Features of Family Health Protector Policy
At IFFCO Tokio, we perfectly understand what importance family holds in everyone’s life, and that has become the basis of the features that we provide in our health insurance policy for the family to make sure that we exceed your expectations, as always.
Let’s familiarize you with these features which make our family insurance plans stand out amongst the rest: -
- Single Premium, Whole Family: - Selecting a comprehensive family health plan was never this easy. Just pay a single premium and get insurance coverage for your whole family. This includes your dependent parents, siblings as well as family members living together, including brother-in-law and sister-in-law. There is also an option to opt for a critical illness cover for the whole family under a floater policy. You can use the online Mediclaim policy premium calculator to find out the exact premium payable by you.
- Pre Hospitalization Coverage: - When you buy family health insurance from IFFCO Tokio, your pre-hospitalization expenses are also covered under the family health protector policy. All expenses incurred during the investigation of the medical condition including consultation fees and diagnostic tests are also fully covered under our policy.
- Hospitalization Coverage: - Once you or your family member gets admitted to a hospital for further treatment, our health policy for family makes sure that you have all the time to look after the patient, instead of worrying about finances. Our policy covers all in-patient hospitalization expenses including room charges, doctor consultation, and all diagnostic tests.
- Post-Hospitalization Coverage: - We understand that post-discharge care is equally important to regain the health completely. That is why we have made sure that your ‘recuperation expenses’ are taken care of in our health insurance plans for family, which helps the patient recuperate and get back to a better state of health.
- Alternate therapies Coverage: - Although Modern Medical Science has made significant progress in the recent years, there are certain conditions for which traditional and ancient healing practices have a better cure. Therefore, our family health plan covers various typesof expenses for treatment under traditional healing sciences which include Ayurveda, Unani, Homeopathy,andSidha.
- Vaccination and Check-up Coverage: - As the old saying goes “Prevention is better than Cure”. Extending support to this axiom, our health policy for family covers preventive treatments that help avoid unnecessary hospitalization related hassles. Our policy includes vaccinations for both kids and adults along with expenses related to preventive checkups and diagnostic tests.
- Life Long Renewal: - Unlike some of the family medical insurance available in the market, our Health Protector Policy comes with life-long renewal which extends beyond the 65 years age restriction. So, now you need not worry about the well-being of your parents or elderly loved ones. Afterall, you have got the best possible medical insurance for them.
- Free-look period of 15 days: - We are confident that our health insurance plans for family offer the best options for your family’s well being, but still, if you are having any second thoughts or doubts, we offer a 15-day free-look period during which you are free to cancel your policy at anytime and receive a full refund. Fulfill your family’s healthcare needs through and through with IFFCO Tokio.
- Tax Benefits: - The premiums paid against our health policy for a family are eligible for tax deduction under Sec. 80D, making it an even better proposition for you and your family.
Why buy IFFCO Tokio Family Health Protector Policy
Due to the sedentary lifestyles and polluted surroundings that we live in today, there has been a significant increase in the incidences of serious illness. On top of that, increasing medical expenses have necessitated subscription to an efficient Family Health Insurance plan.
A comprehensive range of health insurance plans from IFFCO Tokio come as a life saver in the modern times. Not only do our plans offer extensive coverage for the whole family but also take care of pre-hospitalization and post-hospitalization expenses. To make it easier for you, we offer the option for you to get a quote and then buy IFFCO Tokio’s family insurance plans online.
Let’s have a look at some of the significant benefits that you will be entitled to once you buy family health insurance from IFFCO Tokio: -
- Floater Sum Insured for the Whole Family: - With our health insurance plan for family, you can enjoy the benefits and flexibility of a floater sum for your extended family. This enables you to avail the advantages of a high sum insured at a lower premium as compared to an individual policy for every separate family member. For instance, if you avail a floater policy of Rs. 10 Lakhs, any of your family member(s) is eligible for treatment up to that amount in a given year. The amount on this mediclaim policy for family is renewed every year with policy renewal. To find out the exact premium payable for your policy, you can use our mediclaim policy premium calculator available online.
- Easy addition of new family members: - One of the significant benefits of our family health plans is the easy addition of a new family member who will also be eligible to enjoy the benefits of the floater amount right from the day of their inclusion.
- Coverage for Critical Illness: - Our health insurance policy for a family gives you the option for coverage of various critical illnesses by paying a small amount in addition to the basic premium. By paying 30% in addition to the basic premium, you and your family members can avail the benefits of double coverage for the named critical illness. Thus, the amount paid towards insurance would offer you significant peace of mind, and courage to face any emergency. Make sure you select the specific critical illness you want to cover under the policy while using the mediclaim policy premium calculator available on our website.
- A wide range of Plans to choose from: -We offer a vast array of family insurance plans from which you can select the one that’s most suitable for your family. The sum insured in our plans range from Rs. 1,50,000/- to up to Rs. 30,00,000/-. You can easily get a quote and choose the suitable policy for your needs from IFFCO Tokio with assistance from our online tools. Based on your choice, you get to avail attractive discounts on our wide range of insurance products, including our mediclaim policy for family.
- Cashless Hospitalization: -We have entered into strategic agreements with over 4000 hospitals across the length and breadth of India, which makes it easier for you to receive comprehensive care for your ailments without paying anything when you opt for our health insurance plans for family. No matter which city you stay in, there is a hospital nearby which is on our panel,which can serve you and your family members as and when required, with the added benefit of cashless hospitalization.
- Portability: - We understand that you might already have subscribed to some other company’s family insurance plans and might not be happy with that policy. We offer you the opportunity to port your policy to IFFCO Tokio, wherein you can easily port to our family insurance plans from a similar policy with your current insurer. Your family’s insurance cover would remain intact, and you will also enjoy the continuity benefits as per the guidelines specified by IRDA.
- Day Care surgeries: - To save you from the unnecessary hassles of hospitalization for even a minor procedure, our family healthcare plans cover day care procedures also. This means that you or your family members can undergo the required surgical procedures and get discharged the same day conveniently, thus eliminating the need for unnecessary overnight stays.
- Additional Benefits: -In addition to the coverage for hospitalization expenses, our health insurance policy for family offers a host of other benefits to help reduce the financial burden on your family. Some of the additional benefits that our policies offer are: -
- Daily Allowance – upto 0.20% of sum insured per day
- Ambulance Charges – upto 1% of the amount insured upto max. Rs. 2500/-
- Pre and Post Hospitalization Expenses – up to 45 and 60 days respectively
- Cumulative Bonus – Increased by 5% of basic sum insured at each renewal,upto max 50% of the basic sum insured of the expiring policy
- Health Check-up cost covered – 1% of the amountinsured after a block of four continuous claims free policies
- Vaccination Expenses – upto 10% after two claim free periods.
- Emergency Assistance service – upto 150 km from your residential address for a period of 90 days.
- Lifelong Renewal: - Our family insurance plans come with the benefits of guaranteed lifelong renewals which ensure significant peace of mind in terms of the wellbeing of your family. This facility would cease to exist in case of a fraud or gross misrepresentation. Our customers can also enjoy a grace period of 30 days after the policy expires, during which they can get the health cover renewed, and continue to enjoy the continuity benefitswith our health insurance plans for family.
- Buy Online: - Our website contains all the details regarding our vast range of family health insurance policies. You can easily get a quote and check which policy meets your requirements the best. We also offer you the option to buy our family health insurance online with many benefits. Even more importantly, the coverage for your family starts immediately after you purchase the policy online.
Mediclaim Policy Coverage
We understand that when it comes to family, you do not want to leave anything to chance. That's why our mediclaim policy for family offers comprehensive coverage against every possible health and wellness related emergency that you may face during the course of your life.
Different families have different needs at different stages in life, that's why we at IFFCO Tokio have developed a vast array of family insurance plans where the coverage varies on the basis of the premium paid and the benefits required. We have also provided a mediclaim policy premium calculator tool online, so that you can easily calculate the premium payable by you for your family insurance plan.
Let’s have a look at the benefits available under our health insurance plans for family: -
- Basic Coverage
Our Family Protector plans take care of all the primary expenses involved with hospitalization, including: -
- Room Rent Expenses – In order to ensure that you have a comfortable stay at the hospital while you or any of your family members receive the requisite medical treatment, our family insurance plans cover the cost of the room including registration and service charges. The room rent allowable depends on the coverage value of the policy chosen.
- Nursing Expenses – Good nursing care is necessary to ensure timely recovery during the course of treatment, something which our family insurance plans ensure. All nursing care related expenses for a particular duration as prescribed by the doctors are covered under our health protector plans.
- Doctor Expenses – To ensure that you and your family members receive the best possible treatment, our policy covers the expenses for consultation charges of all medical professionals, including physicians, surgeons, anaesthetists and consultants. If services of any external experts are required, their expenses are also taken care of under our mediclaim policy for family.
- Diagnostic Expenses– We leave no stone unturned to ensure that you and your family members receive the best treatment for your ailments. Therefore, our mediclaim policy for family provides coverage for all consumables, medical and diagnostic procedures required during the treatment and recovery stage. Stents, Pacemaker, Artificial Limbs, Anaesthesia administration, Blood transfusion, Oxygen supply, Vitamins and Tonics, Operation Theater, Surgical Appliances, Medicines & Drugs, Diagnostic Materials, X-Ray, Dialysis, Chemotherapy, Radiotherapy, organ donor expenses and other relevant expenses are covered under our policy.
