{"uin":"ZUKHLGA25064V012425","name":"Health Assure","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited","url":"https://indiainsurances.com/insurer/zurich-kotak-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Health Assure is a group health indemnity policy with in-patient, pre and post hospitalisation, day care, domiciliary hospitalisation, emergency ambulance, donor expenses and AYUSH covers. It has a 30-day initial waiting period, a 36-month pre-existing disease waiting period, a 12-month specified disease waiting period and optional covers including air ambulance, maternity, newborn baby cover, cumulative bonus and Prime add-on benefits.","analysis":{"state":"machine","analysed_at":"2026-10-19 22:59:03.081312+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents describe customised group coverage and optional covers, but do not name plan variants.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"1 year or multi-year policy.","display":"1 year or Multi Year Policy","note":"The exact policy period is to be read from the Policy Schedule/Certificate of Insurance.","quote":"For 1 year Policy- Refund proportionate premium for unexpired policy period subject to no claim(s) were made during the policy period. ... For Multi Year Policy -","sources":[{"clause":"Excl02(d)(i)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-d-i"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For planned cashless hospitalisation, contact the insurer or TPA at least 48 hours before hospitalisation. For emergency cashless care, contact them within 24 hours of commencement of hospitalisation; reimbursement claims must be notified within 30 days of discharge.","display":"Cashless: 48 hours before planned hospitalisation; 24 hours for emergency care; reimbursement notice within 30 days of discharge","note":null,"quote":"At least 48 hours prior to a planned Hospitalization, We or Our TPA shall be contacted to request pre authorization ... within 24 hours of commencement of Hospitalisation ... We shall be given written notice of the Claim for reimbursement along with the following details at least within 30 days of the Insured Person’s discharge from Hospital","sources":[{"clause":null,"heading":"1. CLAIMS PROCEDURE","page":20,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-1-claims-procedure"},{"clause":"Excl02(a)(viii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-a-viii"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Duly completed Claim form signed by You and the Medical Practitioner","Original Pre – authorization request","Copy of Pre – authorization approval letter","Copy of the photo identity document of the Insured Person","Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner","Original bills from chemists supported by proper prescription","Original investigation test reports (including CT/MR/USG/ECG, as applicable) and payment receipts","Indoor case papers (if available)","Medical Practitioner’s referral letter advising Hospitalization in non-Accident cases and referral slip for all investigations carried out","Hospital discharge summary","FIR (if done) or MLC (if conducted) for Accident cases","Post mortem report (if applicable and conducted)","Any other document as required by Us or Our TPA"],"display":"Claim form, pre-authorisation papers, ID proof, hospital bills/receipts/discharge papers, pharmacy bills and prescriptions, investigation reports, indoor papers if available, referral letter, discharge summary, FIR/MLC for accidents, post mortem report if applicable and other documents required by insurer/TPA","note":null,"quote":"a) Duly completed Claim form signed by You and the Medical Practitioner (only for reimbursement claims);\nb) Original Pre – authorization request\nc) Copy of Pre – authorization approval letter\nd) Copy of the photo identity document of the Insured Person;\ne) Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner;\nf) Original bills from chemists supported by proper prescription;\ng) Original investigation test reports (including CT/MR/USG/ECG, as applicable) and payment receipts;\nh) Indoor case papers (if available);\ni) Medical Practitioner’s referral letter advising Hospitalization in non-Accident cases and referral slip for all investigations carried out;\nj) Hospital discharge summary;\nk) FIR (if done) or MLC (if conducted) for Accident cases ;\nl) Post mortem report (if applicable and conducted);\nm) Any other document as required by Us or Our TPA to investigate the Claim or Our obligation to make payment for it.","sources":[{"clause":null,"heading":"2. CLAIM DOCUMENTS","page":22,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-2-claim-documents"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The insurer shall settle or reject a claim within 15 days from receipt of the claim along with the claim form and necessary documents. Delayed payment carries interest from receipt of the last necessary document to payment at 2% above the bank rate.","display":"Settle or reject within 15 days from receipt of claim with claim form and necessary documents; delay interest 2% above bank rate","note":null,"quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of claim along with claim form (and necessary documents). ... the Company shall be liable to pay interest to the policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"Excl02(c)(i)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-c-i"},{"clause":"Excl02(c)(ii)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-c-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months","Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident","Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months","Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded","Expenses related to