Kotak Health Care Premium Plan
Product Overview
Kotak - Health Care Premium Insurance Plan is an inpatient hospitalization policy, admission as an inpatient for a minimum period of 24hrs is required, except for day care treatments. It is designed to handle your medical expenses during hospitalization and provide a stress free life for your loved ones.
Unique Features - Kotak Health Care Premium Plan
- Free Health Check-up at the Network Hospital for each insured person each policy year.
- Customer can opt for Double Sum Insured in the event of Accident and Critical Illness if the insured is diagnosed with Listed Major Illness.
- No Co-payment.
OneInsure App Benefits
Critical Features - Kotak Health Care Premium Plan
- Room Rent:
Limits imposed towards room and ICU rent expenses
No Sub-limits on Room Rent & ICU - No Claim Bonus:
Cumulative Bonus offered in the event of No claim during the policy year.
10% of Basic Sum Insured up to a maximum of 50% for each unclaimed year in case opted for. (10% will be reduced on Claim) - Co-Payment:
Specific % of the admissible claim amount to be borne by the Insured.
No Co-payment in the event of Claim. - Pre-Existing Diseases
Means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within specified months prior to the first policy issued by the insurer.
- 4 years Waiting Period for Pre-Existing Diseases
- Maternity is covered after a waiting of 4years
Eligibility Criteria
- Minimum Age of Entry:- Children-91 days/Adults-25 years
- Maximum age of Entry:- 65yrs
- Renewal Age:- Life Long Renewal
- Sum Insured:- 5Lacs, 10Lacs, 15Lacs, 20Lacs & 25Lacs
- Policy Tenure:- 1, 2 & 3yrs
- Family Definition:- Self, Spouse, Dependent Children & Dependent Parents
- Premium Calculated on Basis of:- Age (i.e. Sum Insured)
Add-on's
| Add-On | Description |
|---|---|
| Critical Illness Cover |
Entry Age - 18yrs to 65yrs (Life Long Renewal) |
| Hospital Cash Daily Benefit | Specified amount shall be paid as Daily Cash Benefit for each and every completed day of hospitalization during the policy period. |
| Convalescene Benefit | Amount specified in the policy schedule if the insured person is admitted in the hospital for a minimum period of 10 Consecutive days. |
| Domiciliary Benefit | Medical Expenses incurred on the Insured Person's Domiciliary Hospitalisation during the Policy Period. |
| Donor Expenses | In-patient Hospitalisation Medical Expenses towards the donor for harvesting the organ up to the limits of the opted Base Annual Sum Insured (subject to availability of opted Base Annual Sum Insured). |
| Double Sum Insured for Accidental Hospitalization | Medical Expenses incurred if the insured is hospitalised during the policy period due to an accident upto twice the opted basic sum insured. |
| Cap on Room Rent | If the insurer has accepted a claim during the policy period for In-patient hospitalization and it incurs claim for room rent expenses which is higher than the eligible room rent as specified by the policy schedule, then the insurer is loable to pay only a rateable proportion of the Medical Expenses. |
Waiting Period
- Covered from Day 1 : Accidental Injuries.
- Covered after 30 Days : All incidences apart from specified surgeries, Permanent exclusion & Pre-existing diseases (if any)
- Covered after 2 Years : 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, namely – 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 Tonsilitis, adenoids and sinuses; Gastric and duodenal erosions and ulcers; Deviated nasal septum; Varicose Veins/ Varicose Ulcers.
Exclusions
- Genetic Disorder
- Dental treatment, dentures or surgery
- Circumcision
- Birth control procedures, contraceptive supplies and services
- Routine medical check-up and diagnostic tests
- AIDS and all diseases/illnesses caused by or related to HIV
- All sexually transmitted diseases
- Mental illnesses
- Ailments arising out of alcohol and drug abuse
- Cosmetic surgery except reconstructive surgery for burns and accidents.
- Any form of non-allopathic treatment
- Any robotic or remote surgery
- Any amount which falls under the deductible or co-pay
- Non-medical expenses listed as per IRDA
Note:- Any claims arising out of or attributable to any of the following is not covered, Please refer policy T & C for a detailed list of exclusions.
Tax Benefits
The premium paid towards Health Insurance for Individual (Self, Spouse, Children & Parents) & Parents (Senior Citizens) qualifies for deduction under Section 80D of the Income Tax Act, 1961.
Claim Process
In case you would like to know about the Claim Process or would like to register a Claim please click the link below