- Alternate Therapies– In line with the efforts of the Government of India, we also support the AYUSH initiative in our health insurance policy for family, under which we provide coverage for alternate healing therapies such as Ayurveda, Yunani, Sidha and Homeopathy treatments up to the sum value insured under the policy.
Extent of Benefits under the Normal Coverage
- Room, Boarding and Nursing charges are reimbursed as per your existing mediclaim policy for family, up to a maximum of 20% of the total sum insured, according to which –
If sum insured is above Rs. 7,00,000/-, then reimbursement is done as per the actual invoice
If sum insured is Rs. 7,00,000/- and below: -
For Normal Room: -
- Class A cities: - up to 1.50 % of the sum insured
- Other cities : - up to 1.25 % of the sum insured
For Intensive Care Unit/Therapeutic Expenses: -
- Class A cities: - up to 2.50% of the sum insured
- Other cities : - up to 2.00% of the sum insured
- Limits on Room/ICU Charges are waived if you pay an additional 6% over the basic premium on IFFCO Tokio’s family insurance plans.
- Registration Charges, Service Charges and other similar charges are reimbursed up to a maximum of 0.5% of the sum insured
- In case of any unfortunate incident such as a terrorist attack befalling on you or your family members, we make sure that all expenses related to the treatment are covered as usual through our health insurance plans for family.
Critical Illness Cover
We are well aware about the uncertainties that life comes with, and they are all but inevitable. There could be nothing worse than having to face them unprepared. If you are unprepared and any critical illness affects you or one of your family members, it would create a lot of uncertainty and financial stress. So, it is better to be prepared to take the adversity head on. To help you be prepared for any such eventuality, we offer you the opportunity to opt for a Critical Illness Cover besides the mediclaim policy for family.
Under our critical Illness cover, you only need to pay 30% above the basic premium to avail double the sum insured for any of the named critical illness in your policy. In order to calculate the exact amount payable for the specific critical illness, you can either call our customer care centre or use our mediclaim policy for family premium calculator tool available on our website. Following are the conditions which have been identified as critical under our mediclaim policy for family: -
- Cancer of specified severity
- Coma of specified severity
- Major Organ /Bone Marrow Transplant
- Stroke Resulting in Permanent Symptoms
- First Heart Attack - of specified severity
- Motor neurone disease with permanent symptoms
- Open Chest CABG (Coronary artery bypass grafting)
- Permanent Paralysis of Limbs
- Open Heart Replacement or Repair of Heart Valves
- Kidney Failure Requiring Regular Dialysis
- Multiple sclerosis with persisting symptoms
You never know when a tragedy might befall you or the ones dear to you, so it is better to be safe now than be sorry later on. A critical illness cover can go a long way in ensuring your peace of mind.
- Additional Cover
We understand that undergoing a medical treatment is so much more than just being admitted in a hospital. A lot of variables are involved, and if these were to change even slightly, then it can mess up your estimates. That is why we are covering a vast array of expenses under your health insurance policy for family, which would surely go a long way in reducing your stress.
- Pre and Post Hospitalization Expenses: - Before you or any of your family members are admitted for treatment at a hospital, a lot of diagnostic and investigative procedures are involved to identify the ailment, the expenses for which can be quite burdensome. Similarly, post discharge from the hospital, follow up treatments and procedures can also burn a hole in your pocket. To save you from this stress of arranging funds for these expenses, we cover the Nursing and Medical expenses during the pre-hospitalization period for a duration of 45 days, and for the post-hospitalization period, we cover the expenses up to 60 days, as stated in your mediclaim policy for family.
- Ambulance Charges: - Travelling to and fro from the hospital can also cost a lot, and could be hectic as well. That is why we offer reimbursement of Ambulance charges up to a maximum of 0.75% of the sum insured or Rs. 2,500/- (Two Thousand Five Hundred Only) for each instance of hospitalization.
- Day Care Surgeries: - In order to avoid unnecessary hassles associated with hospitalization for minor procedures that take only a few hours, our health policy for family covers around 121 surgical procedures which do not require hospitalization. Thus, you can conveniently undergo the requisite procedure and get back to your family the same day without staying for the otherwise necessary 24 hours in the hospital.
- Daily Allowance: - When you or any of your family members are under hospitalization for a treatment, it is obvious that it causes monetary loss to some extent due to various other expenses involved besides the medical expenses. To ease your burden, our health insurance plan for family allows you an additional daily allowance of 0.15% of the insured value up to a maximum of Rs. 1000/- (One Thousand Only) per day during the period of hospitalization. In case of day care procedures where the hospitalization period is less than 24 (Twenty Four) hours, the allowance is adjusted proportionately for the duration of stay in the hospital.
- Cost of Health Check Up: - Our mediclaim policy for family reimburses you for cost incurred on behalf of the medical check-up(s) for you and your whole family after a block period of four claim free policies with us. You will be entitled to a maximum of 1% of the average sum insured during the block of four claim free periods.
- Hospitalization Expenses if stay is less than 24 Hours: - We understand that not all treatments require an extended stay at a hospital. Other than the 121 listed day care procedures in our mediclaim policy for family, if you or any other family member has to stay in the hospital for more than 12 (Twelve) hours but less than 24 (Twenty Four) hours, you will be reimbursed all hospitalization related expenses, but the room rent in that case will be a maximum of 50% of the entitled room rent per day.
- Vaccination: - Well, prevention is always better than cure.With the rapid pace with which medical science is progressing,there are new vaccines available for various serious ailments. However, many of these vaccinations can be quite expensive. We at IFFCO Tokio want you and your family to be safe from any severe ailment; that is why we have made sure that you are reimbursed for the vaccination expenses. After a block period of two consecutive claim free policies(365 days + 365 days or 366 days in case of a leap year), you and your family members are entitled to the following benefits: -
- In case of a single family member, a maximum of 7.5% of the premium paid during the block of two claim free periods.
- In case of two or more family members(s), a maximum of 15% of the total premium paid during the block of two claim free periods.
It must be noted that this benefit is available only when you renew the policies on time without any break. Make sure you fill in all relevant details while using our premium calculator for mediclaim policy for family.
- Cumulative Bonus: - If you have not made any claims against the premium paid on your mediclaim policy for family for a particular year, you stand to benefit from it. With our cumulative bonus feature, you can add cumulative bonus to the basic sum insured with each claim free year. This would ensure that whenever you or a family member undergoes a medical procedure, you get additional coverage that’s over and above the basic sum insured. This feature works in the following way: -
- For each claim free year on your mediclaim policy for family, 5% of the basic sum insured at each renewal will be added to your cumulative bonus. This 5% will keep getting added each year up to a maximum of 50% of the basic sum insured of the expiring policy.
- If you make a claim during the policy period of the health insurance policy for family, the cumulative bonus shall be reduced by 5% of the basic sum insured at the next renewal, if the basic sum insured is maintained.
To be eligible for the cumulative bonus on these family insurance plans, you have to make sure that the policy is renewed on time or at most within thirty days of the expiry date, otherwise your cumulative bonus may be forfeited.
- Emergency Assistance Services: - When living in a family, there are instances when you need to travel interstate for extended stays. But sickness does not know that you are travelling, and can catch on with you or a family member off guard while you are away from home. Sometimes, the situation may be an emergency which would not permit you the opportunity to travel back home for medical treatment. You might not be able to do much in such a situation because your policy does not offer you the benefit of seeking treatment away from your city. This is where our health mediclaim policy comes to your rescue.
We offer you a vast array of emergency medical services at no additional cost when you are more than 150 km away from your home within India for a period of 90 days. In cases where it is not possible to ascertain if the situation is an emergency or not, you will get the benefit of doubt.
We are the first company in India to introduce this coverage with the following services without any sub-limit.
- Emergency Medical Evaluation: - You and your family members will have access to operations center with multilingual staff working around the year in case of an emergency. There will be qualified medical personnel who will then refer the case to physicians as required.
- Emergency Medical Evacuation: - If according to the attending physicians, adequate facilities for the treatment are not available anywhere near where there is the emergency, then we will arrange to evacuate the insured family member to the nearest place through suitable means of transport, where the requisite facilities are available.
- Emergency Message Transmission: - Our representative will act as the point of contact between your family and the insured family member, and will convey the messages to and fro.
- Emergency Cash Coordination: - If you have arranged for the funds but are unable to remit them urgently, our representatives,we will also assist you with emergency cash coordination services under our family insurance plans.
- Medical Repatriation: - If necessitated by the family member’s medical condition according to our physicians and consultants, we will arrange to repatriate the patient to the registered address through suitable means of transportation as cleared by our doctors for travelling. If it is not possible to transport the family members using normal air carrier, we shall arrange for the air ambulance along with medical supervision to repatriate the insured family members.
- Transportation to join the patient: - If the family members had been travelling alone, then we will also arrange for transportation of one family member through a suitable air carrier to the nearest airport where that family member is under medical care for more than seven days. We shall also arrange for the accommodation of the family members at the place, but it is the travelling person’s responsibility to arrange for the necessary travel-related documents.
- Transportation and Caring for minor children: - If any minor child is left unattended due to the medical condition of the insured family members, then we shall provide for the transportation of the kids to the designated family member within the city under the guidance of a supervisor.