any admission primarily for enforced bed rest and not for receiving treatment","Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex","Expenses for cosmetic or plastic surgery or any treatment to change appearance","Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports","Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent","Treatments received in health hydros, nature cure clinics, spas or similar establishments","Expenses related to sterility and infertility","Any OPD treatment will not be covered"],"display":"PED 36 months, initial 30 days, specified diseases/procedures 12 months, diagnostics-only admission, rest cure, gender-change treatment, cosmetic/plastic surgery, professional hazardous/adventure sports, breach of law, health hydros/nature cure/spas, sterility/infertility and OPD treatment","note":"Waiting periods may be different if the Policy Schedule/Certificate of Insurance says so.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months ... Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. ... Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. ... Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. ... Expenses for cosmetic or plastic surgery or any treatment to change appearance ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. ... Treatments received in health hydros, nature cure clinics, spas or similar establishments ... Expenses related to sterility and infertility. ... Any OPD treatment will not be covered","sources":[{"clause":"Excl01","heading":"Pre-Existing Diseases (Code – Excl01)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl01"},{"clause":null,"heading":"2. 30 Days Waiting Period (Code – Excl03)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-2-30-days-waiting-period-code-excl03"},{"clause":"Excl02","heading":"Specified disease/ procedure waiting period (Code – Excl02)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02"},{"clause":null,"heading":"5. Permanent Exclusions","page":16,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-5-permanent-exclusions"},{"clause":"Excl02(b)(iv)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-b-iv"},{"clause":"Excl02(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-b-v"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"First contact the company through its website, toll-free number, email, courier address or a branch grievance cell. If not satisfied, contact the grievance officer at grievanceofficer@zurichkotak.com before approaching the Insurance Ombudsman.","display":"Company website/toll-free/email/courier/branch grievance cell first; then grievanceofficer@zurichkotak.com; then Insurance Ombudsman","note":null,"quote":"In case of any grievance the insured person may contact the company through Website: www.zurichkotak.com Toll free: 1800 2120 E-mail: care@zurichkotak.com Courier:\nZurich Kotak General Insurance Company (India) Limited, 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai- 400063. Maharashtra, India. Insured person may also approach the grievance cell at any of the company's branches ... insured | person | may | contact | the | grievance | officer | at\ngrievanceofficer@zurichkotak.com","sources":[{"clause":null,"heading":"16. Redressal of Grievance","page":29,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-16-redressal-of-grievance"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"not-stated","value":null,"display":null,"note":"The base sum insured options are not printed; benefits refer to the Sum Insured or limits in the Policy Schedule/Certificate of Insurance.","quote":null,"sources":[],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"The exclusion does not apply if the insured person has Continuous Coverage for more than twelve months and applies afresh to enhanced sum insured.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident","sources":[{"clause":null,"heading":"2. 30 Days Waiting Period (Code – Excl03)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-2-30-days-waiting-period-code-excl03"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":36},"display":"36 months","note":"The Policy Schedule/Certificate of Insurance may mention a different period. The optional Prime cover can reduce the PED waiting period to 30 Days, 60 Days or 90 Days if opted.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months (or as mentioned in the Policy Schedule/ Certificate of Insurance) of continuous coverage after the date of inception of the first policy with insurer.","sources":[{"clause":"Excl01","heading":"Pre-Existing Diseases (Code – Excl01)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl01"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"months","amount":12},"display":"12 months","note":"The Policy Schedule/Certificate of Insurance may mention a different period; if a listed condition is also a PED, the longer waiting period applies.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 12 months (or as mentioned in the Policy Schedule/ Certificate of Insurance) of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"Excl02","heading":"Specified disease/ procedure waiting period (Code – Excl02)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["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 tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant","Dialysis required for chronic renal failure","Tonsillitis, adenoids and sinuses","Gastric and duodenal erosions and ulcers","Deviated nasal septum","Varicose Veins/ Varicose Ulcers"],"display":"Cataract; BPH; myomectomy/hysterectomy unless malignancy; hernia/hydrocele; fissures/fistula/piles; arthritis/gout/rheumatism/spinal disorders; joint replacements unless accident; sinusitis; urinary/biliary stones; D&C/endometriosis; skin/internal tumors/cysts/nodules/polyps