Kotak Mahindra Health Insurance

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Kotak Mahindra Health Insurance Overview

Buying health is the most important decision you take in your lifetime. It is a financial security that protects your savings from being ruined in case of a medical emergency. With rising inflation, medical costs are at peak and having health insurance is imperative to deal with an exorbitant healthcare cost. In this regard, Kotak Mahindra health insurance comes in handy to cover you!

If you want to insure your family members separately with health insurance by Kotak Mahindra Insurance, you can add 4 adults and 4 children together. If you opt for a family floater plan, you can insure 2 adults and 3 children under a single premium. Moreover, the premiums paid are tax exempted and this policy also comes with additional benefits, apart from the basic one. Let’s delve into detail:

The policy can be availed with individual and family floater basis where you can add a maximum of 8 people together-4 adults and 4 children (in case you choose to insure your family members separately)

Benefits & Features of Kotak Mahindra Health Insurance

Kotak Mahindra health insurance comes with the following benefits and features.

  • Kotak Mahindra health insurance comes with comprehensive coverage
  • Covers in-patient and OPD cover
  • Instant policy renewal is possible by opting for Kotak Mahindra online insurance
  • Less paperwork at the time of claiming Kotak Mahindra health insurance
  • 24x7 insurance assistance
  • Fast claim registration
  • Discounts like NCB Bonus, Voluntary /compulsory deductible etc. can be availed
  • Policy can be port
  • Cashless hospitalisation benefit throughout India at network hospitals
  • The policy coverage can be extended to the entire family by paying a single premium only
  • Avail tax benefit for the premiums paid towards health insurance

Why buy Health Insurance from Kotak Mahindra

Kotak Mahindra health insurance is one the famous product among the customers. Here’s why you should buy health insurance from Kotak Mahindra General Insurance:

  • The insurer is 100 % subsidiary of Kotak Mahindra Bank Ltd. which is one of the leading private sector banks in India. Given that, the authenticity of the insurer is well assured.
  • Health insurance policy offered by Kotak Mahindra General Insurance comes with additional discounts, apart from the basic coverage
  • The plan can be customized by opting for health insurance riders
  • The plan is comprehensive in nature, where round-the-clock assistance can be availed.
  • Cashless services can be availed at network hospitals throughout India
  • The premium paid towards health insurance is eligible for tax benefit

Types of Kotak Mahindra Health Insurance

Kotak Mahindra offers a range of health insurance products to cater to the different needs of people. This plan can be availed as individual or floater basis based on your requirement. Let’s delve into detail:

  1. Kotak Secure Shield: Lifestyle diseases are on the rise these days. A critical illness doesn’t only adversely affect someone’s health, but the finances are at stake. Here comes Kotak Secure Shield, into the picture that covers you for the expenses you incurred towards treatment. As per the rule, a lump sum amount is provided at the time of detection of the illness. The amount can be used either for treatment or paying for the outstanding dues.
  2. Kotak Health Care: With this policy, you can remain assured of not paying a hefty medical bill in case of a health emergency. Now instant quality healthcare followed by a speedy recovery can be ensured with Kotak Mahindra Health Care plan.
  3. Kotak Accident Care: This policy is crafted to cover you and your family in case of an accidental injury, disability or death. The hospitalization expenses are covered, apart from paying a lump sum towards disability of different types.
  4. Kotak Health Super Top Up: With Kotak Health Super Top Up, you can ensure a higher sum insured while being covered even after the basic Sum Insured is exhausted. This policy can be availed at a lower premium, as compared to other health insurance plans offered by Kotak Mahindra.
  5. Kotak Health Premier: It is a comprehensive health insurance policy offers complete protection with rewards and value-added benefits to help you stay fit throughout.