- Return of Mortal Remains: - In an unfortunate scenario of the death of the insured family member, our representative will pay for all the expenses necessary to repatriate the body to the registered address. We will also arrange for all the documents and necessary formalities including embalming and arrangement of casket and death certificate to repatriate the mortal remains to the home. We will also pay for the transportation from the airport to your home.
Conditions precluding the entitlement to benefits under Emergency Assistance Services
- If the insured family member was travelling for a medical treatment
- If the injury is due to attempted suicide or self-inflicted injuries
- If the services are sought outside the borders of India
- If the insured family member was involved in an unlawful act
- If narcotics or drugs had been consumed or any drugs other than those prescribed by the physician
- If the injuries are a result of participation in a war
- If the insured family member was travelling for more than 90 days away from the registered address without any prior intimation to us
- Students at their hostels or campus away from home
But it should be noted that unless agreed by us or our representative, no claims for reimbursement shall be catered to,for any services arranged by you or any family member. Conditions precluding the entitlement to benefits under Emergen
This facility is extended to you in collaboration with AAEMSIL – Assist America Medical Services (India) Private Limited, which is an emergency assistance and personal service provider. This service is available to our Individual Medishield, Swasthya Kavach and Comprehensive Accidental Hospitalization Policy holders.
Eligibility and PrerequisitesConditions precluding the entitlement to benefits under Emergen
Now that you have understood the numerous benefits that can be enjoyed with our health insurance plans for family, let’s have a look at the details to find out if you and your family members fulfill the eligibility criterion for our family health plan. It is necessary that you understand the eligibility criteria and pre-requisites of our family health insurance plans carefully, so that you can draw the maximum benefits of our all-encompassing health insurance policy for the family.
Entry Age: - Besides the policyholder and the spouse, dependents must be between 3 months to 23 years when a new policy commences, and you have not taken any other policy from any other company previously. Dependent children are covered in our health insurance plans for family from the first day since the parents get covered under this mediclaim policy for family.
In case you have an existing family mediclaim policy from any other insurer, and you want to switch over to IFFCO Tokio for the amazing benefits on offer, then you can conveniently do so. You and your family members will enjoy the benefits of continuous coverage without any age restrictions or conditions.
Family Members Covered :-
In India, family is the most important institution, and we respect this tradition. That’s why with our health insurance policy for family, we offer complete coverage for your extended family. In addition to yourself, you can add one or all the following family members as per your preference: -
- Spouse and Dependent Children
- Relatives living together such as In-laws
- Dependent Parents
- Other Dependent Relatives
You can easily add or remove name of any family member conveniently at any time of the year provided the mediclaim policy for family is valid throughout this procedure. But it should be duly noted that all family members covered under the policy must be Indian citizens.
- Subscription of a Policy
Now that you have understood and checked your eligibility for the Family Protector policy, let us run you through the process involved in purchasing any of our family health insurance plans, including checking the premium amount on the mediclaim policy for family through the premium calculator.
Where to buy family health policy
This is an important question. We offer you the option to subscribe to our family health protector policy from multiple sources as per your inconvenience. You can opt to buy the suitable plan through: -
- Company Website – You can avail the fantastic benefits offered by our family health insurance online through our website. Here, you can find details about the various options available to you in regards of family health plans in addition to all details about the policy. You can also know the tentative premium on our mediclaim policy for family with our premium calculator. You can be assured to get the desired policy at the most competitive prices on our website.
In case you have any doubts or questions, you can resolve them instantly by speaking with our customer care representatives. The major benefit you will enjoy when you buy family health insurance online is instant coverage for the whole family (members who have been named in the policy) the moment you complete the payment process. This is the most convenient and quick process to get your family covered.
- Marketplaces – You also have the option to avail our policies through various online marketplaces or aggregators which have premium calculator for mediclaim policy for family, and which will redirect you to our website for completion of the payment process. You can compare the various options available in the market, and choose the best option for you.
In addition to the online options, you can also subscribe to our health insurance plans for family through offline channels. We have developed a robust network of retail dealers and agents who are more than willing to help you with the whole process and make sure that you only select the best option for your family.
- Customer Care – In case you have any doubts regarding the procedure to buy family health plan online, our highly efficient customer care department will be ready to help you out. Our customer care executives are well trained to assist you with any possible issues. They can also help you complete the procedure as well as help you in choosing the best option for your family members.
If you want, we can also arrange for our sales executives to visit you at your home or workplace, and complete the formalities involved on your behalf. Our sales representatives possess complete knowledge about the various plans available, and will help you make an informed purchase decision. You can freely discuss any issues and doubts that you may have, and we assure you that all your concerns will be promptly addressed before buying IFFCO Tokio’s health insurance plan for family.
- Channel Partners - You can also approach or request for a call back from our channel partners who will help you subscribe to the family health protection plans according to your preference. Our channel partners possess complete knowledge about the various family healthcare plans being offered. You can have a comprehensive discussion with them to explain your requirements,based on which they can suggest you the most suitable policy to fulfil all your requirements.
Irrespective of whether you choose to purchase our health insurance plans for family through online or offline channels, you will enjoy the same benefits, and the subsequent procedures will remain the same as well. Make sure you check the probable premium using the premium calculator for mediclaim policy for family.
- Medical Validity and requirements
Once you have shortlisted a mediclaim policy for family by IFFCO Tokio, you need to complete the subsequent procedure to get the complete coverage for your family. Please read this section very carefully as even a slight oversight on your part can result in unnecessary hassles later on: -
You need to submit the self-attested copies of the following documents while you are signing up for our mediclaim policy for family. If you are buying the policy through one of the online channels, you can fill the form and submit the scanned self-attested copies of the documents online.
But if you want to go through offline channels, you will need to fill out the hard copy of the form along with printed and signed copies of the necessary documents for buying IFFCO Tokio’s health insurance plan for family.
Following is the list of documents that you need to keep handy when applying for a health insurance policy for family with us: -
- AADHAAR Card for every person to be insured under this family insurance policy
- PAN Card for every person to be insured
- Passport size photographs for every person to be insured
- Duly completed and signed proposal form/prospectus (in case of offline channels)
- Copy of Current or Expiring Policy (if porting from another insurer)
- Cheque for the payment of premium amount (in case of offline channels)
Pre-Acceptance Health Check-ups
If you are an existing policyholder from IFFCO Tokio or are porting from another insurer with a valid policy in effect, you need not undergo any such Health Check-ups while buying our health insurance plans for family. But if you are applying for a new policy, then you and your family members being covered under the family medical insurance may be requested to undertake these prescribed tests. This is necessary to identify any existing medical conditions which can have a bearing on the premium amount or might need exclusion of a proposed insured person(s) from the family policy coverage. Our online premium calculator for mediclaim policy for family tool will help you get an accurate estimate of the premium payable by you.
Our customer service representatives or channel partners will get in touch with you to book a suitable time slot for you and your family members to undergo these tests. The results of these reports are kept confidential and are disclosed only if you insist. The specifics of these tests are dynamic, and are communicated to you at the time of buying one of our health insurance plans for family.
Calculation of Eligibility and Premium
Family insurance plans have become must these days because the cost of quality medical care is going up with each passing year. We understand that you always want the best for your family and nothing less. That’s why our family protector policies offer coverage up to Rs. 30 Lakhs along with additional benefits in case of critical illness, for the premium amount you pay. We would suggest you to carefully analyse your family’s future medical requirements and then select a suitable plan but do remember that emergencies never arrive with an advance warning. Our premium calculator for mediclaim policy for family will help you accurately calculate the amount of premium you must pay for your desired family insurance plans.
But one thing that we want you to be aware about when looking at health insurance plans for family is under insurance, which is one of the biggest problems in the India. Under insurance is a situation where you underestimate your insurance requirements. There are multiple reasons responsible for this problem, such as:
- Reduce the Premium Payable - You might think that as you lead a healthy lifestyle, premium paid for insurance coverage is an unnecessary expense, and as such might tend to go for a lower sum insured than actually required. This will expose you and your family to unavoidable risks in future in case of any medical exigency.
- Miscalculation of future requirements - We are humans, and it is human nature to make mistakes. It is certainly possible that you might miscalculate your future mediclaim requirements for your family.
- Believing that you may never get sick – It is quite possible that you or some members of the family think that no serious ailment can ever affect them. The kind of environment we live in today, this belief is extremely flawed.
- Unaware of the benefits – It is also possible that you might not be fully aware about the benefits that you get from opting for a higher coverage amount in your family health plan along with opting for selected riders such as critical illness cover which can literally save you from going bankrupt if any tragedy was likely to befall you.
- Buying only for tax saving purpose - We all know that investing in health mediclaim policy also provides tax benefits. That might be the sole reason why a lot of us invest in health insurance. However, it is not really a healthy practice to follow.
As your trusted insurance partners, we at IFFCO Tokio want to suggest you to introspect and analyse carefully before opting for a mediclaim policy for your family.
In order to establish you and your family members’eligibility for the insurance coverage provided by the health insurance plans for family, we would request you to kindly undergo the prescribed medical tests if you or any of the proposed family members to be insured are above 55 years of age. Otherwise, we would just need a declaration of good health from your side.
Kindly make sure to disclose any pre-existing medical conditions in this declaration while buying our health insurance plan for family. In case any critical information is withheld, it could lead to rejection of a claim, or even cancellation of the policy. Once you disclose any existing medical conditions, then you are free from any worries later on regarding any claims that you may have to make in the future forthe same pre-existing condition.