including breast lumps unless malignant; chronic renal failure dialysis; tonsillitis/adenoids/sinuses; gastric/duodenal erosions and ulcers; deviated nasal septum; varicose veins/ulcers","note":null,"quote":"a) Cataract;\nb) Benign Prostatic Hypertrophy;\nc) Myomectomy, Hysterectomy unless because of malignancy;\nd) All types of Hernia, Hydrocele;\ne) Fissures and/or Fistula in anus, haemorrhoids/piles;\nf) Arthritis, gout, rheumatism and spinal disorders;\ng) Joint replacements unless due to Accident;\nh) Sinusitis and related disorders;\ni) Stones in the urinary and biliary systems;\nj) Dilatation and curettage, Endometriosis;\nk) All types of skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant;\nl) Dialysis required for chronic renal failure;\nm) Tonsillitis, adenoids and sinuses;\nn) Gastric and duodenal erosions and ulcers;\no) Deviated nasal septum;\np) Varicose Veins/ Varicose Ulcers.","sources":[{"clause":"Excl02","heading":"Specified disease/ procedure waiting period (Code – Excl02)","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sums insured, the sixty continuous months apply from the date of enhancement only on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":null,"heading":"12. Moratorium Period","page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-12-moratorium-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured person can port the policy to other insurers by applying at least 30 days before, but not earlier than 60 days from, the renewal date. Accrued continuity benefits in waiting periods are available as per IRDAI portability guidelines.","display":"Porting allowed; apply 30 to 60 days before renewal; accrued continuity benefits in waiting periods","note":null,"quote":"The insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. ... the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":null,"heading":"8. Portability","page":26,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-8-portability"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"not-stated","value":null,"display":null,"note":"The documents state renewal terms and no maximum entry age, but do not state lifelong renewal.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading applies on renewal based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"Excl02(d)(v)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-d-v"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The policyholder may cancel by giving 7 days' written notice. For a 1-year policy, proportionate premium for the unexpired policy period is refunded if no claim was made; for a multi-year policy, future policy years are refunded in full and the started policy year pro-rata if no claim was made, with medical examination expenses deducted where applicable.","display":"7 days' notice; pro-rata/proportionate refund for unexpired period if no claim; future years refunded in full for multi-year policies","note":"Expenses incurred by the Company on medical examination are deducted if risk or part of the coverage has already commenced.","quote":"The Policyholder may cancel his/her policy at any time during the term, by giving 7 days notice in writing. The Insurer shall -\n• For 1 year Policy- Refund proportionate premium for unexpired policy period subject to no claim(s) were made during the policy period.\n• For Multi Year Policy - o For any policy year where the risk date has not yet started, the premium will be refunded without any deduction. o For any policy year where the risk has started, the premium will be refunded on a pro-rata basis for that policy year, provided no claim has been made during the policy year and in full for future policy years.","sources":[{"clause":"Excl02(d)(i)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-d-i"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Claims are payable only if the cause of action arises in India, unless the policy specifically provides otherwise; treatment taken outside India is excluded.","display":"India only, unless otherwise specifically provided in the policy","note":null,"quote":"No Claims shall be payable under this Policy unless the cause of action arises in India, unless otherwise specifically provided in Policy. ... Any treatment taken outside India;","sources":[{"clause":null,"heading":"5. Cause of Action/ Currency for payments","page":30,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-5-cause-of-action-currency-for-payments"},{"clause":"Excl02(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-b-v"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":"Applicable on new individual health insurance policies and not on renewals or at the time of porting/migrating.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":null,"heading":"15. Free Look Period","page":28,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-15-free-look-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"atleast 30 days","note":"For instalment premiums, monthly mode has 15 days; quarterly, half-yearly and annual instalments have 30 days.","quote":"the policy shall terminate and can be renewed within the Grace Period of atleast 30 days to maintain continuity of benefits without break in policy. ... race Period of 15 days (where premium is paid on monthly instalments) and 30 days (where premium paid in quarterly / half yearly/ annual instalments) would be given to pay the instalment premium due for the policy.","sources":[{"clause":"Excl02(d)(iv)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-d-iv"},{"clause":null,"heading":"12. Moratorium Period","page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-12-moratorium-period"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Minimum entry age is 1 day and maximum entry age is no limit.","display":"Minimum Entry Age 1 day; Maximum Entry Age No Limit","note":null,"quote":"Minimum Entry Age | 1 day\nMaximum Entry Age | No Limit","sources":[{"clause":null,"heading":"1. Eligibility","page":30,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-1-eligibility"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Annual","Half Yearly","Quarterly","Monthly"],"display":"Annual, Half Yearly, Quarterly and Monthly","note":null,"quote":"If the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly ... 