Kotak Mahindra Health Insurance Plan Table

Plan Name Eligibility Policy Type Renewal age  Benefit Policy period
Kotak Secure Shield Minimum: 18 years Maximum: 65 years Critical illness Life-long
  • Personal accident benefit
  • Comprehensive critical illness benefit
  • Child education
  • Loss of job
  • Tax benefit
  • Kotak Edge benefit
1,2 & 3 years
Kotak health care Minimum: 5 years Maximum: 65 years Individual/Floater -
  • Hospitalisation expense
  • Free health check-up
  • Five add-ons
  • Ambulance cover
  • In-patient treatment
  • Enhanced protection
  • Cumulative bonus
  • Daycare procedure
  • Cashless benefit
 
1,2 & 3 years
Kotak Accident Care Minimum: 5 years Maximum: 65 years Individual Accident Plan Lifelong
  • Death, Permanent Total Disablement
  • Permanent Partial Disablement
  • Temporary Total Disablement with weekly benefit
  • Accidental Hospitalization Accidental Hospital Daily Cash Benefit
  • Convalescence benefit (fixed sum of Rs. 10,000 on hospitalization)
1,2 & 3 years
Kotak Health Super Top Up   Individual  
  • In-patient hospitalisation expenses
  • Daycare treatment
  • Pre and post hospitalization
  • Ambulance cover
  • Organ donor cover
  • Alternative treatment
  • Restoration of sum insured
  • Tax benefit
  • Cumulative bonus
  • Double SI for accidental hospitalisation
1, 2,3 years
Kotak Health Premier Entry Age - 91 Days for Child and 18 Years for AdultMaximum Entry Age for Adult - 65 YearsMaximum Entry Age for Child - 25 Years Individual/Family Floater lifelong
  • In-patient Treatment
  • Day Care Treatment
  • Pre and Post-Hospitalization Medical Expenses
  • Restoration Benefit
  • Cumulative Bonus
  • Health check-up
  • Second E-opinion
  • Ambulance cover
  • Organ donor cover
  • Alternative treatment
  • Domiciliary hospitalisation
  • Hospital daily cash
  • Convalescence benefit
  • Air ambulance
  • Home nursing
  • Daily cash for accompanying an insured child
  • New born baby cover
  • Vaccination expense cover
 
1,2 & 3 years


Kotak Mahindra Health Insurance Inclusions

Kotak Mahindra health insurance comes with a special range of coverage, which includes:

  • Emergency and planned hospitalization expenses due to an accident and illness
  • Pre and post hospitalisation expense cover
  • Ambulance cover
  • Annual health check-up
  • Automatic restoration of policy sum insured in case of exhaustion of basic coverage
  • Daycare treatment
  • Second E-opinion
  • Personal accident cover leading to disability or death
  • Alternative treatment
  • Organ donor cover
  • Daily cash allowance
  • Kotak Edge benefit
  • The premiums paid towards health insurance is eligible for tax benefit
  • Maternity cover (plan basis)
  • Comprehensive critical illness cover (plan basis)

Kotak Mahindra Health Insurance Exclusions:

The main exclusions of Kotak Mahindra health insurance are:

  • Pre-existing illness will be covered only after 4 years continuous renewal
  • A minimum of 90 days of waiting period to claim the insured, except accidental claim
  • Claim arising out of war, warlike situation, foreign invasion, civil war, military operation etc.
  • Accident occurs while driving under the influence of alcohol, drugs or other intoxicants
  • Claim for treating a sexually transmitted disease, AIDS or HIV
  • Injury sustained while serving the operation of Army, Air Force and Navy
  • Act of terrorism

For a complete list of exclusions, kindly refer the policy document.

Kotak Mahindra Health Insurance Sum Insured

Sum insured is a pre-defined amount paid by the insurance company to the policyholder on payment of a regular premium. It is the amount up to which you can claim your Kotak Mahindra health insurance.

Let’s say, you own Kotak Mahindra health insurance with a sum insured of Rs. 2 lakh.  During your first emergency hospitalization, you incur 80,000. In the second hospitalization, you incur 1.5 lakh. So, your total expenses come around 2.3 lakh. But the insurer will cover you for Rs. 2 lakh only and the additional expense has to be paid by you.