Mediclaim Policy for Family Premium Calculator
To ease the process of calculating the premium for the desired insurance coverage, we have introduced a comprehensive online premium calculator for mediclaim policy for family. Here, you just have to fill out the basic details such as: -
- Number of Members to be covered
- Personal details like age etc.
- Insurance Coverage required
- Any Existing Medical Conditions
Once you enter all these details, you will be able to see the premium amount you must pay for the desired coverage with the help of this mediclaim policy for family premium calculator. If you find it to your satisfaction, you can proceed ahead to the payment page and get your family insured against any medical emergencies, there and then, with the best health plan for family as per your choice.
In case you are unable to use the online mediclaim policy for family premium calculator for any reason, you can contact our customer care at 1800-103-5499. Our representative will be more than happy to assist you with the whole process and clear any doubts that you may have.
Payment of Premium
Once you have decided regarding which policy you want for your family’s protection, and calculated the premium payable using our online mediclaim policy for family premium calculator,it is time to pay the premium. Unless you pay the premium, the policy is not in effect, and it leaves you and your family vulnerable to various uncertainties.
Also, if you are an existing policyholder, please make sure that you pay the premium for policy renewal on time, so that your protection through this health insurance plan for family stays intact. In case you delay the payment more than 30 days, then your family protector policy would be null and void, which can lead to serious consequences later on.
Various Acceptable Modes of Payment
We at IFFCO Tokio understand the importance of timely payment of insurance premium to ensure that your mediclaim insurance for family continues to protect your family members against any medical emergency. That is why we provide you with a host of convenient payment options for the payment of insurance premium. You can choose from online as well as offline payment options to pay your policy premium calculated through our mediclaim policy for family premium calculator.
- Online Options
- Website: - If you are buying a new policy online, you will be guided through our self-help portal to complete the payment procedure after you complete the application form, upload the necessary documents and calculate your policy premium using our mediclaim policy for family premium calculator.
If you want to pay your renewal premium on one of our health insurance plans for family, you can log on to the website and click on the “Pay Premium” button, which will take you to the payment page or if you are unable to locate the “Pay Premium” button, you can click on the following link: Premium Payment Modes
Once you are on the payment page, you can select from the list of available options and complete the payment process online. As soon as you complete the payment process, your policy is immediately renewed/comes into effect, and you can enjoy all the benefits of our mediclaim policy for family. With our online tool for Mediclaim policy for family premium calculator and seamless payment interface, availing a family Mediclaim policy was never so easy.
Following are the accepted online modes of payment: -
- Credit Card: - We accept all major credit cards from Indian as well as International Banks including Visa, MasterCard and American Express.
- Debit Card: - We accept all major Debit Cards issued from all major Indian banks including private banks as well as public sector banks.
- Internet Banking: - You can pay your premium through your Bank’s Internet Banking as well. We accept payments from all leading banks in India.
- Online Wallets: - You can also pay your premium through various online wallets.
We do not levy any extra surcharge for online payment of premiums for the health insurance plans for family that we have on offer. It is advisable that once you have made the payment successfully, keep a copy of the payment acknowledgement for future reference.
Mobile Portal :-
You can use our interactive as well mobile-optimized portal to make your premium payments online using the following options: -
- Credit Cards: - You can make the premium payment using your Master/Visa/American Express card.
- Debit Cards: - You can make payment using your Debit Card and ATM Pin.
- Internet Banking: - You can use your internet banking account to make the premium payment.
- Mobile Wallets: - We accept premium payments through all leading mobile wallets.
This is another feature which makes IFFCO Tokio Family Health Protector the best health plan for family.
- Offline Options
For those of you who are not comfortable with the online methods of payment or do not use any such methods, do not worry. We have a host of offline options available for your convenience for paying premiums for health insurance plans for family: -
- Branch: - You can drop into any of our conveniently located branches throughout India, and our staff will be happy to assist you with the payment procedure. You can use the following modes of payment: -
- Cheque: - You can pay through CTS compliant cheques
- Demand Draft: - You can also pay through demand draft/ Bankers Cheque.
- Cash: - You can also make your premium payments at our branch in cash.
- Drop-Box: - We have conveniently placed drop-boxes at strategic locations to make it easy for you to make the premium payments without travelling to the branch. You can pay through Cheque/Demand Draft.
- Post: - You can also mail your cheque and demand draft to make the premium payments conveniently.
You are free to choose a payment method as per your convenience, but do remember to make your payments well in advance to continue enjoying the benefits of your IFFCO Tokio’s mediclaim insurance for family. In case you want to add any other benefits to your existing family insurance plan, you should use our premium calculator for mediclaim policy for family available on our website.
Claims Procedure for Family Health Policy
The procedure to make any claim for medical treatment availed by your or any other insured person is a very important part of your family protector policy, and you should carefully understand all the dos and don’ts so that you do not face any issues later on. In this section,we have laid out the complete guidelines which will give you a clear idea regarding the procedure to be followed for cashless claims or post-hospitalization reimbursement claims.
These are the guidelines that are applicable across all claim categories, whether it is for cashless or reimbursement claims. You should thoroughly understand them to avoid any issues later on, which might lead to rejection of a claim: -
These are a few basic suggestions that you should definitely consider, to make sure that your experience with settlement of the insurance claim is a smooth one.
- At IFFCO Tokio, it is our earnest endeavor to ensure that you and your family members can avail the benefits of cashless hospitalization at all times, but you must understand that under certain conditions your cashless authorizations could be delayed or denied due to many reasons such as: -
- Delay in Intimation of hospitalization or claim submission
- Unavailability of past insurance details of you or the respective insured family member
- Difficulty in establishing our liability due to the inadequacy of medical inputs or symptoms.
- Hospital is excluded from the list of hospitals under our network
- Cases where admission is only for investigation purposes.
- The treatment is not authorized under your policy
- When the hospitalization is for less than 24 hours, other than the mentioned day care procedures.
- If there is any discrepancy in our records and your personal or policy information
- Because of concealment or misrepresentation of any material information
Please note that these are only indicative reasons, not exhaustive ones. Authorization of Cashless claims is the sole prerogative of IFFCO Tokio.
But please understand that even if your cashless authorization has been denied, it does not mean that you will not be reimbursed for a valid claim on your health insurance plan for the family. You can get the treatment done and settle the hospital bills from your personal sources. Later on, you can file a claim with us along with supporting documents, bills and receipts. After due diligence on our part, if we find that your claim is valid, and you have fulfilled all necessary conditions, you will be reimbursed the permissible amount as per existing rules and conditions. We intend our health insurance plan to be the best health plan for family, but only in the most fair and transparent manner.
- Cashless facility is available in our health insurance plans for family only at those hospitals which are under our panel at the time of admission to the hospital. You can get the relevant information about various hospitals under our network on our website as well as with our customer care representatives. You are requested to make sure of this fact so that later on there are no problems regarding the settlement of your claims.
- If you experience any undue delays with your cashless authorizations, you should get in touch with the Third-Party Administrator (TPA) Help-desk and check if any queries are pending for the reply. If it is so, then arrange to provide the required information at the earliest for speedy processing of your cashless claims.
- Please note that it may take up to 4 hours for a final cashless approval, so you are advised to inform us regarding the expected date and time of discharge after consultation with the hospital authorities. This would ensure a seamless cashless final authorization procedure for the claim you’ve made on your health insurance plan for the family.
- Before you make any payments from your own pocket after cashless authorizations, do remember to ask for the invoice and check it thoroughly. Also, please ensure that you check the invoice for any erroneous entries, even if your cashless claim has been approved, as this would help you save precious insured limit that can be used by other family members for the remaining policy period of your health insurance plan for family.
- For your own record, make sure that you collect the copies of invoice, reports and medications from the hospital.
Cashless Hospitalization is a very beneficial facility extended by IFFCO Tokio for your benefit, but it requires a bit of initiative on your part as well to make sure that the whole procedure of cashless hospitalization is smooth and hassle-free.
In some cases, due to any reason, your cashless hospitalization request may not get processed. But there is no need to worry; you can also file a reimbursement claim after discharge from the hospital. So, let’s have a look at some of the important points you should keep in mind while filing a reimbursement claim.
- You must note that you should file your reimbursement claim within 30 days of completion of a procedure or within 90 days after discharge from the hospital.
- While your discharge summary is being processed by the hospital authorities, make sure that you have all the necessary documents that will be needed while filing for the claim such as Discharge Summary, Pharmacy Bills, Test reports, Prescriptions, Bills etc. in the original. Please make sure that the discharge summary and Invoice are as per guidelines specified by IRDA. You can download the format from our website.
- You must take note that all bills should be supported by doctor’s prescriptions and all diagnostic bills should be supported by relevant test reports. You should also download the sample claim form from our website and get the same filled by the hospital.
- Following is an indicative, not exhaustive, list of documents that you should have for a smooth claim settlement procedure on our health insurance plans for family: -
- Claim form duly filled and signed.
- Copy of Policy
- Copy of Photo ID Card
- Test reports
- Original copies of Hospital bills, Hospital receipts, Pharmacy Bills, Diagnostics Bills, and other bills as available.
- Discharge Summary
- All documents for establishing case history.
