
  • War, invasion, act of foreign enemy, hostilities
  • Ionising radiation or contamination by radioactivity from any nuclear fuel.
  • Nuclear weapon materials.
  • Usage, consumption or abuse of substances such as intoxicants, hallucinogens, alcohol and/or drugs.
  • Self-destruction or self-inflicted injury, attempted suicide or suicide.
  • Any sexually transmitted diseases, Acquired Immune Deficiency Syndrome (AIDS), AIDS-related complex syndrome (ARCS).
  • While serving in the Military or Armed Forces.
  • Any act of terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss.

Kotak General Health Insurance Claim Settlement:
Cashless Claim Reimbursement Claim
Approach hospital desk and show ID for identification within 24 hours in case of unplanned and 48 hours prior to hospitalisation in case of planned hospitalisation Intimate company at 1800 266 4545 or care@kotak.com
In case the charges are found admissible, the bill shall be settled upto approved amount. Upon discharge pay the bills and collect all receipts
  Fill claim form and submit the form with all the receipts within 30 days of discharge.

Kotak General Health Insurance FAQs:
1: Where can I download claims form from?
You can download claims form from this link - https://www.kotakgeneralinsurance.com/customer-support/downloads

2: What are the details to be provided at the time of intimation of claim for Kotak General Health Insurance?
Following are the information required at the time of intimation:
  • Claim form duly filled and signed by the insured and attending doctor
  • All treatment papers of current ailment mentioning first symptoms and date of occurrence of the ailment, previous treatment papers (if any)
  • Discharge card from the hospital
  • All original medical investigation reports (viz. X-ray, ECG, blood test, etc.)
  • Original hospital bills and receipts
  • Original bills of chemist, medical practitioner, medical investigation, etc. supported by prescriptions
  • NEFT details: Cancelled cheque of policy holder, copy of blank passbook/statement of policy holder if cancelled cheque does not contain name of the policy holder, and copy of the PAN card of the policy holder
  • Know Your Customer (KYC) details viz. address proof, photo ID, and 2 recent passport size photographs (applicable for claim amounts overRs.1 Lac)
3: Are my existing diseases covered in Kotak General Health Insurance?
Existing diseases covered after 48 months of continuous coverage with Kotak General. There are exceptions in illness specific policies like policies designed for diabetic patients, cancer patients, HIV positive patients etc

4: What medical expenses are covered in Kotak Health Insurance?
Medical expenses under the following heads are covered:
  • Hospital (room & boarding and operation theatre) charges
  • Fees of surgeon, anaesthetist, nurse, specialists
  • Cost of diagnostic tests, medicines, blood, and oxygen; as long as these are medically necessary.
5: What if the cost for treatment exceeds the approved sum in cashless claims?
In such a case, the hospital will request the insurance company to increase the amount approved. The same shall be scrutinised by the company and if found valid, will be honoured.

6: What is the time period within which I should submit my claim for Kotak General Health Insurance?
All claim documents, duly filled along with receipts should be submitted no later than 30 days from discharge.

7: Any time period for claiming pre and post hospitalization expenses?
The pre-hospitalisation claim documents duly completed should be submitted within 15 days from the date of discharge. All post-hospitalisation claim documents should be submitted within 30 days from the date of completion of treatment, or expiry of the post-hospitalisation period as per the Policy.

8: Will my claim be reimbursed even if I do not get myself treated at a network hospital of Kotak General Health Insurance?
Yes, the insured person will still be eligible for a claim.

9: Can foreigners avail policy or is it restricted to Indian nationals?
Foreigners living in India can avail policy but the coverage will be limited to India.

10: Does the list of hospitals remain the same for Kotak General Health Insurance?
The list of hospitals may or may not change and Kotak General Health Insurance reserves the right to modify, add or restrict any network hospital for cashless services available under the policy.