That’s why it is recommended to settle with a higher sum insured. However, it would mean an additional premium to avail such a higher sum insured.

Add-on Covers of Kotak Mahindra Health Insurance

Add-ons covers are to enhance the basic policy benefits where the coverage can be availed at an additional cost:

  • Hospital Daily Cash
  • Donor Expenses
  • Double Sum Insured
  • Critical Illness Cover
  • Convalescence Benefit
  • Cap on Room Rent

Kotak Mahindra Health Insurance Claim

 To ensure a seamless claim settlement with Kotak Mahindra, make sure you follow the below claim steps. Usually, Kotak Mahindra health insurance can be claimed under cashless and reimbursement claim

Cashless Claim Process

The cashless claim is where you can avail cashless healthcare services without paying single money. This facility has to be availed at a network hospital only.

  • Step 1: If it is a planned hospitalisation, fill the pre-authorisation from seeking permission from the insurer before 48 hours of hospitalization. In case of immediate hospitalisation, fill the pre-authorisation form within 24 hours of hospitalisation by approaching the helpdesk in the hospital.
  • Step 2: If the request gets approved, seek treatment from any of the authorized hospitals of Kotak Mahindra General Insurance. In order to avail the facility, use Kotak Mahindra Policy Certificate.
  • Step 3: On submission of documents through the TPA, the hospitalization expenses are directly settled with the hospital authority

Reimbursement Claim Process

When the insured avail healthcare facilities from a hospital other than the network hospital, he/she needs to pay for the hospital expenses and make a claim for the same later. This is called a reimbursement claim. In order to file a reimbursement claim

  • Step 1: Inform the insurer by calling them at the toll-free number 1 800 266 4545, immediately on the hospitalisation
  • Step 2: Settle the medical bills directly with the hospital at the time of discharge. Don’t forget to collect all the required documents, especially the original bills
  • Step 3: The maximum window to submit a claim is within 30 days from the date of discharge. Submit the claim form along with all relevant documents. The insurer will settle the amount if the claim meets all its requirements.

Documents Required for Kotak Mahindra Health Insurance Claims

 You will require furnishing the below documents while filling Kotak Mahindra health insurance claim:

  • Duly filled and signed a claim form
  • Discharge certificate from the hospital
  • Hospital bills duly stamped and signed by the concerned authority
  • Medicine bills
  • Police FIR in case of an accident
  • Other relevant documents as per the insurer norms

How to Calculate Kotak Mahindra Health Insurance Premium?

Health insurance premium pays an important role while it comes to availing policy benefits. The level of cover you can avail under a health insurance policy depends on the premium you pay. Premium is the cost you pay annually, which differs from insurer to insurer. However, there are certain factors considering which your health insurance premium is calculated. They include:

1. Age of the Insured

 In case of health insurance, the age of the person taking insurance plays an important role when it comes to calculating your premium. The younger you are, the less likely you to fall ill. This means the risk associated at your younger age is not high as compared to your old age. Hence, the insurance company charge a lower premium when you buy insurance at a young age.

2. Current Health Status

The second most important aspect is the medical history of the insured. A person with any pre-existing illness or bad health record tends to pay a higher premium or vice versa. The insurer considers a person with any such condition is more susceptible to risk, so imposes higher premium.

3. Location of the Insured

Insurance companies charge higher premiums for a person living in a metro city that a person residing in a rural area. Because, they tend to develop an unhealthy lifestyle due to a busy lifestyle, sedentary working hours and unhealthy food habits, that eventually leads to many health complications. Moreover, the healthcare expenses are also sky-high in the metro cities than it is is a rural area. So, premiums are comparatively on the higher side.

4. Tobacco Habits

Person with a habit of smoking will pay a higher health insurance premium. Tobacco in any of its form can cause serious diseases such as cancer. Due to its high-risk appetite, the insurer charges a higher premium.

