IFFCO TOKIO Health Insurance

IFFCO Tokio Health Insurance Overview:

Life is full of uncertainty and nobody knows when they could land up in an urgent medical exigency situation. Adding insult to the injury are the medical expenses which have now a day have gone sky high. IFFCO Tokio Health Insurance through its all-embracing health insurance plans facilitates customers to bear the huge expenses at the time of unexpected serious illness or injury. The Individual Health Insurance Plans & Family Health insurance plans are not just all inclusive but Comprehensive also to cover both Individual as well the group of Family members.

IFFCO Tokio Health Insurance Highlights:

IFFCO Tokio Health Insurance Policies at a Glance:

Why choose IFFCO Tokio Health Insurance:

• On the spot digitally signed Policy document issued at any of the branches, POS centres and for online purchases.
• Exclusion of pre existing disease applicable only for 3 years as compared to 4 years offered in most of the health insurance plans.
• Auto renewal facility of the Sum Insured in the event of a claim under the health insurance Policy.
• One of the few companies, offering full reimbursement of full eligible claim amount under its various plans.
• Zero involvement of third party administrator, making the entire process simple and hassle free.
• Huge network of nearly 3000 affiliated hospital across India for cashless facility.
• For existing policy holder with any other insurer, the holder may switch over their plans to IFFCO-Tokio.
• Dedicated 24x7 call centre for any assistance pertaining to claims and settlements.
• Discount of premium for any ad-on coverage for enrolling family members.

IFFCO Tokio Health Insurance offers its plans in two different Segments which are

1. The Individual Health Insurance Plans
2. The Group Health Insurance Plans

The Individual Health Insurance Plans by IFFCO TOKIO:

a) IFFCO TOKIO Critical Health Insurance Policy:

A sudden detection of any critical illness or major disease   is no less than a mental ordeal for any person and their family. IFFCO Tokio Critical Health Insurance Policy is a protective plan which cocoons the person from encumbrance due to any critical illness. The features are.

A full-fledged medical cover comprising all expense incurred for the treatment of any critical illness.

Coverage of most of the critical illness such as cancer, renal failure, coronary artery diseases requiring bypass surgery, major organ transplant, paralytic cerebral stroke as well as accidental injuries resulting in loss of limbs.

Cashless facilities available at the Network Hospitals

Eligibility:

• Employers covering their employees including dependants of the employees
• Pre-identified segment/group where the premium is paid by the State/Central Government.
• Members of registered service clubs.
• Holders of credit cards or other financial cards.
• Holders of deposit or certificate of Banks/NBFCs.
• Shareholders of public limited companies, cooperative societies etc.
• Students/teachers of educational institutions.
• Members of any other group having common identification or interest

Exclusions:

• Ailments of any pre existing disease diagnosed prior issuance of policy.
• Expense incurred towards the treatment of any disease diagnosed during 120 days post commencement of policy.
• Treatment of disease caused due to drug addiction or consumption of alcohol.
• Ailment of any critical illness due to self sustained injury or suicide attempt.
• In event of any War, Nuclear or terrorism act.

Important Terms & Conditions:

• Mandatory confirmation by any registered Medical Practitioner for the critical illness.
• Apart from this, the confirmation should be supported by clinical, radiological, histological and laboratory evidence.
• Onetime payment is made only to the person insured.
• Once the reimbursement towards the expenses incurred shall be made, the policy shall come to an end automatically.

b) IFFCO TOKIO Individual Medishield Policy:

A medical plan expressly designed to cover the hospitalization expenses for an individual or his family members.

The features of this policy are

• Expenses incurred for the treatment of physical disease or injury caused during the plan coverage.
• Available only for medical expenses incurred for treatment in India
• Plan is available for person aged between 3 months to 80 years.
• Minor between 3 months till 5 years are included subject to coverage of both the parents.
• No medical checkups required for applicants till 45 years.
• For applicants beyond 45 years, a pre acceptance medical check-up comprising of Blood Sugar, Urine & ECG is required for new applicants and for cases of break coverage.
• For applicants beyond 55 years, additional tests (LP & KFT) is mandatory for fresh/break coverage/
• Discount in premium for inclusion of including spouse, dependent children and dependent parents in the Family Package cover plan.
• Dependent children shall be treated as unmarried individuals till 23 years of age.
• Hospitalization shall be referred as for only those cases where the treatment is being done at the defined institution mentioned in terms of plan and for minimum duration of 24 hours.
• Separate list of 121 treatments has been incorporated in the Individual Medishield Plan, and the expenses towards the same as covered as well.