- Hospital’s Registration Certificate in confirmation with state authorities
- KYC Form if the claim is above Rs. 1 Lacs.
- Any other relevant document received from the hospital
- In some instances, even more information might be required. The same shall be conveyed to you by Telephone and Email. Make sure you reply to the same within 15 days with supporting documents.
- You must make sure that you communicate your policy IDand correspondence number with every communication. In case there is any change in your communication details, please make sure that you convey the same to us at the earliest.
Cancellation of Policy
We would like to recommend you to keep your policy renewal dates set on reminder and make sure that the renewal premium is paid prior to the expiry date. Under any circumstances, the renewal premium should be paid within 30 days of the policy expiry date on your health insurance plan for family.
If due to any reason whatsoever, you fail to pay the premium for the renewal on time, your family mediclaim insurance policy will stand cancelled,and the protection cover offered by the Mediclaim policy for your family would cease to exist. This is a very serious situation which should be avoided at all costs. If your policy is cancelled due to any reasons, then you would have to get a new family mediclaim policy which would not have any continuity benefits that you had accumulated over the years. You should then again calculate your new premium using our mediclaim policy for family premium calculator tool and then again complete the whole procedure, as it would be an entirely new policy.
Here, we have explained the various circumstances under which a health insurance plan for family may be cancelled, and the process involved: -
Cancellation of Policy from your side
In case you want to cancel your health insurance plans for a family, the following procedure needs to be followed: -
- Cancellation during Free-look period: – Every new policy for family medical insurance comes with a free-look period of 15 days. During this period of 15 days, you are free to cancel the policy for any issues that you may have with the terms and conditions. While filing the request for cancellation of the policy, you must specify the reason for doing so. This option is not applicable for renewal policies. You will be entitled to refund of premium on the following basis: -
- If the risk cover has not commenced, expenses incurred by us on account of medical examination and stamp duty charges will be deducted from the refund amount.
- If the risk cover has commenced, then a deduction for expenses incurred by us on account of medical examination, stamp duty charges and proportionate premium for a mediclaim policy for a family shall be made before processing the refund.
- Through Notice: - You may cancel the family health insurance policy by sending 30 days written notice to us through registered post. We will then allow a refund as per the guidelines.
- Automatic Cancellation: - In case you do not pay your premium for renewal of your mediclaim for family before the due date (or a maximum of 30 days beyond the due date) then it shall be deemed that you are not interested in continuing the policy, and your health insurance policy for family shall be cancelled with immediate effect. If there is any refund claim, that shall be processed according to the company policy prevailing at the time.
Cancellation of Policy by IFFCO TOKIO
Although we try our best to make sure that your health insurance plans for a family are not cancelled,we may take the decision to cancel the policy under certain circumstances. The key reasons responsible for the cancellation of your mediclaim for the family have been mentioned below: -
- Moral Hazard or Misrepresentation: - We may cancel your family health insurance on the grounds of moral hazard or misrepresentation from your side, by sending a 30 (thirty) day notice by registered post to your last known address. You will then be entitled, except in case of fraud or illegality on your part, to a pro-rata refund of premium for an unexpired period of this mediclaim policy for a family in respect of such insured person(s) in respect for whom no claim has arisen.
- Fraud or Non-Disclosure: - We reserve the right to cancel your health insurance policy for the family by sending a 30 (Thirty) day written notice through registered post to your registered address in case we discover that there has been a fraud or non-disclosure from your side. No refund for the premium will be made in such cases.
- Non-Cooperation: - Your health insurance policy for the family may also be cancelled in case of non-cooperation from your side with the company. You will be sent a 30(Thirty) day written notice regarding the same at your registered address. In such a case, we will refund the premium on a pro-rata basis, provided that no claim has been made under the family health plan.
Reinstatement of Policy
After you or any of your family members make a claim under your family medical insurance policy, there are chances that you may exhaust the complete sum insured. In such a scenario, your family is at risk because they are without any coverage for the remaining period of the family medical insurance. Following the method of reinstatement, the basic sum insured will be used to restore the health policy for the familyafter charging an appropriate premium. This will make sure that full amount of basic sum insured is available to your family members for the remainder of the health policy for family’s period: -
- Basic Sum Insured would be reinstated only up to the extent of claim amount paid out of it.
- Premium payable for the reinstatement of the policy would be deducted from the amount of the claim.
- After the reinstatement premium has been paid, it will be effective from the first date of hospitalization, for which the claim has been made, till the expiry date of the policy.
- After the health insurance plan for family has been reinstated, it must be noted that it cannot be used for payment of expenses incurred for treatment of that particular disease, illness or injury for which the insured person had been hospitalized. It can be used for payment of expenses for treatment of similar ailments or some other diseases (other than chronic diseases mentioned in point no.9) which are not caused due to relapse of the ailment within 45 days of initial hospitalization, for which the insured person had been admitted.
The reinstated basic sum insured will be available to pay for any subsequent claims if,during initial hospitalization period, the insured person sustains any further injury or contract any other ailment, other than that for whose treatment the insured was hospitalized.
- The premium for reinstatement of the health insurance plan for a family will be recovered from the amount of claim settlement andthe basic sum insured shall be reinstated as soon as the insured person is hospitalized.
- This facility shall be available to policies having a basic sum insured of Rs 3 Lacs (Three) or above.
- Calculation of premium for the family health Insurance policy shall be done on pro-rata basis of the proportion of annual premium and basic sum insured to the amount claimed.
- Once the health policy for the family has been reinstated, the basic sum insured cannot be used to claim expenses for treatment of the following chronic ailments, where the initial claim under the same policy has been filed: -
- Perpetual limb paralysis
- Specific severity coma;
- Specific severity initial Heart Stroke
- Open Chest CABG;
- Major Bone Marrow or Organ Transplant;
- Specified Severity Cancer;
- Regular Dialysis requiring kidney failure;
- Permanent Symptoms causing stroke;
- Permanent Symptoms causing Motor neuron disease
- Heart Valves repair or Open-Heart transplant;
- Persisting Symptoms accompanying Multiple Sclerosis
- After reinstatement of the mediclaim for family policy, the basic sum insured shall not be available for a cumulative bonus or critical illness extension.
- Once the mediclaim for family policy has been reinstated, the basic sum insured shall not be claimable against expenses incurred for Domiciliary Hospitalization of Unani, Ayurvedic, Sidha or Homeopathic treatments.
The Company will not be liable to honor any claims against the health insurance plans for family, for any expenses that have been incurred by you or any of your family members in connection with, or in respect of:
- Behavioural, Mental and Psychiatric ailments
- Frenuloplasty, Circumcision, Prenuptial Dilatation, Angioplasty and Removal of SMEGMA
- Substance abuse, consumption of intoxicating substances, smoking, drugs / alcohol, and tobacco chewing
- Vaccination or Inoculation (other than post-bite treatment and for medical treatment for therapeutic reasons)
- Unless necessitated due to accidental injuries warranting hospitalization, dental treatment or surgery are not payable. (Dental implants are not payable)
- Surgical or Medical treatment of the genetic and endocrine disorder and Sleep neap,
- Congenital External Defects /Anomalies and Conditions
- Sexually Transmitted Diseases and Venereal Diseases
- Biological, Oral Chemotherapy and Immunotherapy, other than when given as an in-patient, indicated clinically and warranted due to hospitalization.
- Run-down condition, Nutritional deficiency state, convalescence, rest cure or general debility.
- Medical conditions caused directly or indirectly or attributable toasts of foreign enemy, war, warlike operations or invasion, whether there is a war declaration or not
- Deliberate injury to oneself
- Expenses that come up due to any condition directly or indirectly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV-III) or Lymphadenopathy Associated Virus (LAV) or HIV / AIDS. However, it is being clarified that patients who are tested HIV positive (Human Immune Deficiency Virus) shall be eligible for expenses borne for treatment. Expenses are not allowed for opportunistic infections and for treatment of HIV/AIDS, given that during the initial start of coverage under this policy, their CD4 count is more than 350.
- Expenses incurred on diagnostics that do not tally with the treatment for the ailment for which you or your family member has been admitted to the nursing home or hospital. Expenses on account of admission to the hospital mainly for diagnostic purpose without any diagnosis of ailment/sickness /injury/disease, and without any further indication of any treatment being administered. Disease or injury directly or indirectly caused due to nuclear materials or weapons
- Treatment is arising from or traceable to family planning, pregnancy, miscarriage childbirth, abortion and complications due to any of these conditions (other than ectopicpregnancy).
- Treatment for Assisted Conception, Sub-Fertility, and or other associated complications caused due to the same conditions
- Expenses incurred for Bariatric Surgery or weight management services comprising of surgical procedures for medical treatment of obesity.
- Expenses incurred on Rotational Field Quantum Magnetic Resonance Therapy, Deep Brain Stimulation, Photodynamic therapy, High Intensity Focused Ultra Sound, Balloon Sinoplasty, Enhanced External Counter Pulsation, Low-level laser therapy, Uterine Fibroid Therapy and related therapies, Embolisation, Chelation therapy, Hyperbaric Oxygen Therapy, VAX-D, and other such therapies similar to those mentioned herein.
- Experimental, Untested, Unproven and Unconventional therapies that are not covered under health insurance plans for family.
- Expenses incurred on Refractive Error Correction treatments such as Lasik Laser, treatment for disorders of eye requiring intra-vitreal injections and other related complications.
