About Kotak Mahindra
Kotak Mahindra General Insurance Company Ltd, a fully owned subsidiary of Kotak Mahindra Bank Ltd, operates in India's expanding non-life insurance sector. The company serves diverse customer segments across various regions, offering a broad portfolio of non-life insurance products, including Motor, Health, and Fire insurance. As a rapidly growing insurer, Kotak General Insurance delivers tailored products and services supported by advanced technology and digital infrastructure, ensuring a unique value proposition.
Benefits & Features of Kotak Group Health Insurance
Kotak Mahindra Group Health Insurance offers a range of features and benefits, making it a valuable investment for employers and employees alike:
- Covers a group of individuals under a single policy, providing extensive medical protection.
- Offers financial support in cases of accidental injuries, disabilities, or fatalities.
- Acts as a financial safeguard during medical emergencies without requiring employees to pay premiums.
- Employers can claim tax deductions on premiums paid, as per the Income Tax Act.
- Enjoy instant policy renewal through Kotak Mahindra's online platform.
- The claim settlement process is simple, quick, and efficient.
- Round-the-clock assistance to address any queries or concerns.
- Employees can extend coverage to their families, including spouses, children, and parents.
- Includes coverage for specific illnesses up to predefined limits.
- Policies do not require medical tests, and coverage starts from day one.
- Provides additional protection alongside individual health insurance plans.
- Some policies may offer coverage for maternity-related expenses.
- More economical compared to individual health insurance plans.
- Covers pre-existing conditions, subject to policy terms.
- Employees are insured regardless of their age or medical history.
Types of Kotak Mahindra Group Health Insurance
Kotak Mahindra General Insurance comes with a variety of Group Health Insurance policies to serve the interest of both employers and employees. Here are the types of Kotak Mahindra Group Health Insurance:
- Kotak Group Accident Care: This policy is designed to protect employees from the growing risks of unforeseen accidents, this policy offers financial security in case of accidental death or disability. It provides comprehensive coverage at an affordable premium, ensuring peace of mind for both employers and employees.
- Kotak Group Health Care: This policy offers tailored health insurance coverage to employers, covering employees and their dependents. Rising healthcare costs can challenge organisations, making this policy an excellent way to retain talent and motivate employees. It helps alleviate financial stress during medical emergencies by covering hospitalisation costs resulting from accidents or illnesses. Additional benefits include coverage for alternative treatments, daily cash allowances, home nursing, and convalescence benefits.
- Kotak Group Secure Shield: A critical illness plan that offers a lump sum benefit for treating specific critical illnesses. The policy also includes additional coverage for accidental death or disability, which can be used to settle loan liabilities for banks or financial institutions.
- Kotak Group Accident Protect: A comprehensive policy designed to secure employees against the financial strain of accidental disability or death. It supports the family's financial needs in the event of accidental demise or disability, safeguarding against loss of income and employment-related consequences.
- Kotak Group Hospital Cash: This policy provides a fixed daily allowance during hospitalisation, in addition to medical cost coverage. Ideal for organisations, it helps cover medical and non-medical expenses not included in regular health insurance plans, offering extra financial support during tough times.
- Kotak Group Smart Cash: Similar to the Hospital Cash policy, this plan also provides a fixed daily benefit during hospitalisation. However, it extends coverage globally, offering flexibility and peace of mind for employees. It ensures additional financial support for expenses that may not be covered under standard health insurance plans.