Expenses covered under the mediclaim plan:

• Room Rent @ 1.0% of Basic Sum Insured daily
• ICU/ITU Rent @ 2.5% of Basic Sum Insured daily.
• Expense incurred towards Registration, Service Charges, and Surcharges etc. of hospital bill subject top maximum of 0.5% of Basic Sum Insured.
• Pre and post hospitalization nursing expenses subject to attachment of qualified nurses on recommendation of Medical practitioner.
• Surgeon, Anaesthetist, or any other kind of consultancy expenses.
• Daily Allowance @0.1% of Basic Sum Insured, subject to maximum Rs. 250 per day, for the duration of hospitalization.
• Ambulance charges @ 1.0% of Basic Sum Insured or Rs 1,500, whichever is higher.
• Expense incurred towards the purchase of medicines, blood, oxygen, anaesthesia, diagnostic and pathological tests, operation theatre charges, cost of chemotherapy, dialysis, pacemaker, artificial limbs etc.
• For any treatment done as home instead of Hospitalization with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured.
• In case of organ transplant of insured person, the hospitalization expenses of the donor shall be inclusive within the overall and individual limits of Sum Insured covered under the plan.
• Prescribed package charges of hospital for specific treatments, subject to a maximum of 80% of Sum Insured.
• Cost of health check-up, once at the end of 4 claim free years block @ 1.0% of average Basic Sum Insured.

Exclusion:

• Any expense towards newly incepted disease within 30 days waiting period post commencement of plan.
• Any pre existing disease till 3 years post commencement of the policy shall not be covered under the plan.
• Expenses incurred towards the cost of spectacles, contact lens or hearing aids or any Dental treatment, unless requiring hospitalization.
• Convalescence, general debility, congenital diseases/defects, sterility or related to pregnancy, other than ectopic pregnancy.
• No outpatient treatment of treatment from shall not be covered under the plan.
• Cost of external medical equipments.
• Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
• Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
• Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
• Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.

c) IFFCO TOKIO Individual Accident Insurance Policy:

In this age of uncertainty, one has to be prepared for any untoward happenings in life. Especially when it comes to any medical exigency, the huge expenses makes a hole in the pocket. The Individual Accident Insurance Policy by IFFCO Tokio like its various other plans, offers cushion to its customer in any such event.

The features of this plan are

• Policy available for Individual, family members and Group.
• Complete cover against anybody injury or death caused due to any accidental event.
• In the event of death, the plan proffers pecuniary security to the applicant’s family members.
• In the event of loss of fingers/toes or any other permanent partial disablement, a benefit ranging from 5% to 40% is paid depending on the nature of disability.
• In cases of temporary total disability 1% of sum assured or Rs. 6000/- , whichever is higher per week is paid.
• The plan swathe the education of dependent children in the case of inopportune scenario such as death or loss of limbs/eyes or permanent total disablement of the Insured.
• For any job loss due to the loss of limbs/eyes or permanent total disablement in the accident, Individual Accident Insurance Plan offers financial assistance to the person insured.
• Any expense towards the usage of ambulances in the event of accident is covered up to a specific limit.
• Add-on benefits such as compensation for clothing damaged in an accident, expenses for carriage of dead body etc. are covered under this plan.
• Sum assured on Individual and Family plan are enhanced automatically on every renewal.

Discounts on Premium for Group plans by IFFCO TOKIO

Any disablement post accident is covered as well, where the insured shall be paid a fixed percentage of the sum insured under the plan.

Exclusion:

• Cases of any self-injury, suicide
• venereal disease, insanity
• Accidents or injury under the influence of intoxicating liquor or drugs.
• Cases pertaining to pregnancy or childbirth.
• Death or any other complications /disability due to HIV or AIDS
• war and nuclear risks
• Death or accident resulting due to involvement in any sports of fatal nature such as aviation, ballooning
• Members of armed forces

The Group Health Insurance Plans:

a) IFFCO TOKIO Family Health Insurance Policy

The family health insurance plan has been intended to meet the medical requirements of a family member. The plan is not only within the means of common customers, but also covers a wide spectrum of medical need for a modern day family.