- Expenses incurred on tonics and vitamins unless they are a part of the treatment and have been certified by the attending physician of the hospital where the treatment is being performed.
- Hospital registration charges, record charges, telephone charges, admission charges, or any other such charges.
- Cost of Nutritional Supplements, hearing aids, infusion pump, spectacles and contact lens, Continuous Ambulatory Peritoneal Dialysis [CAPD], walkers and crutches, Cochlear implants, wheelchairs, CPAP, BIPAP and other such similar aids and procedures and associated expenses for hospitalization.
- Cosmetic or plastic surgery (other than necessary as a result of an illness or an accident).
- Chondrocyte Implantation, Intraarticular injection therapy, Stem cell Therapy, and Procedures using Platelet RichPlasma.
- Treatment for erectile dysfunctions, Sec change operations, Cosmetic and aesthetic treatment of any description.
- If the following conditions which are aggravated by diabetes are present in you or any of the family members(s), considered on an individual basis, at the time of subscribing to the first health policy for family by the insured person, it will be considered as a pre-existing condition and shall be subject to a waiting period of 48 (Forty Eight) months before being covered: -
- Diabetic Angiopathy;
- Diabetic Retinopathy;
- Diabetic Nephropathy;
- Diabetic Foot Wound;
- Diabetic Ketoacidosis or Hyper Hypoglycaemia;
- Hypoglycaemia; and
- Diabetic Neuropathy
- If the following conditions which are aggravated by hypertension are present in the insured person(s), on an individual basis, at the time of subscribing to the first family health insurance policy by the insured person, will be considered as a pre-existing condition and shall be subject to a waiting period of 48 (Forty Eight) months before being covered:-
- Hypertensive Nephropathy;
- An aneurysm
- Hypertensive Heart Disease such as Congestive Heart Failure(CHF) etc. or Coronary Artery Disease (CAD)
- Hypertensive Encephalopathy
- Cerebro Vascular Attack; and
- Hypertensive Retinopathy
- During the first 30 days of a new health insurance plan for the family, any expenses incurred on account of hospitalization of you or any other insured family member, for any of the diseases shall not be covered under the mediclaim for family. This exclusion shall be waived off in the scenario if you have any existing family insurance plans from any of the registered Indian Insurance companies for a continuous preceding period of 12 months without any break over 30 days. If the hospitalization is due to an accident, then also this limit of 30 days shall be waived off.
- If the following conditions are present in the insured person(s), on an individual basis, at the time of subscribing to the first health insurance policy for family by the insured person, it will be considered as a pre-existing condition and shall be subject to a waiting period of 48 (Forty Eight) months before being covered by the health insurance policy for family:
- Fistula in anus, Anal Sinus, Piles
- Varicose Veins / Varicose Ulcers
- Any type of Carcinoma / Sarcoma/ Blood Cancer
- Surgical treatment for Tonsillitis/ Adenoids
- Tympanoplasty / Septoplasty
- All types of Ligament Meniscus Tears
During the first 30 days of a new health insurance plan for the family, any expenses incurred on account of hospitalization of you or any other insured family member for any diseases shall not be covered under the family health insurance. This exclusion shall be waived off in the scenario if you have any existing family insurance plans from any of the registered Indian Insurance companies for a continuous preceding period of 12 months without any break of over 30 days.
- If the following conditions are present in the insured person(s), on an individual basis, at the time of subscribing to the first health insurance plan for family by the insured person, will be considered as a pre-existing condition and shall be subject to a waiting period of 48 (Forty Eight) months before being covered by our health insurance plans:
- Cataract, Benign Prostatic Hypertrophy, DUB
- Uterine Fibroids/PV Bleeding like Hysterectomy, Myomectamy, etc.
- A hernia, Hydrocele
- Gall Bladder, Biliary, Renal and Urinary Stones
- Inter-vertebral Disc disorder like Spondilytis, Spondylosis, prolapse etc. (other than caused by accident)
- Knee replacement/Joint Replacement/Hip replacement (other than caused by accident)
- Chronic Renal failure
- Any type of benign growth/Cyst/Nodules/Polyps/Tumour/Lump
During the first 30 days of a new family health plan, any expenses incurred on account of hospitalization of you or any other insured family member for any diseases shall not be covered under the family health insurance. This exclusion shall be waived off in the scenario if you have any existing family medical insurance from any of the registered Indian Insurance companies for a continuous preceding period of 12 months without any break over 30 days.
- The following conditions which are aggravated by diabetes or hypertension,if incurred in the first two years of the operation of the family health plan: -
It will be considered as a pre-existing condition and shall be subject to a waiting period of 48 (Forty Eight) months before being covered. During the first 30 days of a new health insurance policy for family, any expenses incurred on account of hospitalization of you or any other insured family member for any diseases shall not be covered under the health insurance plans for family. This exclusion shall be waived off in the scenario if you have an existing individual or group insurance policy from any of the registered Indian Insurance companies for a continuous preceding period of 24 months without any break over 30 days.
This exclusion shall also be waived off in the scenario of you having any existing family medical insurance or group insurance from any of the registered Indian Insurance companies for a continuous preceding period of 12 months without any break over 30 days.
- From time to time, we keep on revising our list of hospitals blacklisted in our records, and it should be referred to before undergoing treatment at any such hospital not covered under the family medical insurance policy. If you or any of the other insured family members undergo any treatment or procedure at any such hospital, then your claim shall not be approved. It is advised that you contact our customer care center or website before taking admission in any such hospital.
- Other excluded expenses as detailed under “Other Excluded Expenses.”
Any signed document submitted from your side to our company including forms, declarations, written statements, questionnaires and any other written statements.
It refers to the health insurance documents consisting of applicable endorsements, policy wordings and schedules. It contains all details regarding the extent of coverage, terms and conditions, inclusions and exclusions.
- Basic Sum Insured
The total coverage amount as opted by each insured person under the policy without any riders, bonuses or discounts.
- Sum Insured
It means the total coverage available for all insured persons under the health insurance plans for family inclusive of cumulative bonus.
- Extended Sum Insured
The total coverage available for all insured including the cumulative bonus, riders and additional coverage under health insurance plans for family.
The use of either of these pronouns refers to IFFCO Tokio GENERAL INSURANCE COMPANY LIMITED.
The person(s) named as insured in the schedule.
- Insured Person
This defines the individual or all family members covered by the health policy for the family.
- Period of Insurance
The duration i.e. start date and end date, during which the policy will remain in effect.
It means being admitted in a recognized Hospital or Nursing Home for a minimum consecutive duration of 24 Hours for treatment of an approved condition or ailment. In other scenarios, procedures which have been recognized as day care procedures and are covered under the policy are also included in this meaning for the matter of family health plans.
- Pre-Hospitalization Medical Expenses
All those medical expenses which have to be borne before you or your family members who are covered under the mediclaim policy for family, immediately before hospitalization, given that: -
i. All such expenses were for the particular ailment for whose treatment the insured person has been hospitalized and was administered under the guidance of a registered medical practitioner.
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by us.
- Post-Hospitalization Medical Expenses
Expenses which are of medical nature and are borne immediately after the insured person is discharged from the hospital, subject to the insured person being covered under health insurance policy for family and fulfilling conditions that: -
i.All such expenses were for the particular ailment for whose treatment the insured person had been hospitalized and was administered under the guidance of a registered medical practitioner.
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by us.
- Medical Practitioner
An individual possessing a valid license from the statutory authorities such as The Medical Council of India or any other equivalent Central or a State Government body and is thus eligible to practice the medical profession. All his actions shall fall between the jurisdiction and scope defined by the license possessed by such Medical Practitioner.
- Qualified Nurse
A person who possesses proper registration from the Nursing Council of India or the Nursing Council of any state in India.
- Domiciliary Hospitalization
The medical treatment for an illness/disease/injury which under normal circumstances warrants treatment and nursing care at a hospital as an in-patient, but is actually administered when the insured person under mediclaim for family is confined to his/her home due to certain prevailing circumstances such as: -
a.The insured person is not in a physical position to be transferred to a hospital
b.The insured person has to take treatment at home due to unavailability of beds or rooms at the hospital
- Pre-existing Condition
Any ailment or an associated condition(s) for which the insured person had been showing symptoms, and had been diagnosed or received medical attention within 48 months or 4 years, prior to the first family medical insurance policy availed by the insured person.
- Day Care Treatment
Medical treatments or surgical procedures administered by registered Medical Practitioners after which the patient is normally discharged within 24 hours without any hospitalization, depending on the facts that:
a.The treatment is given under General or Local anaesthesia and did not require hospitalization because of advanced medical facilities. It must be included in our list of day care procedures listed under health insurance plan for the family, which otherwise would have warranted a hospitalization period of at least 24 hours.
b.Normal treatments which are administered on out-patient basis are not covered under the definition of Day Care procedures.
- Network Provider
It means all those hospitals, nursing homes or health care providers that have been enlisted by the company for their mediclaim for family, and are authorized to offer medical treatment to an insured person on a cashless basis.
- Non- network hospitals
It means all those hospitals, nursing homes, day care center or another provider that is not authorized by the company and cannot offer the cashless facility for their mediclaim for family.