30 days (where premium paid in quarterly / half yearly/ annual instalments)","sources":[{"clause":null,"heading":"12. Moratorium Period","page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-12-moratorium-period"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Air Ambulance","Hospital Daily Cash Benefit","ICU Daily Cash Benefit","Convalescence Benefit","Cover for Non-Medical Expenses","Maternity Benefit","New Born Baby Cover","Pre and Post Natal Care","Cumulative Bonus","Wellness Program","Floater Cover","Corporate Buffer","Room Rent Capping with proportionate deduction","Room Rent Capping without proportionate deduction","Deductible","Co-payment","Disease-wise sublimit","Prime rider benefits including Unlimited Reset Benefit, Loyalty Bonus, Inflation Protect, Reduction in PED waiting period, Well-being Benefits, Annual Health Check-up, Air Ambulance +, Emergency Ambulance+, Maternity Cover & its complications, New Born Baby Cover +, Double cover, Cash Bag, Chronic Care, Durable Medical Equipment Cover, Value Added Services, Day Care Treatment + and Personal Accident Cover"],"display":"Optional covers include air ambulance, hospital/ICU daily cash, convalescence, non-medical expenses, maternity, newborn, pre/post natal, cumulative bonus, wellness, floater, corporate buffer, room-rent capping, deductible, co-payment, disease-wise sublimit and Prime rider benefits","note":"The applicable optional covers and limits depend on the Policy Schedule/Certificate of Insurance.","quote":"There are several other optional covers like Air Ambulance, Daily Cash Benefit, Convalescence, etc. along with a rider which can be included in the policy. ... The Covers available under this Policy are described below. The Policy Schedule/ Certificate of Insurance will specify which of the following Covers are applicable and in force for the Insured Person. ... 13 Room Rent Capping with proportionate deduction ... 14 Room Rent Capping without proportionate deduction ... 15 Deductible ... 16 Co-payment ... 17 Disease-wise sublimit ... 1 | Unlimited Reset Benefit ... 2 | Loyalty Bonus ... 3 | Inflation Protect ... 4 | Reduction in PED waiting period ... 5 | Well-being Benefits ... 6 | Annual Health Check-up ... 7 | Air Ambulance + ... 8 | Emergency Ambulance+ ... 9 | Maternity Cover & its complications ... 10 | New Born Baby Cover + ... 13 | Double cover ... 14 | Cash Bag ... 15 | Chronic Care ... 16 | Durable Medical Equipment Cover ... 17 | Value Added Services ... 18 | Day Care Treatment + ... Personal Accident Cover","sources":[{"clause":null,"heading":"HEALTH ASSURE PROSPECTUS Overview","page":1,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-health-assure-prospectus-overview"},{"clause":null,"heading":"WHAT WE WILL PAY (COVERS AVAILABLE UNDER THE POLICY)","page":1,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-what-we-will-pay-covers-available-under-the-poli"},{"clause":"13","heading":"Room Rent Capping with proportionate deduction","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-13"},{"clause":"14","heading":"Room Rent Capping without proportionate deduction","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-14"},{"clause":"15","heading":"Deductible","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-15"},{"clause":"16","heading":"Co-payment","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-16"},{"clause":"17","heading":"Disease-wise sublimit","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-17"},{"clause":"Row 1","heading":"Unlimited Reset Benefit","page":52,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-row-1-9"},{"clause":"Row 2","heading":"Loyalty Bonus","page":52,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-row-2-3"},{"clause":"Row 3","heading":"Inflation Protect","page":52,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-row-3-2"},{"clause":"Row 4","heading":"Reduction in PED waiting period","page":52,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-row-4"},{"clause":null,"heading":"Benefit Table","page":52,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-benefit-table-2"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available during the renewal grace period. If premium is paid in instalments during the policy period, coverage is available during the grace period.","display":"Renewal grace period: no cover; instalment-premium grace period: cover available","note":null,"quote":"Coverage is not available during the grace period. ... If the premium is paid in instalments during the policy period, coverage will be available for the grace period also","sources":[{"clause":"Excl02(d)(iv)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-d-iv"},{"clause":null,"heading":"12. Moratorium Period","page":27,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-12-moratorium-period"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"not-stated","value":null,"display":null,"note":"Room rent limits are said to be as set out in the Policy Schedule/Certificate of Insurance; no rupee or percentage limit is printed.","quote":null,"sources":[],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"The document refers to Normal and ICU room category limits in the Policy Schedule/Certificate of Insurance, but does not print allowed room categories.