Iffco Tokio Health Insurance
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IFFCO TOKIO HEALTH INSURANCE

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Iffco Tokio Health Insurance

Overview
Iffco Tokio General Insurance (ITGI) was incorporated on 4th December 2000 as a joint venture between Indian Farmers Fertiliser Cooperative (IFFCO) and its associates and Tokio Marine and Nichido Fire Group. The company currently ranks as the third largest private insurance provider in India and operates with 104 strategic business units, 171 lateral spread centres and 400 Bima Kendras.

Iffco Tokio Health Insurance at a Glance
  • Cashless access to over 4300 network hospitals
  • 143697 policies issues till date
  • Offers lifetime renewability
  • Approximately 99.93% grievances resolved.
  • The brand has an incurred claims ratio of 104.25%
  • Claim settlement ratio of 92%.

Awards & Recognitions
  • IFFCO-Tokio Wins the CIO100 Super achiever Awards in 2013.
  • IFFCO-Tokio Conferred "Best Employer Brand" at IPE BFSI Awards in 2013.
  • AITA E-commerce Award for IFFCO-Tokio in 2013.
  • IFFCO-Tokio wins National Award for the successful implementation of RSBY by Ministry of Labor, Government of India in 2014.

Documents needed to apply for Iffco Tokio Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph

Why Iffco Tokio Health Insurance?
Here are some reasons why Iffco Tokio is the right insurance provider for you:

Features Description
Sum Insured Sum insured ranging from Rs. 1.5 Lacs to Rs. 30 Lacs available.
Cashless hospitalisation Iffco Tokio provides access to over 4300 network hospitals across India where you can avail cashless facility.
Claim process Cashless access to over 4300 hospitals. Iffco Tokio has a claim settlement ratio of 92%.
In-patient hospitalization/treatment Expenses incurred during hospitalisation for 24hours or more is covered by all Iffco Tokio Health Insurance plans.
Pre-hospitalization Expenses Expenses incurred during 45 days prior to hospitalisation are also covered.
Post-hospitalization Expenses Expenses incurred during 60 days post hospitalisation are covered.
Floater Basis Family is covered in all policies, where family is specified as the policy holder, spouse and dependent children (upto 25 years of age)
Reinstatement of sum assured Once your sum insured is exhausted during the year, the same is reinstated without any extra charges. The facility is available after a specified number of claim-free years.

Types of Iffco Tokio Health Insurance Plans
Iffco Tokio offers insurance coverage in three variations: Individual Plans, Family Health Insurance Plans and Senior Citizen Health Insurance Plans.

1: Iffco Tokio Family Health Protector Policy –The family health protector policy by Iffco focuses on providing economical financial coverage for the entire family against eventualities leading to injury or illness.

2: Iffco Tokio Individual Health Protector Policy– This policy is designed to offer individuals and family members financial protection against injury or illness related contingencies.

3: Iffco Tokio Swasthya Kavach Policy–This policy from ITGI offers families with financial coverage at competitive but low-insurance premiums. There are two plans available – base plan and wider plan.

4: Iffco Tokio Individual Medishield Policy – In case a person faces hospitalisation resulting from injury of illness, this policy offers cash-free hospitalisation and reimbursement of pre and post hospitalisation expenses.

5: Iffco Tokio Personal Accidental Insurance Policy- This unique provides financial coverage to protect you against expenses and lost incomes in times of accidents.

6: Iffco Tokio Critical Illness Insurance Policy–Critical illnesses can be a big financial liability and in order to protect you from those financial burdens ITGI offers critical illness covers at affordable prices.

7: Iffco Tokio Health Protector Plus Policy–This policy offers protection against high treatment costs with option for compulsory deductible, at a low premium.