How to Compare Kotak Mahindra Health Insurance?

In order to ensure the right insurance, health insurance comparison is a must. There are many insurance aggregator websites that offers suitable insurance suggestions as per your needs. You can approach such platform and compare. While comparing, keep certain things in mind or you can say some parameters such as policy coverage, claim settlement ratio of the insurer, premium, features etc. The different policy may come with different features and coverage. Without comparing them as per your requirements, you can’t land on the right deal. Moreover, the claim settlement ratio is another important aspect to consider as it indicates the capability of the insurer to settle your claim. Company with a higher claim settlement ratio is preferable. Likewise, premiums may vary from insurer to insurer. You should opt for the one that offers maximum coverage within your affordability.

How to Buy Kotak Mahindra Health Insurance?

Buying Kotak Mahindra health insurance is easy. You can either choose the online or offline mode. After comparing the various plans available online, if you find Kotak Mahindra suitable for you, you can visit the official website of the insurer and follow the below options

  • Go to the ‘Get Quote’ option
  • Mention your requirement and personal details
  • Select the plan of your choice
  • Calculate the premium and pay online using various modes of payment accepted by the insurer.

If you don’t want to buy online, you can approach an agent and get the details of Kotak Mahindra health insurance plans. Complete the formalities with him/her and pay the premium by cheque. Moreover, you can directly visit the insurer’s office and buy a plan.

Kotak Mahindra Health Insurance Renewal

Without renewing your Kotak Mahindra health insurance timely, you can’t avail the policy benefits continuously. In the advent of the internet, most of the health insurers avail their products easily available online, with this renewing health insurance becomes more convenient. While renewing the policy, you can stay with the existing insurer or switch to another. So, if you are not satisfied with your current insurer and want to switch to Kotak Mahindra, this is the time. The best part of porting your policy is you don’t have to serve the waiting period all over again. All insurance company is authorised to provide the portability facility as per the guidelines of IRDA.

How to Renew Kotak Mahindra Health Insurance Online?

Health insurance renewal online is the most convenient and fastest process of renewing your policy. nowadays policy renewal with Kotak Mahindra General Insurance can be ensured in just a 4 simple steps:

  • Visit the official website of the insurer and navigate through the ‘Renewal’ option
  • Provide all the necessary details of your policy. In the case of port, provide the details of the previous insurer and other required details
  • Calculate the premium using health insurance calculator and pay the amount by using a debit/credit card/net banking etc.
  • You will receive a digitally signed copy of the policy upon successful payment of the premium. You can print the policy copy at any time using your registered mail Id
  • While renewing, an user Id and password are provided to complete the renewal related formalities relevant to Kotak Mahindra health insurance.

Things to Consider  While Renewing Kotak Mahindra Health Insurance

Renewing your Kotak Mahindra health insurance on time is very important. However, the insurance provider will certainly send a renewal notification but they are not obliged. It’s your responsibility to keep a track of your policy and renew it on time. Usually, it is recommended to renew 15 days before the actual due date. However, in case you miss the date, the insurer will offer a 15 days grace period within which Kotak Mahindra health insurance needs to be renewed to avoid a lapsed policy. However, by adhering certain renewal tips, you can ensure a safe policy experience:

  • Renew before the Policy Due Date: it is advised to pay the policy premiums before the due date to avoid nick hour’s rush. Even if you forget to renew it, the insurance company will provide a grace period of 15 days to renew the policy. however, the only condition is no claim will be accepted within this period. Moreover, in such a case you will lose out the lifelong renewability feature of your policy.
  • Review your Health Insurance Needs: Renewal is the best time to review health insurance requirements and work on them. As your needs tend to change with every phase of life, the insurance requirement may not be the same as it was at the time of buying. Analyse your needs and renew the policy accordingly.
  • Revise your Sum Assured: After evaluating your health insurance policy if you find the sum insured insufficient, revise it. And renewal is the best time to do so. You can even opt for any add-ons to boost the policy coverage at this time. Moreover, if you earn an NCB benefit for not claiming the policy, you can avail this now.
  • Change in Terms & Conditions of the Policy: It is the time to check for any change in policy terms & condition. Usually, policy term and conditions remain the same throughout the policy terms. However, no change is permitted without the approval of IRDA and the insurance provider is bound to let their customers know about this three months before the renewal.

