Kotak General Insurance Company is a 100% subsidiary of Kotak Mahindra Bank Limited, one of the fastest-growing banks in India. The company is known for its quality customer service and innovation. The company was established to serve the growing demands of the non-life insurance segment in the country which focuses on innovative and quality insurance products with great customer service. It offers a diverse range of products and various add-ons to suit the requirements of corporate as well as individual clients.
Claim settlement ratio 97%
NCB* 50%, up to 100%* of SI
PED Waiting 48 months
Network Hospital 7200+
Paybima's Right Advisor = Expert Solutions
| Kotak Health Insurance Plan(s) | Plan Type | Entry Age |
|---|
| Gross written premium | Rs 1,134.09 crores as of March 2022-23 |
| Policies issued | 31,94,507 policies issued in FY 2022-23. Total 1.23 Cr Policies + issued |
| Number of customers | 45 lakhs+ customers as of 30 September 2021 |
| Incurred claims ratio (within India) | 69.50 % in 2022-23 |
| Features | Meaning |
| Inpatient-hospitalization covers | If your stay in a hospital is longer than 24 hours, then the insurance company will take care of all expenses associated with hospitalization and treatment. |
| Pre-hospitalization cover | If you incur medical costs before you are hospitalized, the plan covers such expenses up to a specified number of days |
| post-hospitalization cover | After discharge, the medical costs incurred on recovery and follow-ups are covered under the policy |
| Day-care cover | Medical treatments that do not require 24-hour hospitalization are called daycare treatments. Such treatments are also covered under the policy |
| Ambulance cover | The cost incurred on hiring an ambulance for hospitalization would be covered under the policy up to specified limits |
| Organ donor cover | In the case of an organ donor treatment wherein you are receiving the organ, the cost of the donor’s hospitalization and organ harvesting is covered |
| AYUSH cover | Kotak Health plans also cover Ayurveda, Unani, and Homeopathic practices. |
| Domiciliary cover | If you are getting treatment at home instead of a hospital, such treatments would be covered provided that a hospital bed is not available or your medical condition does not allow hospitalisation |
| Free health check-ups | To ensure that you can monitor your health regularly, Kotak health plans allow free health check-ups |
You can get 100% restoration of the sum insured if your coverage is used up in any policy year and you suffer multiple claims. This allows additional coverage so that you don’t run out of the sum insured in a medical emergency.
You can avail of a second medical opinion, free of cost, online through the company’s panel of medical experts. The facility is available multiple times so that you get the best medical care.
The plan offers coverage up to Rs.2 crore so that you can opt for a high-sum insured against expensive medical costs.
You can avail of free health check-ups every year to monitor your overall health.
The plan promotes healthy living and provides health risk assessment facilities besides preventive health check-ups. Furthermore, if you engage in healthy activities, you can earn health rewards which can be redeemed against non-admissible medical expenses and co-payments.
Compassionate Visit pays for the cost incurred by an immediate relative of the insured in traveling from the place of residence to the hospital.
Medical expenses for the delivery of a child are also covered. It also covers expenses for the lawful termination of a child. A maximum of two deliveries is available across all policy years. Maternity benefit has a waiting period of three years during which no benefit would be payable.
All the medical expenses incurred on your newborn baby would also be covered after a waiting period of three years.
Vaccination expenses for your newborn baby from childbirth till the child attains two years are also covered only if you take the maternity benefit, newborn baby cover, and vaccination cover together.
You might need to travel from one city to another for medical treatment in emergencies. Your health plan covers the expenses for ambulance transportation in a helicopter or airplane for life-threatening or other emergencies.
Critical Illness covers pay a lump sum if the insured is diagnosed with a covered critical illness. The benefit would be payable over and above the sum insured in the plan. Health Premier Edge covers 18 critical illnesses listed in the policy document.