Iffco Tokio Health Insurance Plans in detail
1: Iffco Tokio Family Health Protector Policy
Entry age 18 to 65 years
Type of Plan Individual / Floater
Sum Insured 1.50-30 lacs
Coverage for Spouse, dependent children (upto 25 years of age), dependent parents and any relatives living together.
Policy term 1year

Inclusions, Benefits and Features
  • In-patient expenses – Covers room, boarding and nursing expenses per day.
  • Pre-hospitalisation - Covered upto 45 days.
  • Post-hospitalisation – Covered upto 60 days.
  • Day-Care Procedures - The medical expenses for all day-care procedures, which do not necessarily require 24 hours of admittance, will also be covered
  • Domiciliary Treatment– Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy.
  • Ambulance–Expenses incurred for emergency ambulance service will be reimbursed (up to Rs.2500 or 0.75% of the sum insured)
  • Organ Donor–Covers treatment expenses for organ donor.
  • Daily Allowance – Allowance upto 0.15% of sum insured, capped at Rs. 1000.
  • Health Check up–Expenses towards health check-up are covered upto 1% of basic sum insured. Facility is available at the end of a block of four continuous claim-free policies.
  • Vaccination coverage – new born vaccination charges covered till 7.5% of sum insured.
  • Reinstatement of sum insured–This policy enables the basic sum assured to be reinstated once it has been exhausted during the year.
  • Emergency Medical Evacuation –Expenses incurred while travelling an insured person from one hospital to another is covered upto a certain limit.
  • Transportation to Join Patient - The policy covers travel charge of transferring a patient from one hospital to another via flight.
  • Return of Mortal Remains –The policy covers expenses borne to recover the mortal remains to the residence of the insured uptoRs. 5000.
  • Medical Consultation, Evaluation and Referral –The policy beneficiaries can get a second medical opinion form the company’s network of medical practitioner.
Basic Sum insured per insured person per policy year(Rs. in Lacs) 1.5-30 Lacs
Inpatient treatment Covered
Pre-hospitalisation 30 days
Post hospitalisation 60 days
Day Care procedures Covered
Domiciliary Treatment Covered
Organ donor Covered
Emergency Ambulance Up to certain limit
Daily allowance Covered; up to Rs. 1000 per day
E-opinion in respect of critical illnesses Covered
Emergency Ambulance Cover Covered
Automatic restoration Available after a block of 4 consecutive claim-free years
Bonus After a claim free year, 25% of expiring sum insured is available. After that 10% of every subsequent year. Limit upto 100%
Health Checkup Upto certain limit

2: Iffco Tokio Individual Health Protector Policy (Medishield)
Features Description
Entry age 3 months to 80 years, 3 months to 5 years for children, if both parents are covered under the same plan.
Type of Plan Individual/Floater
Sum Insured 1-5lacs
Coverage for Spouse, dependent children (upto 25 years of age), dependent parents and any relatives living together.
Policy term 1 year

Inclusions, Benefits and Features
  • In-patient expenses –Covers room, boarding and nursing expenses per day.
  • Pre-hospitalisation -Covered upto 45 days.
  • Post-hospitalisation –Covered upto 60 days.
  • Day-Care Procedures - The medical expenses for all day-care procedures, which do not necessarily require 24 hours of admittance, will also be covered. Up to 121 day care procedures.
  • Domiciliary Treatment – Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy. Up to 20% of sum assured.
  • Ambulance – Lower of 1% of sum assured or Rs.1,500.
  • Daily Allowance – Lower of 1% of sum assured or Rs.250 for each day of hospital stay.
  • Health Checkup– Expenses towards health check-up are covered upto 1% of basic sum insured. Facility is available at the end of a block of four continuous claim-free policies.
  • Ayurvedic treatment– Up to 10% of the sum assured.