- Emergency Assistance Service Provider
The entity or body which has been authorized to offer emergency medical services, assistance or personal services to the insured person, when they are more than 150 kms away from their registered domicile address in the mediclaim policy for family, provided that places fall within the geographical boundaries of India.
- Medical Assistance Services
These are the authorized medical services offered by the emergency assistance service provider during a medical emergency situation while the insured person(s) is(are) more than 150 kilometers away from their registered domicile address in the mediclaim policy for family, provided that places fall within the geographical boundaries of India. It consists of medical consultation, medically supervised repatriation, medical referrals, and medical evacuation.
It means a cost-sharing arrangement under a health insurance plan for the family, where you or any of the insured family member must bear a particular percentage of the admissible claim amount. This has no effect on the basic or extended sum insured of the mediclaim for family.
- Emergency Care
Immediate and urgent medical treatment of a severe ailment or injury which requires the attention of a medical practitioner. It is necessary to administer immediate care to the insured person to minimize the risk to life and manage long-term implications on the health of the insured person.
- Grace Period
It means the explicitly mentioned period of 30 days immediately following the premium due date, during which the premium due for the mediclaim policy for the family must be paid to continue enjoying the continuity benefits, waiting for period benefits and cumulative bonus benefits. Coverage of the policy for family health ceases to exist from the date premium was originally due, if the payment is not made within 30 days of the policy expiry date.
- Inpatient Care
Medical treatment for which an insured person must stay in the hospital for not less than 24 hours under the guidance of a medical practitioner. If the mediclaim policy for family acknowledges certain day care procedures which do not require 24-hour hospitalization, they are also considered under inpatient care.
- Outpatient Treatment
The treatment for which the insured person visits the particular department at a hospital or nursing home, to get an opinion of a medical practitioner regarding diagnosis and treatment of a condition being suffered from. Herein the insured person is not admitted to the hospital under inpatient or daycare category.
- Day Care Centre
Any institute that has been set up to offer day care treatment for specified ailments or conditions which are covered under the health insurance plans for a family, or proper departments set up under a recognized Hospital. The day care center must be registered with statutory authorities and should be run under the supervision of a qualified medical practitioner and should fulfill the following criteria: -
- Must have a qualified and registered medical practitioner(s) in charge of operations;
- Must have adequately qualified nursing staff;
- Must maintain daily records of patients;
- Must have a fully equipped operation theater for conduction of surgical procedures;
- Must share maintained records with statutory authorities and our personnel when demanded.
- Medical Expense
It refers to those expenses in health insurance plans for family which have actually been incurred on advice of a medical practitioner for treatment and management of a medical condition. These expenses should not be artificially inflated and should be in sync with the prevailing prices in the market which other doctors or hospital normally would have charged and should be similar to what the insured person would have had paid from their own pocket as if they were not covered under the family insurance plans.
- Cumulative Bonus
An increase in the Basic Sum Insured granted by us without an associated increase in premium.
- Dental Treatment
The medical treatment carried out by a registered dental practitioner and might include prescriptions, pain management, fillings, crowns, implants or cosmetic treatments. Unless explicitly specified, Dental treatment is not covered under health insurance policy for the family.
- Condition Precedent
It means terms and conditions of a policy under which our liability is conditional.
- Notification of Claim
The process of intimation of a claim to our customer service center or the Third Party Administrator (TPA) along with specifics such as timelines, your name, policy number, registered address and contact details.
- Disclosure to information norm
This means that the Family Health Insurance will become null and void in the event of non-disclosure, misrepresentation, fraud pertaining to concealment of a medical fact. In such an event all the premium paid shall be forfeited immediately.
- Cashless service
A facility which has been extended to the insured person under the mediclaim policy for family, where all the payments pertaining to expenses incurred for treatment of an ailment according to policy terms and conditions is made directly to the hospital by the company. The limit of cashless service is up to the extent of pre-authorization approval.
It defines our right to call upon other insurers who have also covered the same insured person under a different policy other than the mediclaim for family, to share the liability on an indemnity claim on a pro-rata basis of the sum insured.
The terms and conditions which will govern the possibility of a family insurance plan to be renewed with mutual consent of the company as well as the insured person(s). There must also be a provision of a grace period to treat the renewal as continuous as well as an explanation regarding various waiting periods forming a part of the policy.
It defines the right of an insured person(s) under a mediclaim for family, to transfer the policy from one insurer to another. Through portability, the insurer gets to continue enjoying the continuity benefits for pre-existing conditions or time-bound inclusions and exclusions which were gained under the previous policy.
- Room rent
It means the amount that is charged by the hospital for occupancy of a bed by the insured person who is undergoing medical treatment for more than 24 hours. All associated medical and nursing expenses shall be included in the room rent.
- Class “A” Cities
Thiscategory includes the cities of Mumbai, NCR Delhi, Kolkata, Pune, Jaipur, Lucknow, Kanpur, Chennai, Nagpur, Ahmedabad and Bengaluru. The list may be revised from time to time according to the discretionary powers of the company
- Additional Benefits
The benefits which are extended to the family health Insurance policyholders over and above the basic sum insured, for which no additional premium is payable.
The optional coverage which is available to all insured persons under the health insurance plans for the family over and above the sum assured and additional benefits on payment of an additional amount other than the policy premium.
- Terrorism/Terrorist Incident
Any use of force or violence with an explicit intention of causing damage or injury to human life. It consists of acts harmful to human life and property and can be with a stated or unstated motive of pursuing objectives contrary to the national interests and can be against government or individuals. Terrorism also includes those activities or actions which have been verified by the relevant state or central governments as terrorism.
- Alternative Treatment
Under the mediclaim policy for family, it consists of an alternative form of treatment for various ailments other than recognized medical procedures. In the context of India, they include Ayurveda, Homeopathy, Unani and Sidha treatments aimed at treating the root cause of any ailment, which is otherwise considered un-treatable under allopathic treatments.
- Dependent Child
A child, whether natural born or adopted, who is financially dependent on a primary insured, and is without an independent source of income.
- Newborn Baby
It means those babies who have been born to an insured person under the mediclaim for family. Any baby aged between 1 to 90 days is considered a newborn baby.
- Specific Severity Cancer
It is a malignant tumor which is characterized by unrestricted growth and destruction of normal cells by malignant tumor cells. The term cancer encompasses sarcoma, leukemia and lymphoma. The presence of cancer can only be confirmed by a pathologist and there shall be supporting histological evidence.
Following instances of Cancer are excluded from the scope of this policy: -
- Microcarcenoma of the bladder
- Any type of skin cancer other than invasive malignant malenoma
- Unless historically classified with a Gleason score of over six and clinical T2N0M0, all prostate tumors are also excluded from the scope of this policy
- If insured person is HIV+, then all tumors are excluded from the scope of this policy
- Tumors which show carcinoma’s malignant changes in situ and tumors which have otherwise been specified as non-invasive such as Carcinoma in situ of breasts, Cervical dysplasia and various others.
- Chronic Lymphycyticleukemia lower than stage 3 RAI
- Papillary Micro-carcinoma of Thyroid less than 1 cm diameter
- Specified Severity Heart Attack
The first instance of death of a portion of the heart due to inadequate supply of blood i.e. Myocardical Infarction. Its diagnosis will be evidenced by: -
- Open Chest CABG
Use of Coronary Artery Bypass Graft (CABG) to correct the problem of blocked or narrowed coronary arteries, through open chest surgery. Need for the surgery has to be confirmed by a registered medical practitioner and shall be supported by a coronary angiography.
- Key-Hole Surgery
- Laser Surgery
- Angioplasty or similar Intra-arterial procedures
- Repair of Heart Valves or Open Heart Replacement
It implies that in order to replace or repair one or more heart valves which have been rendered defective by abnormalities or diseases, if an open heart surgery has to be performed that it shall be done by a specialist medical practitioner and the diagnosis has to be supported by an Eco-Cardiography. Catheter based techniques such as Valvotomy and Valvuloplasty are not covered under the policy.
- Specific Severity Coma
It is defined as a state of unconsciousness in which external stimuli or internal needs cannot generate any response from the body. Following evidences must support the diagnosis: -
- For sustaining life, life support measures are required.
- Permanent Neurological deficitmust be assessed after 30 days from the first instance of coma
- Lack of or No response till at least 96 hours continuously to external stimuli.
The diagnosis in such health insurance plans for family must be confirmed by a registered and specialist medical practitioner. If the coma has resulted from over consumption of alcohol or drugs, then it is excluded from the scope of the policy.
- Regular Dialysis requiring Kidney Failure
A specialist medical practitioner has to confirm the diagnosis if it is an instance of last stage renal disease which results in chronic and non-reversible failure of both the kidney’s functions, which demands regular dialysis or kidney transplantation.
- Permanent Symptom causing Heart Attack
A specialist medical practitioner has to confirm the occurrence of any cardiovascular incident which has resulted in permanent neurological sequel. The diagnosis has to be substantiated with findings of CT Scan and MRI of the brain. It includes intracranial vessel thrombosis, embolism and hemorrhage from additional cranial source, and brain tissue infraction. Evidence regarding permanent neurological deficit for 90 days has to be produced.
Exclusions are Traumatic Brain Injuries, Vascular Ailment affecting optic nerve or vestibule functions and Transient ischemic attacks.