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"not-stated","value":null,"display":null,"note":"ICU room limits are said to be as set out in the Policy Schedule/Certificate of Insurance; no amount or percentage is printed.","quote":null,"sources":[],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"quote-verified","value":"There are two variants. Under Room Rent Capping with proportionate deduction, if actual room rent is higher than eligible room rent, associated medical expenses are paid only in rateable proportion; under the without-proportionate-deduction variant, only eligible room rent is paid and associated medical expenses are not proportionately deducted.","display":"Yes if the room-rent capping with proportionate deduction variant applies; no under the without-proportionate-deduction variant","note":"Both variants say proportionate deductions will not apply to hospitals without differential billing or to expenses where differential billing is not adopted by room category, and not to ICU Charges.","quote":"If the Insured Person incurs Room Rent that is higher than the eligible Room Rent as per the limits specified under this Benefit then We will be liable to pay only a rateable proportion of the Associated Medical Expenses incurred in the proportion of the difference between the eligible Room Rent and the Room Rent actually incurred ... If the Insured Person incurs Room Rent that is higher than the eligible Room Rent as per the limits specified under this Benefit then We will be liable to pay only the eligible Room Rent as mentioned in the Policy Schedule/ Certificate of Insurance. Proportionate deductions will not be applied in case of the Associated Medical Expenses.","sources":[{"clause":"13","heading":"Room Rent Capping with proportionate deduction","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-13"},{"clause":"14","heading":"Room Rent Capping without proportionate deduction","page":14,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-14"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"not-stated","value":null,"display":null,"note":"The document states a co-payment option up to the limit in the Policy Schedule/Certificate of Insurance, but does not print the co-payment percentage or amount.","quote":null,"sources":[],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":"The document states deductible limits are as specified in the Policy Schedule/Certificate of Insurance and can apply per policy year or on each payable claim, but does not print the deductible amount.","quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"not-stated","value":null,"display":null,"note":"Disease-wise sub-limits are said to be as specified in the Policy Schedule/Certificate of Insurance; the documents do not print named treatments or caps.","quote":null,"sources":[],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"not-stated","value":null,"display":null,"note":"The cover is stated, but the number of pre-hospitalisation days is only said to be as specified in the Policy Schedule/Certificate of Insurance.","quote":null,"sources":[],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"not-stated","value":null,"display":null,"note":"The cover is stated, but the number of post-hospitalisation days is only said to be as specified in the Policy Schedule/Certificate of Insurance.","quote":null,"sources":[],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"Base day care treatment covers only day care treatments listed in Annexure II of the policy; OPD treatment is not covered. Optional Day Care Treatment + covers all day care treatments not listed in the base policy.","display":"Base: listed Annexure II day care treatments only; optional Day Care Treatment + covers all day care treatments not listed in the base policy; OPD excluded","note":null,"quote":"We will only cover the Medical Expenses for those Day Care Treatments which are listed in Annexure II of this Policy. ... We will not cover any OPD Treatment under this Benefit. ... We will only cover the Medical Expenses for all Day Care Treatments which are not listed in the Base policy as coverage.","sources":[{"clause":"4","heading":"Day Care Treatment","page":2,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-4"},{"clause":null,"heading":"R. Day Care Treatment +","page":48,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-r-day-care-treatment"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalisation is covered for treatment at home that would otherwise have required hospitalisation, or where the insured person's condition did not allow hospital transfer or a hospital bed was unavailable, if medically necessary and lasting at least 3 consecutive days.","display":"Covered if treatment at home would otherwise require hospitalisation, or transfer is not possible/bed unavailable; at least 3 consecutive days","note":"The policy lists illnesses/conditions not indemnified under domiciliary hospitalisation.","quote":"We will cover medical expenses of an Insured person for treatment of a disease, illness or injury taken at home which would otherwise have required hospitalisation or since the Health Assure UIN - ZUKHLGP27067V042627 Insured person's condition did not allow a hospital transfer or a hospital bed was unavailable. ... The Insured Person's Domiciliary Hospitalisation extends for at least 3 consecutive days in which case We will pay Medical Expenses under this Extension from the first day of Domiciliary Hospitalisation;","sources":[{"clause":"5","heading":"Domiciliary Hospitalisation","page":2,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-5"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"AYUSH treatment is covered within the Basic Sum Insured when administered by an AYUSH Medical