Zurich Kotak LiveWise

Zurich Kotak LiveWise is a health insurance policy designed by Zurich Kotak General Insurance Company Limited. A health insurance policy assists in covering hospitalization charges and the costs incurred prior to and subsequent to hospitalization. It acts as a shield for healthcare and savings, whereby you and your family are able to live a contented, cheerful life. The Zurich Kotak LiveWise policy has a vast array of benefits, features, and add-ons to fulfill the medical needs of you and your family.

The plan has a number of salient features and compelling discounts at a reasonable price. Apart from covering hospitalisation and allied charges, it also covers consumable charges like gloves, oxygen masks, and others. Interestingly, it doubles your coverage for the same claim in a single hospitalisation once the basic sum insured is depleted.

On the negative side, this plan does not provide the option to pay premiums monthly. Furthermore, according to our investigation, the insurer has received more complaints pertaining to both claim settlement and the purchase of the policy. This is an indication that the insurer has a poor track record when it comes to both the purchase experience and claims service.

Now, let’s dive deeper into what the Zurich Kotak LiveWise Plan has to offer.

What are the benefits offered by the Zurich Kotak LiveWise Plan?

The following are the salient product benefits that identify what the Zurich Kotak LiveWise Plan has to provide:

• Inpatient hospitalisation coverage: This plan covers the expenses when you are hospitalised for more than 24 hours. It gives coverage for the room rent, nursing care, doctor's prescribed medicines, doctor's consultation fees, ICU, and other costs incurred by your hospital stay. 
• Pre-hospitalisation coverage: Before hospitalisation, you might have to undergo medical tests, investigations, X-rays, CT scans, and so on. These are known as pre-hospitalisation charges. In this plan, these expenses are covered for 60 days, but within the limit of the sum insured. But they will be paid only if they are related to the illness that caused your hospitalisation, and the claim is accepted under inpatient or daycare treatment.
• Post-hospitalisation coverage: Once discharged, you might continue to have follow-ups, medical tests, or check-ups. These are referred to as post-hospitalisation charges. The plan covers them for 180 days, up to the amount insured. Just like pre-hospitalisation, these are covered only if they are related to the disease you were hospitalised for, and your inpatient or daycare claim is approved.
• Daycare treatment coverage: Daycare treatments are medical procedures or surgeries that once required extended hospitalisation, but can now be done within 24 hours with the advancements in medical technology. All daycare treatments are covered under the Zurich Kotak LiveWise plan to the extent of the sum insured, so you don't have to worry about the expense incurred.
• Domiciliary treatment coverage: Domiciliary treatment is accessing medical care at home for a chronic illness or injury when hospitalization is not possible. This could be due to the patient's health condition or the unavailability of beds in the hospitals. For the Zurich Kotak LiveWise plan, costs of domiciliary treatment are reimbursed up to the amount of the sum insured. However, 12 illnesses are excluded.
• Organ donor coverage: The plan also provides organ donor costs coverage if the insured is the receiver, and it covers the cost of retrieving the organ of the donor up to the sum insured.
• Modern Treatment coverage: Advanced and technically sophisticated treatments are covered with no financial limit as long as they are medically required and within the scope of listed procedures.
• Non-medical expenses coverage: Non-medical expenses are also covered by the Zurich Kotak LiveWise plan with no monetary limit to the extent of the sum insured. It is an add-on paid feature, available at an additional price. This covers consumables that are applied in the course of treatment, like nebulisation kits, gloves, oxygen masks, and other basic medical items, which are normally non-payable items.
• No Claim Bonus: If you do not claim anything during the term of the policy, the insurer awards you a No Claim Bonus (NCB). With the Zurich Kotak LiveWise plan, you are eligible to receive up to a 100% bonus. For every claim-free year that you have driven, you get a 50% annual bonus, which guarantees that you increase your overall cover over time. If you do make a claim during the policy term, your bonus you've accrued will get reduced in the same ratio as it has been earned. 
• Super No Claim Bonus: The Super No Claim Bonus is a more advanced form of the normal NCB and functions in the same way. That being said, the Zurich Kotak LiveWise plan doesn't include this advantage.
• Restoration benefit: The restoration benefit assists in refilling your sum insured after it has exhausted itself in a policy year. For this plan, the benefit grants unlimited refills during a policy year. The refill benefit will activate once the Sum Insured and No Claim Bonus are fully exhausted, and it will apply to subsequent claims. It is applicable for both related and unrelated diseases, such that you are still covered despite the initial sum insured being exhausted. The refill benefit for related illnesses or diseases will be available only for admissions that occur at least 45 days after the discharge date of the previous claim.