Personal Accident Cover includes accidental death or permanent total disablement suffered by the insured. A lump sum amount would be payable which is above the base sum insured in the plan.
| Features | Kotak Health Premier- Total | Kotak Health Premier- Elite | Kotak Health Premier- Edge |
| Inpatient treatment | Covered | Covered | Covered |
| Day Care Treatment | Covered for listed 405 daycare procedures | Covered for listed 405 daycare procedures | Covered for listed 405 daycare procedures |
| Pre- and post-hospitalisation expenses | Covered | Covered | Covered |
| Restoration Benefit | Covered | Covered | Covered |
| Cumulative bonus | Available | Available | Available |
| Annual health checkup | Covered for each insured person above 18 years of age | Covered for each insured person above 18 years of age | Covered for each insured person above 18 years of age |
| Second E-Opinion Cover | Covered | Covered | Covered |
| Ambulance Cover | Covered | Covered | Covered |
| Organ Donor cover | Covered | Covered | Covered |
| Alternative treatment (AYUSH) | Covered | Covered | Covered |
| Domiciliary Hospitalisation | Covered | Covered | Covered |
| Add-on covers | Available | Available | Available |
| Hospital daily cash | Covered if hospitalization extends more than 3 consecutive days | Covered if hospitalization extends more than 3 consecutive days | Covered if hospitalization extends more than 3 consecutive days |
| Convalescence Benefit | Covered if hospitalization exceeds for a minimum of 10 consecutive days | Covered if hospitalization exceeds for a minimum of 10 consecutive days | Covered if hospitalization exceeds for a minimum of 10 consecutive days |
| Home nursing benefit | Covered | Covered | Covered |
| Daily cash for accompanying insured child | Covered for hospitalization extending for at least three consecutive days | Covered for hospitalization extending for at least three consecutive days | Covered for hospitalization extending for at least three consecutive days |
| Compassionate Visit | Covered | Covered | Covered |
| Air Ambulance Cover | Covered | Covered | Covered |
| Maternity Benefit | Covered | Covered | Covered |
| Newborn baby cover | Covered | Covered | Covered |
| Vaccination expenses of newborn baby | Covered till the baby completes 2 years | Covered till the baby completes 2 years | Covered till the baby completes 2 years |
| Entry Age | Minimum- 91 days for Children and 18 years for adults Maximum- 25 years for children and 65 years for adults | ||
| Policy Term | One year/Two years/Three years | ||
| Premium Payment Frequency | Monthly, Quarterly, Half-yearly and Annually | ||
| Pre-existing waiting period | 48 months | ||
| Sum Insured | Rs 2 Lakhs to Rs 2 Crores | ||
The company offers great benefits to its customers to make a claim either through a cashless or reimbursement facility. For cashless claims, you will have to locate the nearest network hospital with which the company has a tie-up and get admitted to the same. You can locate a network hospital through the website of Kotak General Insurance.
Get admitted to the networked hospital by showing your ID card and health card.
The pre-authorization form is necessary if you want your cashless claim to be approved. You can either download the form from the company’s website and fill it out or obtain a hard copy from the insurance desk of the network hospital. Fill in all required fields correctly and completely to get your claim processed faster. You should fill out and submit this form three to four days before your hospitalization. You can also submit the pre-authorization form within 24 hours of your hospitalization only in case of emergency admissions.
Insurers approve cashless facilities based on preauthorised claim forms. After assessing the form, the company approves the claim and intimates the same to the hospital which would begin your treatment. Once your claim has been approved, you will not be required to pay anything. The company will directly settle all the hospital bills.
If you want to get your claim settled on a reimbursement basis or if a cashless claim has been rejected, then you will have to pay all your bills related to illness and then submit the original bills after discharge to the company. The company will assess your claim and approve the treatment cost. Upon approval, the amount will be credited to your bank account. PayBima is committed to making sure that your claim gets settled quickly and smoothly. You can contact us via email at paybimacare@mahindra.com or call 1800 2676767 for any kind of claim-related assistance. Some documents are required to be submitted along with the claim form to enable the company to assess your claim.
At Kotak General Insurance, comprehensive health insurance policies ensure to take care of yourself and your family in all emergencies and illnesses. Other highlights of Kotak health plans are as follows:
* The accumulated cumulative bonus or the NCB shall not exceed 50% of the Sum Insured on the Renewed Policy as specified in the policy terms.
# Ailments diagnosed within 48 months before the policy issuance date or any medical treatment received within 48 months before the issue date of the policy