The key features of this plan are:

• Available only for medical expenses incurred for treatment in India
• Plan is available for person aged between 3 months to 80 years.
• No medical check-up required for applicants till 45 years.
• For applicants beyond 45 years, a pre acceptance medical check-up comprising of Blood Sugar, Urine & ECG is required for new applicants and for cases of break coverage.
• For applicants beyond 55 years, additional tests (LP & KFT) is mandatory for fresh/break coverage/
• Discount in premium for inclusion of including spouse, dependent children and dependent parents in the Family Package cover plan.
• Dependent children shall be treated as unmarried individuals till 23 years of age.
• Hospitalization shall be referred as for only those cases where the treatment is being done at the defined institution mentioned in terms of plan and for minimum duration of 24 hours.
• Separate list of 121 treatments has been incorporated in the Individual Medishield Plan, and the expenses towards the same as covered as well.

Expenses covered under the plan:

• Room Rent @ 1.0% of Basic Sum Insured daily
• ICU/ITU Rent @ 2.5% of Basic Sum Insured daily.
• Expense incurred towards Registration, Service Charges, and Surcharges etc. of hospital bill subject top maximum of 0.5% of Basic Sum Insured.
• Pre and post hospitalization nursing expenses subject to attachment of qualified nurses on recommendation of Medical practitioner.
• Surgeon, Anaesthetist, or any other kind of consultancy expenses.
• Daily Allowance @0.1% of Basic Sum Insured, subject to maximum Rs. 150 per day, for the duration of hospitalization.
• Ambulance charges @ 1.0% of Basic Sum Insured or Rs 750, whichever is higher.
• Expense incurred towards the purchase of medicines, blood, oxygen, anaesthesia, diagnostic and pathological tests, operation theatre charges, cost of chemotherapy, dialysis, pacemaker, artificial limbs etc.
• For any treatment done as home instead of Hospitalization with apt reasons, the expenses shall be reimbursed for 3 days subject to maximum limit of 20% of basic sum insured.
• Pre and post hospital expenses covering expenses incurred post 30 days of hospitalization. Post hospitalization amount could be either 7% of total hospitalization expense of Rs. 7,500/- whichever is higher.
• Expenses towards the recommended package charges of hospitals for a particular ailment are reimbursed

Additional coverage Benefits in Wider Plan

• Room Rent @ 1.5% of Basic Sum Insured daily and ICU/ITU Rent @ 2.5% of Basic Sum Insured daily.
• Ambulance charges on actual basis, subject to maximum Rs 1,500.
• Daily Allowance @ Rs. 250 per day, for the duration of hospitalization.
• Up to 20% of basic sum insured as the expenses for Treatments done at home for a period of more than 3 days.
• 30 days cap for Pre Hospitalization expenses60 days for post hospitalization expense are reimbursed under the plan without any limit on amount.
• 0% of average Basic Sum Insured can be reimbursed as the cost of health check-up, once at the end of 4 claim free years block

Exclusions

• Any pre existing disease up to 4 years post commencement of policy.
• 30 days cap for newly incepted disease.
• Cost of spectacles, contact lens or hearing aids.
• Convalescence, general debility, congenital diseases/defects, sterility or related to pregnancy, other than ectopic pregnancy.
• No outpatient treatment of treatment from shall not be covered under the plan.
• Cost of external medical equipments.
• Claim towards the ailment of any disease or accidental injury suffered during participation in dangerous sports/activities.
• Medical expenses incurred in the treatment of obesity, hormone replacement therapy, sex change , Genetic disorders, stem cell implantation and surgery.
• Any expense towards the personal comfort and convenience item services shall be refereed as non medical expense and hence not covered under the plan.
• Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
• Claims arising out of participation in dangerous sports/activities.
• Claims arising from or related to HIV/AIDS.
• War, terrorism and nuclear risks.
• All non medical expenses, including personal comfort and convenience item services.
• Treatment of obesity, hormone replacement therapy, sex change.
• Genetic disorders stem cell implantation and surgery.
• Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
• First 10% of any admissible claim, if insured person is suffering from either diabetes or hypertension and first 25% of claim, if he is suffering from both diabetes and hypertension. Expenses incurred for the treatment of physical disease or injury caused during the plan coverage.