Please note that the limitations and conditions mentioned above apply to a sum insured of Rs. 10 lakhs.

Zurich Kotak LiveWise: Financial Limits

• Room rent limit: The room rent limit represents the most your insurer will cover for your hospital room. Provided you don't exceed this limit, you won't be paying anything more than that. But if you opt for a higher-cost room that exceeds your eligible value, a proportionate reduction will be made. With the Zurich Kotak LiveWise plan, there is no room rent limit.
• ICU rent cap: The ICU rent cap is the maximum amount your insurer will cover for your Intensive Care Unit stay. For the Zurich Kotak LiveWise policy, there is no cap on ICU rent. ICU charges are covered in full up to the sum insured.
• Copayment: You pay a fixed percentage of the claim out of your pocket, and the insurer pays the remaining amount. In the Zurich Kotak LiveWise plan, there is no copayment clause.
• Deductible: A deductible is the amount that you pay out of your pocket before the insurance firm will pay for your medical expenses. The Zurich Kotak LiveWise does not offer any deductible options.
• Limits on treatments/surgeries: This pertains to the extent of coverage for certain medical treatments or procedures. Caps are included in some health policies. Under the Zurich Kotak LiveWise plan, cataract treatment and joint replacement surgery are covered to the extent of the full sum insured.

Please note that the above financial limits apply to a 30-year-old individual who has chosen a sum insured of Rs. 10 lakhs.

Zurich Kotak LiveWise: Waiting Periods & Exclusions

👉Waiting period

The waiting period is the time period after you purchase a health insurance plan during which certain illnesses or treatments will not be covered. You can only claim these illnesses after the waiting period has passed.

The following are the most important types of waiting periods:

• Initial waiting period: For all the diseases except those caused by accidents, the initial waiting period is 30 days. You cannot claim hospitalisation for any reason within this period except if caused by an accident.
• Waiting period for pre-existing diseases: Pre-existing disease is any disease or health issue you experienced during the past 36 months before buying the policy. In the Zurich Kotak LiveWise plan, there is a 36-month waiting period for pre-existing diseases. During this period, you cannot make any claim on account of these diseases.
• Waiting period for specified diseases or procedures: In addition to pre-existing conditions, insurers maintain a list of specific illnesses that come with a waiting period, regardless of your past health history. The length of these waiting periods is set by the insurer. For the Zurich Kotak LiveWise plan, there is a 12-month waiting period, available as an add-on, for various specific diseases.

👉 Exclusions

Exclusions are particular situations or conditions that an insurance policy does not cover. Described below are some of the common exclusions:

• Standard Permanent Exclusions: According to the directives of the Insurance Regulatory and Development Authority of India (IRDAI), each health insurance provider must adhere to a specified list of standard permanent exclusions. Some examples include:
  • Investigation and evaluation: Hospital stays are done only for observation or monitoring.
  • Rest, rehabilitation, and respite care: Admission to a facility purely for rest or recovery, without any active medical treatment.
  • Obesity/weight control: Surgeries, treatments, or procedures aimed at weight loss.
  • Gender reassignment: Medical procedures intended to change physical characteristics to match a different gender identity.
  • Plastic/Cosmetic surgery: Treatments or surgeries done to change or enhance physical appearance.
  • Profession in adventure sports: Injuries that occur during professional participation in activities like river rafting, mountaineering, scuba diving, etc.
  • Breach of law: Treatment for injuries sustained while attempting to commit a criminal offence.
  • Excluded providers: Care obtained from hospitals or medical practitioners not included in your policy.
  • Narcotics: Rehabilitation for alcohol, drug, or other allied substance addiction.
  • Treatments in establishments arranged for domestic purposes: Health care administered in facilities such as nursing homes, spas, or any such arrangements intended for domestic or non-health purposes.
  • Dietary supplements purchased without prescription: Vitamins, minerals, or other supplements that are not prescribed by a registered medical professional.
  • Refractive error: Expenditures for the correction of refractive errors up to 7.5 diopters for improving vision.
  • Unproven treatments: Any surgery, treatment, or procedure not proven to be effective.
  • Sterilisation, conception, and infertility costs: Expenditures on sterilisation, contraceptives, artificial insemination, or high-tech fertility treatments like IVF, GIFT, ZIFT, ICSI, and gestational surrogacy, among others.
  • Maternity costs: Fees charged for maternity care, both prenatal and postnatal, childbirth, etc.
• Additional Permanent Exclusions: In addition to the standard list, insurers can also opt for other permanent exclusions for specific diseases or conditions they find too risky to insure. The exclusions should be from the approved list provided by IRDAI. Insurers cannot exclude any illness or condition from coverage unless it is on this approved list.
• Non-standard exclusions (Specific exclusions): Non-standard exclusions are more than the general permanent exclusions prescribed by the IRDAI. They are individual-specific and derived from the policy's detailed terms and conditions. The following are some of the specific exclusions referred to under the Zurich Kotak LiveWise plan:
  • Charges for routine eye tests, ear tests, dentures, false teeth, and other comparable external devices or appliances
  • Costs on external devices such as wheelchairs, walkers, glucometers, crutches, sleep apnea devices, oxygen concentrators, or cochlear implants and associated surgery are excluded
  • Costs associated with treatment and products for hair loss
  • Costs associated with screening, counseling or treatment of external congenital defects
  • Treatment of mental retardation, arrested or incomplete development of the mind, subnormal intelligence, or intellectual disability
  • Circumcision, except for the treatment of a disease or injury
  • Cost of preventive health check-up, cost of vaccinations and inoculations (excluding post-animal bite treatment), and tonics
  • Ventilator use for a patient in a vegetative state (brain dead) with no hope of recovery
  • Expenses in respect of non-allopathic, alternative, or treatment of any unrecognised systems of medicine
  • Abuse of depressants or stimulants that affect cognitive skills, except when prescribed by a physician
  • Costs pertaining to HRT or any other hormone medicine

What can you expect in terms of Claims Experience if you buy from Zurich Kotak General Insurance Company Limited?

• Speed of claims: Zurich Kotak General Insurance Company Limited pays about 78.53% of the claims within 30 days, thereby offering an easy and speedy claims process to the insureds.
• Claim-related complaints: Based on our research, however, the percentage of complaints in the company's case is 0.21% higher than in other insurers. This means that they do have loopholes within their claim settlement process.
• Claims incurred ratio: The claims incurred ratio compares the total claims the insurer has paid out to the total premiums collected over a financial year. For Zurich Kotak General Insurance Company Limited, it is 59.06%, which indicates how well they are settling claims in terms of revenues earned.
• Claim settlement ratio: The claim settlement ratio is a percentage of claims an insurer receives that are settled in a financial year compared to the total no. of claims received. 89.04% has been submitted by Zurich Kotak General Insurance Company Limited as a claim settlement ratio.
• Network hospitals: Zurich Kotak General Insurance Company Limited has an extensive network of over 11,200 hospitals. With such a huge network, it becomes convenient for the customers to get such a cashless treatment at various places.

How is the Customer Service of Zurich Kotak General Insurance Company Limited?

• Policy purchase complaints: Our research reveals that Zurich Kotak General Insurance Company Limited has a complaint ratio of 0.02% for its after-sales service, which is much higher than that of other insurance corporations.
• Response on Toll-Free: Our research indicates that the response time on toll-free for Zurich Kotak General Insurance Company Limited is average compared to other players.
• Twitter response: Zurich Kotak General Insurance Company Limited's Twitter response time is average compared to others in the insurance industry.

About Zurich Kotak General Insurance Company Limited

Zurich Kotak General Insurance Company (India) Limited, erstwhile Kotak General Insurance Company Limited, is a 70:30 joint venture between Zurich Insurance Group and Kotak Mahindra Bank. It sells a broad spectrum of general insurance products such as health, home, car, and bike Insurance. It was established in 2015 and has its headquarters in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Alok Kumar Agarwal.