Comprehensive Health Insurance - Health Premier Plan

A comprehensive health insurance policy that comes with protection plus rewards and value added benefits to help you stay fit

Health & Rewards

Now get rewarded for taking care of your health/ fitness through regular preventative and fitness habits. You can earn reward points for the activities mentioned below. These points can be redeemed in accordance with the redemption terms and conditions.

Note:

1.    Health Risk Assessment (HRA): Insured person should be above 18 Years of age.

2.    Health Check-up: The Insured needs to undergo the check up as per Annual Health Check Up cover. If the results are within normal limit, additional 500/ 1500 points will be awarded.

3.    Preventive Health Check-up: If the results are within normal limit, additional 250 points per test and a maximum of 1500 points per family will be awarded.

Redemption of Reward Points:

a) Each Reward Point will be equivalent toRs.0.25.

b) These reward points can be redeemed against any of the following options:

    i) Outpatient medical expenses like consultation charges, medicine & drugs, dental expenses, wellness & preventive care.

    ii) Diagnostic expenses and health check-ups through our Network providers.

    iii) In-patient Treatment and Day Care Treatment claims

    iv) Payment of Co-payment

    v) List of Non-medical expenses

    For more details on wellness/fitness activities and terms of redemption please refer to the policy wordings

Note: # Awarded if all medical test parameters are within normal limit
Note: Please refer policy wordings for list of eligible preventive health checkup tests

Note:

Maximum 5,000 reward points per Insured Person in case of Individual Policy and a maximum of 10,000 reward points per family in case of Floater Policy in a Policy Year can be earned.

Value Added Benefits
The benefits listed below will be applicable as per the plan opted for.

Note: The activities may attract additional charges payable directly to the vendor.
Availing the said value added benefits will not impact the Sum Insured or the eligibility for Cumulative Bonus.

Optional Covers

Advantage Plan:

• Home Nursing Benefit

• Daily Cash for Accompanying an Insured Child

• Compassionate Visit

• Critical Illness Cover (Available for Age 18 years and above)

• Personal Accident Cover

• Cap on Room Rent

Edge and Elite Plans:

• Compassionate Visit

• Maternity Benefit* (with 3 year waiting period)

• New Born Baby Cover* ( with 3 year waiting period)

• Vaccination Expenses* ( with 3 year waiting period)

• Air Ambulance Cover

• Critical Illness Cover (Available for Age 18 years and above)

• Personal Accident Cover

Register a Claim/Claim Process

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 1800-2120 within 24 hours of admission

• Visit any of our network hospitals & use our Policy Certificate to avail cashless facility.

Re-imbursement Claim

• Intimate us by calling 1800-2120 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: www.zurichkotak.com

Note: All claims will be processed subject to Policy terms & conditions available in the Policy wordings
Reward Points Accumulation
Collect the relevant reports/ bills/ certificates after undergoing the tests or undertaking the activity.
Send us the relevant reports for the tests and/ or receipts/ bills for the specific activities which you have undergone.
To track your reward points, call us on 1800-2120 or email us at care@zurichkotak.com
Reward Points Redemption

• Send the original bills, test reports if any along with the duly completed redemption form to Zurich Kotak General Insurance Company (India) Limited, Unit no. 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East) Mumbai- 400063, India..

• To track the redemption status, call us on1800-2120 or email us at care@zurichkotak.com

Waiting Period/Exclusions

For a smooth and hassle-free claims experience, it is important to understand the exclusions/ waiting period in your policy.

30 Day Waiting Period
Expenses related to treatment of  any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident. This exclusion also doesn’t apply if the Insured Person has continuous coverage for more than twelve months.

Specified disease/ procedure Waiting Period
This 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.

Pre-existing Disease Waiting Period
Any Pre-Existing Disease will not be covered until waiting period as per Plan opted for as elapsed.

Permanent Exclusions
Treatment for alcoholism, drug or substance abuse; intentional self-injury; cosmetic surgery; Expenses related to any, unproven treatment; Expenses related to sterility and infertility, claim related to breach of law with criminal.
For a complete list of permanent exclusions, please refer to the policy wordings on our website.

Terms of Cancellation

• The policyholder may cancel this policy by giving 15days' written notice. For Policyholder’s initiated cancellation, the Company would compute refund amount as pro-rata (for the unexpired duration) premium. This would further be deducted by 25% of computed refundable premium.
  No refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the insured person under the policy.

• The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of material facts, fraud by the insured person by giving 15 days' written notice and there would be no refund of premium.