Kotak Mahindra Group Health Insurance Plan Table
| Plan Name |
Type of Plan |
Benefit &Features |
| Kotak Group Accident Care |
Group Accidental Plan |
- Accidental Death
- Permanent Total Disablement (PTD)
- Permanent Partial Disablement (PPD)
- Temporary Total Disablement (TTD)
- Accidental Hospitalisation
- Broken Bones/ Burns Benefit
|
| Kotak Group Health Care |
Regular group health plan |
- In-patient Treatment
- Pre-hospitalisation Medical Expenses
- Post-hospitalisation Medical Expenses
- Day Care Treatment
- Domiciliary Hospitalisation
- Emergency Ambulance
- Donor Expenses
- alternative treatment cost
- daily cash allowance
- home nursing
- Â convalescence benefit
|
| Kotak Group Secure Shield |
Critical Illness Plan |
- Critical Illness
- Accidental death/ Accidental Permanent Total Disablement (PTD) due to the accident
- Loss of Job
- Child Education cover
|
| Group Accident Protect |
Accidental Plan |
- Accidental Death
- Permanent Total Disablement (PTD)
- Permanent Partial Disablement (PPD)
- Temporary Total Disablement (TTD)
- Accidental Hospitalisation
|
| Kotak Group Hospital Cash |
Hospital Cash Plan |
- Hospital Daily Cash Benefit
- Accident Daily Cash Benefit
- ICU Daily Cash Benefit
- Surgery Benefit
- Day Care Procedure Benefit
|
| Kotak Group Smart Cash |
Cash Benefit Plan |
- Hospital Daily Cash Benefit
- Accident Daily Cash Benefit
- ICU Daily Cash Benefit
- Worldwide Cover
- Alternative Treatment Benefit
|
Kotak Mahindra Group Health Insurance Inclusions
The common exclusions of Kotak Mahindra Group Health Insurance include:
- Accidental hospitalisation expenses cover pre and post-hospitalisation expenses
- Emergency ambulances cover up to a certain fixed amount
- The insured is covered for domiciliary expenses
- Personal accident cover in case of accidental death/disability/injury leading to loss of income
- ICU daily cash benefit
- Critical or specific illness cover (plan specific)
- Surgery benefit
- Accident daily cash allowance, hospital daily cash allowance
- Donor expense cover
- Alternative treatment expenses cover
- Home nursing expenses
- Convalescence benefit cover
Kotak Mahindra Group Health Insurance Exclusions
To avoid misunderstandings, both employers and employees must carefully review the exclusions in the Kotak Mahindra Group Health Insurance policy. A lack of awareness about these exclusions could lead to disputes or a perceived breach of trust. As exclusions may vary between insurers, here are some common ones often associated with group health insurance policies:
- Sub-Limit Restrictions: Coverage may be subject to sub-limits,and as a master policy for a group, it may lack customisation for individual needs.
- Employment Duration: Coverage is valid only during the period of employment with the organisation. Claims made after leaving the company will be denied.
- Exclusions for AYUSH Treatments: Expenses related to treatments like naturopathy, homoeopathy, Ayurveda, Unani, immunisations, cosmetic surgery, or plastic surgery are not covered.
- Other Common Exclusions:
- Intentional injuries, suicide, or attempted suicide.
- Injuries sustained during involvement in criminal activities.
- Accidents occurring under the influence of alcohol or drugs.
- Driving without a valid license.
- Treatment for AIDS or HIV-related conditions.
- Natural death or disability.
- Coverage limitations for family members.
For the complete list of exclusions, kindly refer to the policy document.
Kotak Mahindra Group Health Insurance Sum Insured
Group Health Insurance sum insured is pre-decided at the time of buying a plan, up to which the insurer indemnifies the claim. Every sum insured is subject to a definite premium without which one can't avail the policy benefits.
Let's say you own Kotak Mahindra Group Health Insurance of Rs. 5 lakh. During your first hospitalisation due to an accident, you claim the insurance for medical expenses of Rs. 70,000. While in your second hospitalisation, you incur 1.5 lakh. Your total expense is 2.2 lakh, which is paid by the insurer. Now you can claim the policy for the remaining Rs. 2.8 lakh, up to which the insurer will pay and anything above that will be borne by you.
Usually, the sum insured for Kotak Group Health Insurance is decided based on the size of the group and the coverage offered. However, opting for a higher sum insured is recommended to cover maximum hospitalisation and enjoy tax benefits.
Kotak Mahindra Group Health Insurance Claim
The process for filing a claim under Kotak Mahindra Group Health Insurance is straightforward and similar to other health insurance policies.
For cashless claims, you can seek treatment at a network hospital, where the hospital handles the submission of claim-related documents, allowing you to receive treatment without any upfront payment. Whereas, for reimbursement claims, you can settle the hospital bills yourself and later submit the required documents to the insurer to get reimbursed.