Practitioner and the insured is admitted to an AYUSH Hospital or AYUSH Day Care Centre.","display":"Covered within Basic Sum Insured in AYUSH Hospital / AYUSH Day Care Centre","note":null,"quote":"We will indemnify the Medical Expenses incurred on the Insured Person's AYUSH Treatment (subject to availability of Basic Sum Insured), provided that:\na) The AYUSH Treatment is administered by a AYUSH Medical Practitioner;\nb) The Insured Person is admitted to AYUSH Hospital / AYUSH Day Care Centre for the AYUSH Treatment to be administered. The payment under this benefit is within the Basic Sum Insured.","sources":[{"clause":"8","heading":"AYUSH Treatment","page":4,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-8"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"not-stated","value":null,"display":null,"note":"The documents do not state a general cover or cap for modern treatments such as robotic surgery, immunotherapy, oral chemotherapy or stem cell therapy.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"quote-verified","value":"Donor in-patient hospitalisation medical expenses for harvesting the organ are covered up to the Sum Insured, subject to availability of Basic Sum Insured, when the organ is for the insured person and the insured person's in-patient transplant claim is accepted.","display":"Covered up to Sum Insured for donor in-patient harvesting expenses, within Basic Sum Insured","note":"Pre- and post-hospitalisation donor expenses, organ acquisition costs and donor complications/other treatment are excluded.","quote":"We will indemnify the In-patient Hospitalisation Medical Expenses towards the donor for harvesting the organ up to the limits of the Sum Insured (subject to availability of Basic Sum Insured), provided that: ... The organ donated is for the use of the Insured Person who has been asked to undergo an organ transplant on Medical Advise; ... We have accepted a Claim for In-patient Treatment under the Policy in respect of the Insured Person;","sources":[{"clause":"7","heading":"Donor Expenses","page":4,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-7"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Emergency road ambulance is covered up to the limit in the Policy Schedule/Certificate of Insurance, within the Basic Sum Insured, including transfer between hospitals/diagnostic centre where required. Air ambulance is an optional cover, subject to schedule limits.","display":"Emergency ambulance covered up to schedule limit within Basic Sum Insured; optional Air Ambulance available","note":"The exact road and air ambulance rupee limits are not printed.","quote":"We will indemnify the Reasonable and Customary Charges incurred up to the limit specified in the Policy Schedule/ Certificate of Insurance towards transportation of the Insured Person by a healthcare or Ambulance service provider to a Hospital for treatment of an Illness or Injury following an Emergency ... The payment under this benefit is within the Basic Sum Insured, subject to the limits specified, if any. ... We will indemnify the amount up to the limit specified in the Policy Schedule/ Certificate of Insurance for the reasonable expenses incurred by You for ambulance transportation in an airplane or helicopter","sources":[{"clause":"6","heading":"Emergency Ambulance","page":3,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-6"},{"clause":"6(c)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-6-c"},{"clause":null,"heading":"II. Optional Covers 1. Air Ambulance","page":4,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-ii-optional-covers-1-air-ambulance"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"There is no stated base restoration benefit unless the optional Unlimited Reset Benefit is availed. Under that optional cover, the Sum Insured can be reset if completely exhausted or insufficient, unlimited times during the policy year, up to the opted percentage of Base Sum Insured and subject to variations in the Policy Schedule/Certificate of Insurance.","display":"None unless optional Unlimited Reset Benefit is availed; then reset can be used unlimited times during the Policy Year","note":"Optional cover; applicability may be from 1st or 2nd claim and for policy year or policy life as specified in the schedule.","quote":"On availing this optional cover, we shall provide a reset (reinstatement) of the Sum Insured if it is completely exhausted or insufficient to cover a claim. This benefit may be utilized unlimited times during the Policy Year, subject to the limits (up to the opted and specified percentage of the Base Sum Insured) and in accordance with the variations and applicability specified in the Policy Schedule or Certificate of Insurance. ... The Reset Sum Insured can be utilized in respect of any illness (related / unrelated) and its complications as mentioned in certificate of Insurance except for claim under “Any one Illness” condition.","sources":[{"clause":null,"heading":"A. Unlimited Reset Benefit","page":1,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-a-unlimited-reset-benefit"},{"clause":"1(b)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-1-b"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"There is no stated base no-claim bonus unless Cumulative Bonus or optional Prime Loyalty Bonus is chosen. Cumulative Bonus increases the Sum Insured by a percentage up to a maximum specified in the Policy Schedule at renewal; Prime Loyalty Bonus is optional and may increase the Sum Insured by 10% to 100% of Base Sum Insured up to 1X to 10X, depending on the variant.","display":"Cumulative Bonus as per schedule if selected; optional Prime Loyalty Bonus: 10% to 100% of Base Sum Insured, up to 1X to 10X","note":"Cumulative Bonus and Loyalty Bonus are