b) IFFCO TOKIO Group Critical Illness Plan

Features of this plan are:

• Enhanced sum insured to cover the higher expenses during ailments of critical illness.
• Daily allowance @0.15% of the sum insured else maximum limit of Rs. 1,000/-
• Ambulance charges @0.75% else Rs. 2,500/- , whichever is lower.
• 45 days pre hospitalization and 60 days post hospitalization charges including nursing and other medical expenses.
• Expenses towards preventive health check for insurer, individual or group subject to maximum 1% of sum insured and at the end of each block of four claim free policies.
• Vaccination charges at the end of block of two consecutive 365 days and 366 days for leap years. The amount is derived as 7.5% of the net premium paid by insurer in individual cases and 15 % for group plans.

The list of diseases termed in critical illness category is:

1. Cancer of Specified Severity
2. First Heart Attack - Of Specified Severity
3. Open Chest CABG
4. Open Heart Replacement or Repair of Heart Valves
5. Coma of Specified Severity
6. Kidney Failure Requiring Regular Dialysis
7. Stroke Resulting In Permanent Symptoms
8. Major Organ /Bone Marrow Transplant
9. Permanent Paralysis Of Limbs
10. Motor Neuron Disease with Permanent Symptoms
11. Multiple Sclerosis with Persisting Symptoms

Basic Eligible Expenses:

• Room Rent Expenses as provided in the Hospital/Nursing Home including Hospital Registration/ Service charges.
• Nursing Expenses during hospitalization period on the advice of Medical Practitioners for duration specified.
• Surgeon, Anaesthetist, Medical Practitioner, Consultant, Specialist fees.
• Anaesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Organs and similar expenses.
• Ayurveda and/ or Homeopathy and/or Unani and/or Sidha Hospitalization Expenses in line with the limit of the Sum Insured.
• Reasonable and customary charges incurred for Domiciliary Hospitalization, if medically necessary up to a maximum aggregate sub-limit of 20% of the sum insured.

Other Value add services available in IFFCO Tokio Health Insurance

IFFCO Tokio brings a host of value add services apart from the regular coverage. All these services are offered absolutely free of cost in any event of urgency.

• Medical Consultation, Evaluation and Referral
• Emergency Medical Evacuation
• Medical Repatriation
• Transportation to Join Patient
• Care and/or Transportation of Minor Children
• Emergency Message Transmission
• Return of Mortal Remains
• Emergency Cash Coordination

Health Protector Plus Policy by IFFCO Tokio Health Insurance 

The policy is added on plan which can be integrated with the traditional plans to provide enhanced coverage for hospitalization expenses. The other features of this plan are

• Can be with or without any traditional basic health plans.
• Short Term plan for one years
• Flexible top up option as either Top up or Super Top up
• 8 different plans to cover the every possible aspect and situations.
• Option to choose plan as individual basis or for group.
• Lifetime renewal possible for those whose policy doesn’t have any breakup in between the terms.
• Cosmic network of more than 4000 hospitals offering cashless facility.
• No third party administrator involved in the entire process.
• For those who are travelling in India within a radius of 150km from their domicile town, emergency assistance service is offered with no extra cost.
• Portability scheme available to those who wants to switch over from any existing insurer.

Eligible expenses

• Charges for Room Rent for the period of hospitalization
• Expenses incurred Medical Practitioner/ Anaesthetist, Consultant fees.
• Expenses on Anaesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of transplantation of Organs and similar expenses.
• Expenses on Vitamins and Tonics only if forming part of treatment as certified by the attending Medical Practitioner.
• any ailments done at Ayurveda and/or Homeopathy and/or Unani hospitals recognized by Government
• Ambulance Charges as per actual or Rs.3000/- (Three Thousand) per claim; whichever is less.
• An additional Daily Allowance amount equivalent to 0.10% of the Sum Insured for the duration of Hospitalization towards defraying of miscellaneous expenses.
• The above stated relevant expenses incurred for Domiciliary Hospitalization if Medically Necessary and at Reasonable and Customary Charges up to a maximum aggregate sub-limit of 20% (Twenty percent) of the Sum Insured.