3: Iffco Tokio Swasthya Kavach Policy
There are two types of plan available under this policy – base and wider

Features Description
Entry age 18 to 60 years. Dependent child from 91days and up to 23 years.
Type of Plan Individual / Floater
Sum Insured 2-5 lacs
Coverage for Policy holder, spouse, dependent children.
Policy term 1 year

Inclusions, Benefits and Features
  • In-patient hospitalisation – covers room, boarding, nursing, doctor’s fees, pharmaceutical costs and pathological costs.
  • Pre Hospitalization - Medical expenses upto 45 days prior to the date of admission.
  • Post Hospitaliztion- Medical expenses up to a period of 30/60 days (30 in case of base plan and 60 in case of wider plan) after the discharge
  • Day Care Procedures - covered.
  • Cumulative bonus – 5% bonus for every claim free year, upto a maximum of 50% (only in wider plan)
  • Health check-up – Free health check-up at the end of a block of 4 consecutive claim free years.
  • Daily allowance – Rs. 150/day in base plan and Rs. 250/day in wider plan
  • Ambulance charges – Rs. 750/day in base plan and Rs. 1500/day in wider plan
  • Domiciliary Hospitalization

4: Iffco Tokio Individual Medishield Policy
Features Description
Entry age 18 to 65 years.
Type of Plan Individual
Sum Insured 1-5 lacs
Coverage for Individual
Policy term 1

Inclusions, Benefits and Features
  • In-patient hospitalisation – covers room, boarding, nursing, doctor’s fees, pharmaceutical costs and pathological costs
  • Pre-hospitalization medical expenses up to 60 days prior to the date of admission
  • Post-hospitalization up to 60 days from the date of discharge from the hospital
  • Ambulance charges
  • Day care treatment - 121 treatments covered
  • Health check-up - once every block of four claim-free years
  • Ayurvedic hospitalisation cover
  • Emergency assistance services in case of accidental cases up to 150km.
  • Domiciliary treatment
  • Daily allowance

5: Iffco Tokio Personal Accidental Insurance Policy
Features Description
Entry age 5 years to 70 years
Type of Plan Individual/Family
Ambulance charges Rs. 1000 per insured person
Coverage for Those involved in any activity that is hazardous in nature like aviation, ballooning etc.
Those who are a member of the armed forces Those who fall outside the specified age bracket of 5 to 70 years. Coverage for:
  • Proposer
  • Spouse
  • Dependent children
Policy term 1 year

Inclusions, Benefits and Features
The complete benefit plan under the Policy is given below:

TABLE OF BENEFITS PERCENTAGE OF CAPITAL SUM INSURED
1. Death 100
2. a) Loss of sight (both eyes) 100
2. b) Loss of two limbs 100
2. c) Loss of one limb and one eye 100
3. a) Loss of sight of one eye 50
3. b) Loss of one limb 50
4. Permanent Total and absolute disablement 100

6: Iffco Tokio Critical Illness Insurance Policy
Features Description
Type of Plan Group
Coverage for Spouse, dependent children
Policy term 1 year
Exclusions
  • Treatment cost related to pre-existing diseases.
  • Any medical treatment during the first 120 days of insurance cover.
  • Expenses in treatments related to Human T-Cell Lymphotropic Viruses Type II (HTLV-III) or Lymphadinopathy Associated Viruses (LAV) or AIDS related conditions.
  • Expenses incurred in treatment for ailments caused by drug addiction or alcoholism.
  • Attempted self-injury or suicide
  • Injuries caused by nuclear weapons, war and terrorist attack.

7: Iffco Tokio Health Protector Plus Policy
Features Description
Entry age 18 to 65 years
Type of Plan Individual / Floater
Sum Insured 2-25 lacs
Coverage for Self, spouse, dependent children (up to 25 years) and parents.
Policy term 2 years

Inclusions, Benefits and Features
  • In-patient expenses – Covers room, boarding and nursing expenses per day.
  • Pre-hospitalisation - Covered upto60 days.
  • Post-hospitalisation – Covered upto90 days.
  • Domiciliary Treatment – Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy. Up to 20% of sum assured.
  • Ambulance – Max limit up to Rs.3,000.
  • Daily Allowance – Lower of 1% of sum assured.
  • Health Checkup – Expenses towards health check-up are covered up to 1% of basic sum insured. Facility is available at the end of a block of four continuous claim-free policies.
  • Ayurvedic treatment – Up to 10% of the sum assured.