variants/optional covers; the base percentage and maximum for Cumulative Bonus are not printed.","quote":"We will increase the Sum Insured by a specified percentage subject to the maximum limit specified in the Policy Schedule at the end of the Policy Year if the Policy is renewed with Us ... Loyalty Bonus | 1. Increases by Minimum - 10%, Maximum - 100% of Base Sum Insured 2. Covered up to - 1X to 10X of Base Sum Insured 3. Variation: i. Accrued bonus doesn’t decrease in case of a claim ii. Bonus accrues irrespective of claim on each renewal","sources":[{"clause":"9","heading":"Cumulative Bonus","page":7,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-9"},{"clause":"Row 2","heading":"Loyalty Bonus","page":15,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-row-2-2"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"The in-patient cover includes allowable consumables prescribed by the treating medical practitioner. Non-medical items are otherwise excluded, but an optional Cover for Non-Medical Expenses reimburses generally excluded items such as toiletries, cosmetics, personal comfort or convenience items, certain room-charge elements, administrative or non-medical charges and external durable devices.","display":"Allowable consumables covered; non-medical items excluded unless optional Cover for Non-Medical Expenses is selected","note":"Cover for Non-Medical Expenses is optional and applies within the Basic Sum Insured subject to limits, if any.","quote":"Medicines, drugs and other allowable consumables prescribed by the treating Medical Practitioner; ... We will reimburse the expenses incurred towards generally excluded items such as non-medical items like toiletries, cosmetics, personal comfort or convenience items, certain elements of room charges, administrative or non-medical charges, and external durable devices","sources":[{"clause":"1","heading":"In-patient Treatment","page":1,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-1"},{"clause":null,"heading":"5. Cover for Non-Medical Expenses","page":6,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-5-cover-for-non-medical-expenses"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity is not a base cover unless the optional Maternity Benefit or Prime Maternity Cover & its complications is selected. The prospectus maternity benefit has a 9 month waiting period and pays up to the maternity benefit sum insured in the schedule for delivery including caesarean section or medically necessary lawful termination of pregnancy.","display":"Optional; 9 month waiting period under Maternity Benefit; Prime option can be Day 1, 9 months, 1 Year or 2 Years","note":"Maternity is a permanent exclusion unless the maternity optional cover applies to the extent of that benefit.","quote":"We will indemnify the Medical Expenses incurred up to the Maternity Benefit Sum Insured specified in the Policy Schedule/ Certificate of Insurance for the delivery of the Insured Person's child (including caesarean section) ... A 9 month waiting period shall apply ... Maternity Cover & its complications | 1. Maternity Sum Insured (Any or all can be chosen): Normal Delivery - Min: 5000 to Max: 5,00,000 ... 2. Waiting periods options as below: i. Coverage from Day 1 ii. Coverage after 9 months iii. Coverage after 1 Year iv. Coverage after 2 Years","sources":[{"clause":null,"heading":"6. Maternity Benefit","page":6,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-6-maternity-benefit"},{"clause":"Row 9","heading":"Maternity Cover & its complications","page":16,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-row-9-2"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"New born baby cover is optional. It covers hospitalisation medical expenses of the insured person's newborn baby during and post birth up to 90 days from delivery, within the Basic Sum Insured or Maternity Sum Insured and subject to limits in the schedule.","display":"Optional; hospitalisation expenses during and post birth up to 90 days from delivery","note":"The newborn can be covered beyond 90 days on payment of requisite premium by endorsement or at the next renewal, whichever is earlier.","quote":"We will indemnify the Medical Expenses incurred on the Hospitalisation of the Insured Person's New Born Baby during the Policy Period within the Basic Sum Insured/ Maternity Sum Insured, subject to limits specified, if any ... Medical Expenses incurred on the New Born Baby during and post birth up to 90 days from the date of delivery and is within the Basic Sum Insured or the Maternity Sum Insured, subject to limits specified, if any","sources":[{"clause":null,"heading":"7. New Born Baby Cover","page":7,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-7-new-born-baby-cover"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The documents do not specifically state cover for in-patient treatment of mental illness. They list psychiatric or psychosomatic disorders as excluded under domiciliary hospitalisation.