Things to know about Kotak Mahindra Health Insurance

  • Kotak Mahindra health insurance is a comprehensive policy that covers both liability and own damage cover
  • The policy can be extended to 4-5 members under a single premium
  • Tax benefits can be earned for the premiums paid for Kotak Mahindra health insurance under Section 80D of Income Tax Act
  • Avail cashless services at network hospitals throughput India
  • Discounts like NCB benefit, Voluntary deductible etc. can be earned
  • To boost the policy coverage, add-on covers such as zero depreciation, NCB protection, roadside assistance cover etc. can be bought along with the basic cover.
  • Fast claim settlement with cashless and reimbursement claim options

Kotak Mahindra Health Insurance FAQ

Q1. Where can I avail cashless services?

Cashless health care services under Kotak Mahindra health insurance can only be availed at network hospitals. Network hospital means the hospitals that are associated with the insurer, where one can avail healthcare facility free of cost. Under a network hospital, you can avail the treatment across the country. The list of network hospital is attached in the policy document. In case of an emergency refer this list and approach the hospital that is in your vicinity.

Q2. What is a pre-authorisation form?

Pre-authorisation form is an essential document to avail cashless service. By filing this form you can request for availing the cashless benefit. This needs to be filled and duly signed by the attending doctor and submitted to the TPA/insurance help desk in the hospital. Upon approval from the insurer, you can avail treatment without worrying about the expenses.

Q3. What are the necessary documents to carry while applying for cashless hospitalisation?

You will require the following documents to apply for cashless healthcare services:

  • Health card issued by Kotak Mahindra General Insurance
  • Reports/prescriptions related to the ailment
  • Commencement of the illness
  • Policy copy
  • Photo Id of the insured such as PAN card, Driving License, Passport, Employer ID, Voter ID etc.

Q4. Can I avail the policy benefit even if I don’t avail healthcare from a network hospital?

Yes, policy benefits can be availed in this case under the reimbursement clause, where you pay the hospital bills on your own and register a reimbursement claim. You will need to submit the original hospital bills along with the duly filled claim form. The insurer will reimburse the money if the claim meets the requirements.

Q5. What are the expenses covered under Kotak Mahindra health insurance?

Kotak Mahindra health insurance comes in handy while covering hospitalisation expenses arising out of an accidental or illness claim. Usually, the policy covers in-patient expenses including room rent, nursing expenses, doctor’s consultation fee, ICU rent, OT rent, medicine, blood, oxygen, x-ray or other test, OPD, Daycare etc. Depending on the plan expenses such as Second E-opinion, ambulance cover, organ donor cover, alternative treatment, domiciliary hospitalisation, Hospital daily cash, convalescence benefit, air ambulance, home nursing etc. are also covered.

Q6. Under which condition my cashless claim can be rejected?

You cashless claim may get rejected by the insurer under following grounds:

  • In case the cashless request doesn’t meet the requirement or insufficient to judge the acceptability of a possible claim
  • If the treatment is not availed from a network hospital
  • If the claim attracts any of the permanent exclusion of the policy, including pre-existing illness
  • If the claim is made within the initial waiting period or if the defined waiting period for a specific illness not served
  • In case of violation of policy terms and conditions
  • In case the insured is found furnishing fake documents or hiding about a medical condition while buying the policy to avoid a higher premium

Q7. What if the cost of hospitalisation exceeds the policy sum insured?

