IFFCO Tokio Health Insurance

• 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.

  Table of Benefits	% of Capital Sum Insured
  1. Death	100
  2. a). Loss of Sight (both the eyes)	100
  b) Loss of two limbs	100
  c) Loss of one limb and one eye	100
  3. a) Loss of Sight of one eye	50
  b) Loss of one limb	50
  4. Permanent Total and absolute disablement	100

   

  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

• 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

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.