Emergency Hospitalisation | Planned Hospitalisation | |
---|---|---|
Step 1 | In the case of network hospital, on admission, intimate the Third-party administrator (TPA) through their Toll-free no. Please quote your health card Membership number. | Select a hospital from our list of network hospitals for treatment. |
Step 2 | Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor. | Intimate our Third-party administrator (TPA) through the Helpline Number before 3 days of admission, quoting your Health card Membership number. |
Step 3 | Fax the cashless request form along with supporting medical records to the TPA. | Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor. |
Step 4 | The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required. | Fax the cashless request form along with supporting medical records to the TPA. |
Step 5 | On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges, etc would have to be settled by you. | The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required. |
Step 6 | If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions. | On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you. |
Step 7 | If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions. |
Step 1 | Intimate IFFCO-Tokio through the toll number - 1800 103 5499 immediately on admission not later than 7 days from the date of discharge. Please quote your Policy Certificate Number while intimating the claim. |
Step 2 | Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement. |
Step 3 | Download the relevant claim form from our website (or) request for one through our call center. |
Step 4 | Claim documents may also be submitted to the local IFFCO TOKIO Office address which can be obtained by calling our Toll Number 1800 543 5499. |
IIFCO Tokio Health Insurance | Sum Assured | Entry Age | Critical Illness | Coverage and Benefits |
---|---|---|---|---|
Swasthya Kavach Family Health Insurance | 2 to 5 Lakhs | No Limit | NA |
|
Individual Medishield Policy | 1 to 5 Lakhs | 3 months to 80 years | NA |
|
Critical Illness Insurance Policy | NA | No Limit | It provides coverage only for critical illness |
|
Family Health Protector Policy | Up to 7 Lakhs | Entry age is 0 and there is no maximum limit | NA |
|
Health Protector Policy | More than 5 Lakhs | No Limit | Covers more than 10 critical illnesses |
|
IFFCO Tokio Personal Accident Insurance Policy | NA | 5 years to 70 years | NA |
|
It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.
Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.
These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.
Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.
When you approach a hospital which is listed in the provider list of our network and disclose the health-card, hospital will pursue TPA for pre-authorization. Once the authorization is issued by TPA, you do not have to pay any money towards the covered services provided by the hospital. This is called as a cashless service.
The claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment.
Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.
No, all benefits shall be payable when incurred in India only, in Indian rupees.
Your health insurance policy offers cover against medical expenses. If a person meets with a medical emergency, then they can file for a claim with health insurance. However, a policyholder will not get such benefits when the policy has expired. The person must pay the medical expenses out of their pocket. Therefore, it is extremely important that you remember the expiry date of your medical insurance policy and renew your plan on time to enjoy interrupted protection.
Under health insurance, the age and the amount of cover are two main factors that decide the premium. Usually, younger people are considered healthier and thus pay lower annual premiums. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher. Similarly, smokers and those who consume alcohol have higher premiums. Even the nature of your job and where you stay can influence the premium of your medical insurance policy.
Yes, you can have more than one medical Insurance policy. In case of a claim, you can choose which policy to use to cover your costs. The benefit of having 2 health insurance plans is that, once the Sum Insured of one policy is exhausted, the remaining medical expenses, if any, can be claimed through the second policy.
Yes, you can have more than one medical Insurance policy. In case of a claim, you can choose which policy to use to cover your costs. The benefit of having 2 health insurance plans is that, once the Sum Insured of one policy is exhausted, the remaining medical expenses, if any, can be claimed through the second policy.
If you cancel the policy, your cover will cease to exist from the date of cancellation of policy. Additionally, your premium should be refunded to you on short period cancellation rates. You will find these in the policy terms and conditions in the policy document.
No. Maternity/Pregnancy-related, Diagnostic charges expenses are not covered in a Health Insurance plan. However, employer-provided group insurance plans often cover maternity-related expenses.
The waiting period is the time when you can't make a claim. If you have any pre-existing medical condition like if you are suffering from critical illness, or if you have undergone any surgery recently, and if you need hospitalisation, you won't be covered for the same.
In a cashless Mediclaim settlement, it is settled directly with the network hospital. In cases where this is no cashless settlement, the claim amount is paid to the nominee of the policyholder. In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.
Generally, No. In the instances where any of the applicants is above 55 years of age or based on declaration in proposal form, we feel that we require additional information for fair and accurate underwriting purposes, we will ask you to undergo medical tests or ask you previous medical records. Medical Examination reports validity period is 6 months.
Cover for all pre-existing medical conditions are excluded during the first three years of insurance. If you were covered under a health insurance policy from us or any other Indian insurer and we have accepted your request for portability, we shall make due adjustments towards pre-existing diseases and all other time-bound exclusions.
A person who avails the option ‘Treatment in tiered network’ and does not get treated in the tiered networks has to pay a Co-pay of 10%.
No. The level of cover can only be changed at the renewal date. At that time, we will work with you to ensure any benefit level changes are appropriately adjusted.
Yes, we have negotiated with a large number of hospitals all over India to avail you best of medical facilities and have access to quality care when and where you may need it.
Yes, you may cancel your policy by telephoning us, by email or in writing (see contact us for details). You may cancel your policy during the 15 day free look period. This period commences on the day you receive your policy documentation. We will refund any premium paid at the date of cancellation deducting any charges we incurred towards your medical examination and the stamp duty charges and Proportionate risk premium if cover has already covered, provided you have not used any of the services available on your cover and no claims have been made. After the free look period, refunds will only be given if no incident has occurred which has led to an eligible claim, If you decide to cancel your policy before your renewal date and outside of the free look period, you must give us 7 days notice and you will be eligible for refunds on a pro rata basis.
Health insurance covers you and your family against expenses incurred in a medical emergency. With medical bills on the rise, insurance helps in reducing the financial burden during hospitalization. Also, the cases of critical illnesses and lifestyle-related ailments have increased rapidly. Health insurance allows you to be better prepared for such events. The premium that you pay for your health insurance is eligible for tax deduction under Section 80D of the Income Tax Act.
IFFCO Tokio has an extensive network of 5,000+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the hospital closest to them by going through the IFFCO Tokio network hospital list available onIFFCO Tokio health insurance
The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!
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