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: Cancer of Specified Severity First Heart Attack – Of Specified Severity Open Chest CABG Open Heart Replacement or Repair of Heart Valves Coma of Specified Severity Kidney Failure Requiring Regular Dialysis Stroke Resulting In Permanent Symptoms Major Organ /Bone Marrow Transplant Permanent Paralysis Of Limbs Motor Neuron Disease with Permanent Symptoms 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 doesnt 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 companys TPA. If the request is approved, the hospital will receive an approval letter from the insurers 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.