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"quote-verified","value":"There is no stated base free health check-up unless the optional Annual Health Check-up or Wellness Program is selected. The optional annual health check-up provides an Annual Health Check-up Program as prescribed in the Policy Schedule/Certificate of Insurance.","display":"Optional Annual Health Check-up; tests/limits as per schedule","note":"The frequency/limits and whether it is available to all members or members above 18 years depend on the selected cover and schedule.","quote":"On availing this optional cover, We will provide coverage for an Annual Health Check-up Program as prescribed in the Policy Schedule or Certificate of Insurance. ... Health Check-up and Report evaluation We will arrange for a diagnostic/ preventative Health Check-Up at any of our Network Provider based on the list of tests mentioned in the Policy Schedule/ Certificate of Insurance","sources":[{"clause":null,"heading":"F. Annual Health Check-up","page":5,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-f-annual-health-check-up"},{"clause":"10(b)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-10-b"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment is not covered under the base day care benefit and is listed as a permanent exclusion. Optional or wellness-related benefits may be usable for OPD expenses, such as Cash Bag or reward point redemption, if applicable.","display":"OPD treatment not covered; optional Cash Bag/reward points may be used for OPD expenses if available","note":"Cash Bag is an optional Prime cover.","quote":"We will not cover any OPD Treatment under this Benefit. ... Any OPD treatment will not be covered ... This amount can be used for ... d) Payment of OPD expenses (if any)","sources":[{"clause":"4","heading":"Day Care Treatment","page":2,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-4"},{"clause":"Excl02(b)(v)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-b-v"},{"clause":null,"heading":"N. Cash Bag","page":8,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485#c-n-cash-bag"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"The documents do not state that premium or co-pay depends on city or zone. They only say room rent capping may be based on the location of the hospital.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless facility is available at the insurer's network providers. For cashless treatment, pre-authorisation is required and the provider list is available on the insurer's website or call centre.","display":"Available at Network Provider of the Company","note":null,"quote":"Cashless Facility will be available at a Network Provider of the Company. The complete list of Providers is available on Our website (The list is updated as and when there is any change\nHealth Assure UIN - ZUKHLGP27067V042627 in the Network Provider) or can be obtained from Our call centre.","sources":[{"clause":null,"heading":"1. CLAIMS PROCEDURE","page":20,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-1-claims-procedure"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims are handled by the insurer and/or its TPA. The claim procedure refers to We or Our TPA and names Family Health Plan (TPA) Ltd for sending relevant claim documents.","display":"Zurich Kotak / its TPA; Family Health Plan (TPA) Ltd named for claim documents","note":null,"quote":"We or Our TPA shall be contacted to request pre authorization ... In the event of claims, please send the relevant documents to:\nFamily Health Plan (TPA) Ltd, Srinilaya – Cyber Spazio Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, 500 034.","sources":[{"clause":null,"heading":"1. CLAIMS PROCEDURE","page":20,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-1-claims-procedure"},{"clause":"Excl02(a)(viii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-excl02-a-viii"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, Family Floater Sum Insured basis","note":null,"quote":"We will cover the members of the Policyholder as per Relationships defined for the Group members on a Family Floater Sum Insured basis. Where the Policy is obtained on floater basis covering the family members, the Sum Insured will be available to the Insured and all and any one of the Insured Persons for one or more claims during the Policy period.","sources":[{"clause":"11","heading":"Floater Cover","page":13,"url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217#c-11"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Assure","pages":55,"fetched_at":"2026-10-17 20:12:24+00","source_url":"https://cms.zurichkotak.com/uploads/Health_Assure_Policy_Wordings_Website_77938d6256_2_d8f079f3df.pdf","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18269"},{"kind":"wording","label":"Prime","pages":18,"fetched_at":"2026-10-17 20:25:03+00","source_url":"https://cms.zurichkotak.com/uploads/Prime_Policy_Wordings_0784fa4204_002_bf318a274b.pdf","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18485"},{"kind":"prospectus","label":"Health Assure","pages":56,"fetched_at":"2026-10-17 20:09:26+00","source_url":"https://cms.zurichkotak.com/uploads/Health_Assure_Prospectus_6f362b75ee.pdf","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18217"},{"kind":"cis","label":"Health Assure","pages":11,"fetched_at":"2026-10-17 20:11:46+00","source_url":"https://cms.zurichkotak.com/uploads/Health_Assure_CIS_FY_24_25_v1_04042025_dd8ede9a94.pdf","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18258"},{"kind":"benefit-illustration","label":"Health Assure – Benefit Illustration","pages":1,"fetched_at":"2026-10-17 20:08:36+00","source_url":"https://cms.zurichkotak.com/uploads/Benefit_Illustration_Health_assure_871428c832.pdf","url":"https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425/document/18195"}],"versions":[{"uin":"ZUKHLGP27067V042627","version":null,"approved_on":null},{"uin":"ZUKHLGA25064V012425","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Zurich Kotak General Insurance ( ) official website","url":"https://www.zurichkotak.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims","url":"https://www.zurichkotak.com/services/claims","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal process","url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renewals","url":"https://www.zurichkotak.com/renewal","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health Assure (UIN ZUKHLGA25064V012425), IndiaInsurances, https://indiainsurances.com/policy/zurich-kotak-general-insurance/health-assure-zukhlga25064v012425"}