 Probability is that the hospitalisation expenses exceed the total sum insured. In such a case, the hospital authority will request the insurer to increase the approved amount in case of the hour of need. The insurance company will access the request and additional approval will be given applying terms and conditions. It also depends on the availability of sum insured or if they can offer this much.

Q8. How to initiate a claim under Kotak Mahindra health insurance?

In order to ensure a fast and smooth claim, it is essential to inform the insurer immediately. In case of a planned hospitalisation 48 hours of the window prior to the hospitalization is a must to inform the insurer, while in case of emergency hospitalization, the insurer needs to be informed within 24 hours of hospitalisation. A pre-authorization form is required in both the cases seeking permission for cashless services. The incurred expenses will be directly settled with the hospital authority if the insurer approves the cashless benefit.

To intimate a claim you can call on the toll-free number at 18002664545 from 8 am to 8 pm. You can also write to them at care[@]kotak[.]com.

Q9. What's the information required at the time of registering a claim with Kotak Mahindra General Insurance?

You will have to provide the following information at the time of intimating a claim under Kotak Mahindra health insurance:

  • Policy number of health insurance
  • Name of the insured
  • Name and address of the insured
  • Type of injury or illness leading to hospitalization or for which the treatment is needed
  • Name and address of the attending doctor
  • Details of the hospital where the treatment is availed
  • Date of admission and discharge date
  • Police FIR in case of accidental hospitalization
  • Other information relating to the claim

Q10. What is the maximum time which I should register a claim?

The claim form duly filled and signed by the insured along with the supporting documents should be submitted positively within 30 days from the date of discharge.

Q11. What are the clauses associated with claiming pre and post-hospital services?

Pre and post hospitalization benefit is also covered by Kotak Mahindra health insurance, where the insured is cover for a fixed day for availing treatment pre and post hospitalization and the expenses are on the insurance company. The pre-hospitalisation claim documents need to be sent to the insurer with 15 days from the date of discharge. While post hospitalization documents have to be submitted with 30 days from the date of completion of treatment. Usually, health insurers come with a fixed period for covering pre and post hospitalization cover like 30 days and 90 days respectively. However, it may vary from insurer to insurer. You will require to submit the hospital bills along with the claim form in both the cases.

Q12. What are the documents do I need to submit for a reimbursement claim?

To claim under reimbursement claim, you’ll need to submit the following documents:

  • Duly filled and signed claim form by the policyholder and attending a medical practitioner
  • Reports on the ailment mentioning the symptoms and occurrence date, previous treatment proof if any
  • Discharge letter from the hospital
  • Medical investigation reports in original such as ECG, X-ray, blood test etc.
  • Original hospital bills and receipts
  • Original copy of chemist bill, medical practitioner, medical investigation, etc. along with a prescription
  • NEFT requirement: Cancelled cheque of insured. If the cancelled doesn’t contain the name of the account holder, passbook/statement will work
  • KYS documents such as address proof, photo ID
  • 2 recent passport-sized photographs (if the claim amount is above Rs. 1 lakh)

Q13. How to furnish original documents if I apply for more than one claim-one with Kotak Mahindra and one with another health insurer?

In case of a double claim, you’ll need to submit the original documents to one of the insurance provider. Once the claim is settled, you will need to collect the certified true copies of the document accompanying with a settlement letter. Submit the same documents to another insurance to complete your claim.

Q14. How long will it take to settle a claim with Kotak Mahindra General Insurance?

Reimbursement Claim: the insurer takes 15 days of time to proceed with this kind of claims from the receipt of supporting documents. Documentation includes the submission of all medical documents starting from the doctor’s report on the ailment to the bills along with the receipts in original.

Cashless Claims: The process is initiated within 6 working hours from the receipt of details. It includes the pre-authorisation letter, information regarding diagnosis, estimated hospitalisation expense, duration of stay, pre-existing illness if any, pre-admission prescription if any, medical report. The claim form should be duly signed by the insurer and the attending doctor.

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