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Health Insurance 514 views July 13, 2021
Kotak Health Super Top Up provides you a higher health insurance coverage at an affordable premium. This super top-up policy works alongside your basic health insurance plan and the deductible amount shall be covered under your existing policy or borne by you. And once the deductible amount is crossed, Kotak Health Super Top Up Insurance becomes active and covers your medical expenses. Under this plan, you’ll get the following benefits:
- In-patient Treatment Cover
- Day Care Treatment Cover
- Pre & Post-Hospitalization Cover
- Ambulance Cover
- Organ Donor Cover
- Alternative Treatment Cover
- Restoration of the sum insured
- Double sum insured for Hospitalization in case of an accident
- Cumulative Bonus
Read this page below and know more about Kotak Health Super Top Up Insurance Plan coverage.
Table of Contents
Kotak Health Super Top Up Insurance Plan Base Cover
Under this policy, the insurer provides coverage against the following:
In-patient Treatment: Any medical expenses incurred during the policy period following an illness/injury shall be covered, provided hospitalization is for a continuous period of 24 hours. The hospitalization expenses are admissible for the claim if the attending medical practitioner advises these as medically necessary.
Daycare Treatment: Medical expenses that are incurred on daycare treatment during the policy period following an illness/injury.
Pre & Post-Hospitalization Medical Expenses: The insurer will indemnify pre and post-hospitalization expenses that occur during the policy period, provided the insurer has accepted a claim for in-patient or daycare treatment. Pre and post-hospitalization expenses are covered for 30 and 60 days, respectively.
Ambulance Cover: Under this policy, the insurer covers the ambulance charges up to INR 2,000 per hospitalization, for transporting the patient to the hospital for the treatment of an illness/injury following an emergency. This benefit is payable to you if the insurer has accepted a claim for in-patient or daycare treatment. The insurer will also provide cover under this benefit if the insured is transferred from one hospital to another for advanced diagnostic treatment.
Organ Donor Cover: The insurer shall cover the in-patient hospitalization expenses of the donor, provided the organ is donated for the use of the insured person who has been asked to undergo an organ transplant on medical advice. Under this benefit, the insurer will not cover expenses towards the donor in respect of pre and post-hospitalization expenses, costs directly or indirectly associated with the acquisition of the organ or any other medical treatment or complication in respect of the donor after harvesting.
Alternative Treatment: The insurer will indemnify the expenses incurred on alternative treatment up to INR 50,000, provided it is administered by a medical practitioner and the insured is admitted to the hospital as an in-patient. The payment under this benefit is limited to the base annual sum insured.
Restoration of Sum Insured: You’ll get a 100% restoration of the opted base annual sum insured once in a policy year, provided the sum insured and the cumulative bonus (if any) are insufficient to cover the health emergency. The restored base annual sum insured will only be available for future claims under this policy and not in respect of any illness or any complications for which a claim has already been accepted/paid. The restoration of the sum insured shall be done in addition to the opted base annual sum insured
Note: No cumulative bonus will apply to the restored sum insured. Any utilized restored sum insured shall not be carried forward to any subsequent policy year. The restored sum insured will not be available in case of accident hospitalization.
Double Sum Insured for Hospitalization due to Accident: In case of hospitalization due to an accident, the insurer will indemnify the medical expenses incurred during the policy period in respect of an injury sustained due to an accident. Under this cover, the maximum limit is INR 40 Lakhs. The double sum insured shall be calculated from the amount available under Kotak Health Super Top Up Insurance Plan after previously paid claims during the policy year. The amount calculated under this cover shall not be available for payment of benefits other than the in-patient treatment. The payment under this benefit is made over and above the opted base annual sum insured. If the amount is unutilized (in whole or part) in any policy year, it shall not be carried forward to any subsequent policy year.
Cumulative Bonus: Your base annual sum insured shall be increased by 10% at the end of the policy year if the policy is renewed without any break. This benefit is available to you only if no claims have been made in respect of all the insured persons in the previous policy year. The cumulative bonus shall apply differently based on your policy type- If the policy is individual, the cumulative bonus will accrue only if no claim has been made in the expiring policy year in respect of the primary insured person. The cumulative bonus under a family floater policy is available to those insured persons who haven’t filed a claim in the previous policy year.
If any claim is made under this policy after a cumulative bonus has been applied, the accrued cumulative bonus will reduce by 10% on the commencement of the next policy year. The cumulative bonus shall not exceed 50% of the base annual sum insured. If the base annual sum insured is increased at the time of renewal, the cumulative bonus will be calculated based on the sum insured of the previous policy year. Whereas, if the base annual sum insured is reduced at the time of renewal, the cumulative bonus will be applicable to the renewed policy sum insured.
A cumulative bonus will be carried forward to the next policy year, provided the policy is renewed without any break. If the policy period is of more than one year, any accrued cumulative bonus will be credited at the end of the policy year and shall be available to you in the subsequent policy year.
Free Look Period
A free look period of 15 days shall be applicable at the inception of the policy starting from the date of receipt of the policy to review the terms and conditions. During the free look period, you can return the policy if the terms and conditions are not acceptable to you. If you have not made any claim during the free look period, you’ll be entitled to a refund of the paid premium after a deduction of medical examination expenses and stamp duty charges. Where the risk has already commenced and the option of return of the policy is exercised, a deduction towards the proportionate risk premium for the period on the cover will be provided. If only a part of the insurance coverage has commenced, such proportionate premium commensurates with the insurance coverage during the free look period.