How to File a Claim of IFFCO Tokio Health Insurance?

You can  claim for health insurance at IIFCO Tokio in two ways. They are as follows:

• Cashless Claim
• Reimbursement Claim

Cashless Claim:

In case of a planned hospitalisation at any network hospital, inform the insurance company at least 3 days before admission. For an unplanned hospitalisation, inform the insurance company upon the admission via their toll-free customer helpline number. You need to display your health card along with a photo ID proof at the hospital desk. Your identity details will be verified by the hospital and you will be required to submit a complete pre-authorisation request form with your signature to the insurance company’s TPA. If the request is approved, the hospital will receive an approval letter from the insurer’s TPA. Once the verification process of pre-authorisation request is done, your cashless treatment will begin. Approval for cashless claim will be sent within a period of 24 hours of the receipt of the required documents.

Reimbursement Claim:

In case of hospitalisation at any non-network hospital or a cashless claim denial at any network hospital, you will be required to pay the medical bills directly out of your own pocket and can request reimbursement within a period of 7 days of discharge. The claim form has to be submitted with the required medical documents at your nearest IIFCO Tokio branch. Once the documents have successfully undergone the verification process, you will receive the claim amount via cheque within 20 days of receipt of the documents.

Procedure to Renew IIFCO TOKIO Health Insurance Policy Online:

To renew your IIFCO Tokio Medical Insurance you need to follow the steps below:

Step 1: Visit the official website of IIFCO Tokio.

Step 2: There will be a ’Product’ tab. You need to choose your product out of the four products mentioned in the drop down menu, namely, Individual Health Protector (IHP), Family Health Protector (FHP), Individual Medishield (IMI), and Swasthya Kavach Policy (SKP).

Also, enter your policy number in the ‘Policy Number’ tab.

Step 3: Hit the ‘Search’ button.

IFFCO TOKIO Health Insurance - FAQs

1. I am healthy and young. Do I need health insurance?

Health insurance is mandatory for everyone, irrespective of their age. Since medical emergencies may arise anytime, a health insurance policy with adequate coverage will take care of your hospitalization expenses and medical bills. You can avail cashless facility at a network hospital or file a claim against your medical expenses later.

2. My employer has provided health cover to me. Do I need additional cover?

The health insurance policies offered by employers are group insurance policies, which are non-transferrable. This means that whenever you change your job, the coverage ends automatically and you remain uncovered until you join a new company. If you have an individual cover, then you are protected all this while.

3. Do health insurance policies cover maternity or pregnancy?

Generally, health insurance policies do not cover maternity/pregnancy. However, group health insurance plans offered by employers do cover these medical conditions.

4. What does coverage mean?

The term coverage in terms of health insurance refers to the sum assured in particular. This is the amount of money that is paid to an insured in case one files a claim. Generally, coverage is provided as the cashless facility or expense reimbursement.

5. How long is the policy tenure?

Iffco Tokio Health Insurance offers health insurance policies with a minimum period of one year and a policyholder needs to renew it before the due date. Some other insurers offer health coverage for up to 2 years.

6. Does Iffco Tokio health insurance policy cover diagnostic charges?

Iffco Tokio Health Insurance plan covers CT scan, MRI, and some other diagnostic tests.

7. Will the policy continue after a claim is made?

A: Yes. The policies will remain in force after a policyholder files a claim while the claimed amount is reduced to the remaining amount. For instance, if one files a claim of Rs. 2 Lakh where the sum assured in Rs. 5 Lakh, then the sum assured will be reduced to Rs. 3 Lakh after the claim is approved.

8. How will the claim amount distribute if I have multiple health insurance policies?

If you have two insurance policies, then the claim amount will be distributed among both the insurers subject to the sum assured by each policy.

9. Who can buy a health insurance policy from Iffco Tokio?

Anyone who meets the eligibility criteria of health insurance offered by Iffco Tokio can purchase one. The policy has no special requirements except ID proofs when you file a claim.

10. Does Iffco Tokio health insurance base plan provide services in medical emergencies?

Yes. Health insurance policies offered by Iffco Tokio cover medical emergencies and provide services like Ambulance facility at both ends, i.e. back and forth between the hospital and your home. The same goes for minor children, senior citizens etc.