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IFFCO TOKIO Health Insurance Claim

An insured can apply for the claim in two ways – cashless claims and reimbursement for the claim. The procedures to file these claims are given below:

Cashless Claims

The cashless claims are of two types:

  • Cashless Claim in case of Emergency Hospitalization
  • Cashless Claim in case of Planned Hospitalization


Cashless Claim Process for Emergency Hospitalization:

  • In the case of hospitalization in the network hospital, an insured has to contact the third-party administrator (TPA) through the toll-free number and mention his/her card Membership Number.
  • Fill the cashless claim request form. This form is generally available at the Insurance Help Desk of the hospital. This form has to be certified by the treating doctor as well.
  • The insured or his/her family has to fax this cashless form with other supporting documents (medical) to the TPA.
  • The TPA scrutinizes the documents and conveys its decision to the hospital. The TPA can approve this request or can ask for some additional documents if needed.
  • Upon approval of the cashless claim by the TPA, the hospital settles the bills directly as per the limit of the policy.
  • If the TPA does not approve the cashless claim, then the hospital bills have to be settled by the insured only. However, in this case, the policyholder can apply for reimbursement. The claim will be processed as per the terms and conditions of the policy.

Note: Generally, the TPA approves the request of cashless claims within 24 hours of receiving the cashless form and other required documents.

Cashless Claim Process for Planned Admission:

  1. Select a network hospital from the list of network hospitals for treatment.
  2. Intimate the Third-Party Administrator (TPA) through their helpline numbers at least 3 days before starting the treatment. During the call with TPA, the insured or his/her family must provide the card Membership number.
  3. Now fill the cashless request form. This form is available with the insurance help desk of the hospital and it must be certified by the treating doctor of the insured.
  4. Fax this cashless form (duly filled) with other supporting documents to the TPA.
  5. The TPA scrutinizes these documents and conveys its result to the hospital. The TPA can approve this request for cashless treatment or can ask for more documents, as per the requirement.
  6. Upon approval of the cashless claim by the TPA, the hospital settles the bills directly with the hospital as per the policy inclusions.
  7. If the cashless claim is not approved from TPA’s end, the policyholder may ask for reimbursement after the treatment.

Claim Process – Reimbursement Claim:

If an insured is not able to get the cashless facility in any of the network hospitals, then he/she can opt for reimbursement. The process for the same is:

  • Intimate the IFFO Tokio via its toll-free number – 1800-103-5499 soon after the admission. This intimation should happen within 7 days from the date of admission.
  • The policyholder should get the treatment and can settle all the bills in the hospital only and after that file the claim for the reimbursement.
  • Download the necessary claim form from the website of IFFCO TOKIO or one can request for this form through the call-center.

Checklist of Required Documents

The documents required in case of reimbursement of claim along with the filled claim form and treating doctor’s certificate are:

  • All the bills of the hospital.
  • Discharge summary
  • Prescription
  • Diagnostic test reports, Scan, X-Ray, and other relevant medical documents

 

 

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