Iffco Tokio Exclusions:
  • Pre-Existing Diseases / Illness: coverage offered after 48 months
  • Pre-acceptance medical screening: Person above 50 years will need to undertake medical tests before being covered
  • Treatments for intentional self injury
  • Injury/disease directly or indirectly caused by or arising from war or warlike operations
  • Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these
  • Expenses incurred for weight control treatment
  • Medical and / or surgical treatment of Sleep apnea, treatment for genetic and endocrine disorders
  • Expenses on vitamins and tonics as part of treatment
  • Unconventional, Untested, Unproven, Experimental therapies
  • Stem cell Therapy, Chondrocyte Implantation, Procedures using Platelet Rich plasma and Intra articular injection therapy.
  • Oral Chemotherapy, Immuno therapy and Biologicals, except when administered as an in-patient
  • All types of Cosmetic, Aesthetic treatment of any description
  • Cost of spectacles and contact lens, hearing aids, walkers and crutches, etc
  • Hospital registration charges, admission charges, record charges, telephone charges and such other charges

Iffco Tokio Login:
  • For Individuals: Log into the Iffco Tokio Health Insurance website with your User ID and password.
  • You can generate user id and password by registering on the website with your name, phone, email, and password. You can login with your registered email ID and password.

Iffco Tokio Health Insurance Renewal:
  • Visit theIffco Tokio Health Insurance website renewals page and provide policy number and date of birth of the insured.
  • After such you will be provide the option to take a look at your policy and pay for renewal via online payment.
  • Claim your eligible bonus while renewing
  • If you are opting for any additional features or enhancing sum insured, additional premium to be paid.

Iffco Tokio Health Insurance Claim Settlement:
Cashless Reimbursement
Intimate our Third party administrator (TPA) through the Helpline Number before 3 days of admission, in case of planned admission. Intimate IFFCO-Tokio through the toll number - 1800 103 5499
Fill in the cashless request form which is available with the Hospital Insurance Help Desk Upon discharge pay the bills and collect all receipts
Fax the cashless form with the medical records to the TPA Download the relevant claim form from our website. Fill claim form and submit the form with all the receipts to the nearest Iffco Tokio office.
After scrutiny the TPA will convey decision to the hospital  
On approval, hospital bills will be settled by Iffco.  

Iffco Tokio Health Insurance FAQs:
1: Where can I download claims form from?
You can download claims form from this link - https://www.iffcotokio.co.in/customer-services/download-forms?quicktabs_download_forms= 0#quicktabs-download_forms

2: What are the details to be provided at the time of intimation of claim?
Following are the information required at the time of intimation:
  1. Health card
  2. Duly filled claim form
  3. Doctor's consultation papers
  4. Investigation reports (e.g. X-ray, scans, blood report, etc.)
  5. Pharmacy invoices supported by respective prescriptions
  6. In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
  7. Discharge summary
  8. Other relevant documents
3: Are my existing diseases covered?
Existing diseases covered after 48 months of continuous coverage with Iffco Tokio. There are exceptions in illness specific policies like policies designed for diabetic patients, cancer patients, HIV positive patients etc

4: Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?
All diagnostic charges like X- ray, MRI, blood tests etc are covered if they are in relation to hospitalisation for at least 24 hours.

5: Is a medical check-up necessary before buying a Health policy?
Medical check-up is necessary for persons aged 50 years and above.

6: What is the maximum number of claims allowed during the year?
Unlimited number of claims is allowed during the year up to the maximum exhaustion of sum insured.

7: How to claim for pre and post hospitalization?
The claim documents for pre and post hospitalization should be submitted within a specific number of days of completion of treatment or period. Post hospitalisation expenses capped at 7% of sum insured upto a maximum of Rs. 5lacs.

8: Does any health policy cover expenses on outpatient treatment also?
Usually policies cover only in-patient treatment but the Iffco Tokio Health Gain policy covers out-patient treatments.

9: Can foreigners avail policy or is it restricted to Indian nationals?
Foreigners living in India can avail policy but the coverage will be limited to India.

10: Does the list of hospitals remain the same?
The list of hospitals may or may not change and Iffco Tokio Health Insurance reserves the right to modify, add or restrict any network hospital for cashless services available under the policy.