Kotak General Health Care Insurance

Kotak General Health Care Insurance

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When you buy a plan for Kotak Health Care you get all your medical needs covered without having to pay a high premium. Kotak Health Insurance provides everything to the insured, ranging from compensation against medical expenses to free dental check-up. Features covered under the plan include expenses for pre- and post-hospitalization, daycare treatment, ambulance cover, cumulative bonus, and many others.

Kotak Health Care comes to you in the form of three options; Excel, Premium and Prime.

Kotak General Health Insurance Review

Kotak General Health Care Insurance
Kotak General Insurance sum insured
2 lac - 25 lacs
Incurred Claims Ratio *
Kotak General Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio **
List of network hospitals
4000+ hospitals
Number of policies issued *
Maximum family floater coverage
Self, Spouse + dependent children + parents
Number of lives covered *
* As per IRDAI report for 2020-21   |   ** As per NL25 data published on the Insurance Company website

Kotak General Health Care Insurance benefits

  • Eligibility
  • Benefits
  • Coverages
  • How To Claim?
  • Exclusions

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

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

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

Kotak General Health Insurance FAQ’s

The pre-authorisation form is the form that is sent to the insurance company to avail of cashless service, after being duly filled by the insured and the attending doctor. This form is available at the insurance helpdesk/cashless counter in the hospital.

Network hospital refers to all such hospitals/nursing homes in which the cashless facility may be availed by the insured for treatment as provided herein. The list of network hospitals is subject to amendment from time to time and shall be available with the Company.

Yes, you are eligible to lodge he claim with us. Please note, the hospital/nursing home should meet the criteria as defined in the Policy. Your claims will be assessed on reimbursement basis subject to other terms and conditions of the Policy.

The health policy covers medical expenses incurred towards the ailment, subject to the condition that the ailment is admissible under the Policy. Following are the broad heads of expense:

  • 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

Brochure/ prospectus

Review Kotak General Health Care Insurance brochure to understand coverage details.

Excel & Premium Brcohure » Prime Prospectus »

Proposal form

Fill the online Kotak General Health Care Insurance proposal form.

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022