To ensure a hassle-free claim settlement with Kotak Mahindra Group Health Insurance, follow these steps:
Cashless Claim
For cashless claim, follow the steps mentioned below:
- Step 1: For planned hospitalisation, a pre-authorisation form must be completed, and the insurer should be notified at least 48 hours before admission. The employer, typically through the HR department, can assist with these formalities. In the case of emergency hospitalisation, the insurer must be informed within 24 hours of admission, and the completed pre-authorisation form should be submitted to the hospital's insurance desk.
- Step 2: Once the insurer approves the request, the treatment can be availed without any upfront payment.
- Step 3: The insurer settles the claim directly by covering the medical expenses with the hospital.
Reimbursement Claim
For reimbursement claim, follow the below steps:
Step 1: Notify the insurer immediately upon hospitalisation by calling the toll-free number 1-800-266-4545, or inform your employer to initiate the process.
Step 2: Settle the hospital bills upfront and file a claim under the reimbursement process. Ensure all original bills are retained and submitted along with the completed claim form.
Step 3: Submit the reimbursement claim within the stipulated timeframe. Once the insurer verifies the submitted documents, the approved amount will be transferred directly to the registered bank account.
Documents Required for Claims
- Duly filled out the claim form
- A discharge certificate from the hospital
- Hospital bills duly stamped and signed by the concerned authority
- Medicine bills
- Police FIR in case of an accident
- Attending doctor's report
- The insurer may ask for other relevant documents
How to Calculate Kotak Group Health Insurance Premium?
The premium calculation of Group Health Insurance is quite different from individual health insurance. The premiums, benefits, coverage, and deductibles are usually based on certain factors, including:
- The size of the group or number of employees covered
- The type of coverage needed
- Amount of sum insured required
- Employer's prior claim history
- An employer's prior claims history
However, the premiums are borne by the employers, against which a tax benefit is payable.
Kotak Mahindra Group Health Insurance FAQs
-
Ans: The common advantages of group health insurance offered by Kotak Mahindra include:
- The policy can be availed at a lower premium than individual health insurance.
- It comes in handy to cover maternity expenses (optional)
- There is no waiting period to serve and employers are covered from the day 1
- No pre-policy health check-up is required to avail the policy
-
Ans: Kotak Mahindra Group Health insurance only active until the time you are with the organization. The policy ceases when you resign or leave the organization. However, group health insurance can be transferred to an individual plan, if the insured wants.
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Ans: You can find out from its name, that a group health insurance caters to the needs of a group of the people, while an individual plan is for an individual. Apart from this, individual plans come with a separate renewal option, while group health insurance has only one renewal date. Moreover, premiums are paid by the employer (s) in case of group health insurance, where it is not the same if it is an individual plan.
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Ans: The basic of Kotak group health insurance is that a master policy is issued against a single premium where a group of employees are covered for medical expenses. Under this policy, the inclusions and exclusions or terms and conditions are the same for every member of the group. When a claim arises, the insured can avail cashless or reimbursement services.
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Ans: The policy doesn’t include the below conditions:
- If the accident or injury happens due to the consumption of alcohol, drugs or intoxic substances
- The insurance policy would not cover the insured if he/she doesn’t carry a valid DL in case of an accident
- Any claim arising for treatment other than allopathic such as Ayurveda, Unani, Naturopathy, homoeopathy
- The member and his family are not covered in case he/she resigns
- Some coverage are not extended to the insured family such as group personal accident cover, where the insured is covered for disability or death.
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Ans: Yes, Kotak Group Secure Shield policy is designed to cover critical illness or other specific illness, where a lump sum amount is paid towards the treatment of an illness.
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Ans: The motive behind offering group health insurance is to retain the talent and motivate them to be more productive, These policies considered under employees benefit schemes where the policy benefits are extended to a group of people from the same organisation.
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Ans: These policies come with lower premiums, hence suitable for both large and small organization. However, the lower premium at times leads to the exclusion of several conditions.
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Ans: As plan with co-payment never seems beneficial to the insured, as with this clause, the insurer cut their costs and the insured has to pay a fixed amount of total claim.
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Ans: The employer apart from retaining its talent can also earn tax benefits. The premiums paid towards Kotak Mahindra group health insurance are eligible for tax benefits as per the Income Tax Act 1988.
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