- Bone Marrow or Organ Transplant
It encompasses actual transplantation of major organs such as: -
- Heart, Kidney, Liver, Pancreas and Lung due to end stage failure of the organ
- Bone Marrow Transplant, with the procedure being duly confirmed by a specialist medical practitioner. Exclusions are other stem cell treatments or instances where only islets of Langerhans are transplanted.
- Permanent Paralysis of Limbs
It means complete and non-reversible loss of functioning of two or more limbs due to injury to brain and/or spinal cord. The diagnosis must be confirmed by a specialist medical practitioner who is of an opinion that the paralysis is irreversible and there are no chances of recovery in near future. The paralysis must be present for more than 90 days continuously to be covered under this policy.
- Permanent symptoms accompanying Motor Neuron Disease
It means that the disease diagnosed by the specialist medical practitioner as spinal myopathy, primary lateral sclerosis, bulbar palsy and amyotrophic lateral sclerosis. There must be current significant and permanent functional neurological impairment with objective evidence of motor dysfunction that has persisted for a continuous period of at least 3 (three) months.
- Multiple Sclerosis with consistent symptoms
The opinion of the specialist medical practitioner must substantiate the permanency of multiple sclerosis, with diagnostic being supported by: -
- Findings of the MRI and CSF must firmly establish the presence of multiple sclerosis.
- There should be well documented clinical history establishing impairment of sensory and motor functions for a continuous period of six months. There must be remissions of said symptoms at least with two clinically documented episodes with a time difference of one month. Other neurological cases such as HIV and SLE are excluded.
- What do you mean by Family Floater Policy?
A family floater policy is a single insurance policy which covers all your family members and dependent children with a single sum insured. This family health insurance plan takes care of all medical and hospitalization expenses incurred during the validity of the policy.
In most cases taking a floater health mediclaim policy for your family is a better option as you can enjoy a higher sum insured with minimum premium payment, as chances of multiple family members falling ill together are very remote.
- What is Health Insurance?
A health insurance policy can be described as a binding contract between IFFCO Tokio and you wherein we agree to indemnify you and other insured members of your family for any hospitalization expenses incurred while you are under the coverage of mediclaim policy for the family. It covers all hospitalization related expenses for most medical conditions.
- Which Family Health Insurance policies are offered by IFFCO Tokio?
At IFFCO Tokio, we understand the importance of wellbeing of your family members for you. Therefore we offer a vast variety of mediclaim for family plans with varying coverage and benefits, to choose from. You can choose a policy according to your preference and offer protection to your family against any unforeseen exigencies.
- Why is a Health Mediclaim Policy important?
In modern day society, health insurance has become more of a need rather than a luxury. With the kind of polluted and dangerous surroundings that we live in, access to quality medical care is very crucial. But with quality medical care becoming very expensive, if any of your family members need to be hospitalised in the absence of a health insurance plan for family, there are good chances that all your savings might be wiped off.
With health insurance plans for family, you and your family members are able to enjoy the safety blanket offered by a floater policy wherein depending on your policy, your medical expenses upto the extent to Rs. 30 Lacs shall be reimbursed to you in case you ever need to make a claim.
- What kinds of Family Health Insurance covers are available?
At IFFCO Tokio, we understand that different families have different needs; that is evident in our health insurance plans for family. The premium for the mediclaim insurance for the family depends on the extent of coverage and range of additional benefits chosen by you. We also offer you the benefit of opting for additional cover for critical illness by paying a basic premium amount and enjoy much higher coverage benefits. For more details, you can Click here or get in touch with our customer care department.
- Is cashless facility available under Mediclaim Policy for Family?
At IFFCO Tokio, we have strategic tie-ups with over 4000 Hospitals, Nursing Homes and Medical care providers to offer cashless treatment for a vast range of ailments and medical conditions under our health insurance plans for family. All the hospitals under our network offer you the benefit of cashless treatment, where you need not pay any charges out of your own pocket, every expense is taken care of by us. Though you should remember that there are certain sub-limits applicable to some treatments and if your expenditure is beyond that limit, you might have to pay some amount out of your pocket.
We would suggest you obtain a pre-authorization, if the ailment is not life-threatening, for the impending hospitalization for your medical condition. This way your claim settlement and cashless treatment process would be very streamlined when you purchase our health insurance policy for family.
- What are the tax benefits I get if I opt for Family Health Insurance Policy?
What makes an investment in family medical insurance an attractive option is the benefits under Sec 80D of the Income Tax Act. At present, the Government allows a deduction of up to Rs. 25,000/- when you buy a family health insurance.
- What are the factors that affect the Family Health Insurance premium?
The premium for your family mediclaim policy depends on a variety of factors including: -
- Number of Family members included
- Age of the family members
- Previous medical History
- Existing Medical Conditions
- Optional Critical Illness cover
- Optional Additional benefits
- Claim free years
At IFFCO Tokio our only priority is the well being of your family. Therefore we offer attractive family insurance policies at very reasonable premiums so that you do not think twice before opting for our health insurance policy for family.
- What does a Family Health Insurance policy not cover?
Certain pre-existing conditions are not covered by our family health insurance policy. You can click here [Please mention the link for same]to access the list of exclusions under our policies.
Cosmetic treatments which are purely optional are not governed by medical compulsions. They are also not covered under our health insurance plans for family. Then there are certain medical conditions which are only covered after a waiting period of 12, 24 or 48 months in case of a new family mediclaim policy. For more information, please Click here or call our customer care centre at 18001035399
- Is there any waiting period for claims under a Family health plan?
When you buy a family medical insurance policy for the first time, there is a waiting period of 30 days before you can file a claim under the policy coverage, starting from the coverage commencement date. During this period, no claim will be accepted by the company. But this waiting period of 30 days is waived off in case the hospitalization is due to an accident.
Policies which are pending for renewal do not have any such waiting period applicable.
- How is a pre-existing condition defined under Family health insurance policy?
A pre-existing condition means any particular disease or ailment that you or any other insured family member was suffering from before you buy a family insurance policy. The coverage for treatment of pre-existing conditions will not come in force until after 48 months of continued coverage. But in case you are porting from some other insurance plan to IFFCO Tokio, then your policy comes into effect right from the date you sign up for our mediclaim policy for the family.
- If my policy is not renewed in time before the expiry date, will I be denied for renewal?
We will suggest you make sure that the family insurance plan’s renewal premium is paid on time, much before the due date so that you and your family members can continue to enjoy the benefits of continuity as well as an accumulated bonus. If due to any circumstances, you are unable to pay the premium on time, please make sure you make the payment within 30 days of the date of premium being due.
If you are unable to pay the premium even after 30 days, then your family mediclaim policy will be deemed cancelled,and the protection cover for your family would cease to exist. Thereafter, you will need to buy family health insurance online or through our offline channels.
- Can I transfer my health insurance plan(s) for the family from one insurance company to another without losing the renewal benefits?
Yes, as per guidelines of the IRDA, customers can freely port their health insurance plan(s) for the family from one insurance company to another without losing the continuity and renewal benefits accumulated over the years.
At IFFCO Tokio, we have a vast range of health insurance plans for a family, from which you can choose the one suitable for your family and enjoy the amazing benefits on offer.
- What happens to the mediclaim policy for the family’s coverage after a claim is filed?
After you file a claim for undergoing medical treatment for yourself or any of the insured family members, the total claim amount is deducted from the sum insured, and the remaining amount is available for the rest of the policy period as defined in the terms and conditions of our health insurance policy for family.
If the whole policy amount for the health insurance plans for a family is exhausted, you can pay a small amount and opt for reinstatement of the basic sum insured to continue paying for the treatment.
- What is the maximum number of claims allowed over a year?
Under our health insurance plans for the family, there is no limit on the number of claims that can be filed during a year. Though the maximum amount that could be claimed is limited to the extent of Sum Insured.
- Does your health insurance plan for family cover everything from accident, surgery, normal hospitalization?
Yes, all our health insurance plans for family offer extensive coverage against a vast range of ailments, injuries and accidents for you and all your insured family members. There are no exceptions to claims against accident related hospitalization.
However, please make sure that when you purchase a family health plan online or through other channels, you disclose all pre-existing conditions as well as medically relevant information, so that there are no issues while settling claims against your health insurance plan for a family.
- What are the advantages of sticking to one Insurance company for a long time?
We would like to recommend that you should continue with the insurance company on a continuous basis to enjoy a maximum range of benefits. Sticking with one company for your requirement of health insurance plans for a family, will make it easier for you to claim the continuity benefits. There are certain pre-existing conditions, for which the coverage starts only after 48 months waiting period.This conditionmakes it preferable to not shuffle around too much.
Moreover,if you stick to one insurance company with your health insurance plans for a family, you also get to enjoy the benefits of accumulated bonuses, which provide you additional coverage over and above the sum insured.
Claim settlement is also faster when you have a long-term association with the company, as all the waiting period requirements would be satisfied by then.
As such, if you do not have some serious unresolved grievances with your insurer for family medical insurance, then changing your insurer makes little sense.
- What is the key to a successful claim for health insurance plans for a family in case of emergency and planned hospitalization?
Staying organized while filing a claim for hospitalization and other related expenses, is the success mantra for a successful claim settlement with our amazing health insurance plans for a family. You should keep all your documents and record up to date. Organize all your test reports, doctor prescriptions, treatment details in a folder, so that when asked to submit any document, you do not have to search through different files.
You should also make sure that your communication details are up to date in our records, as all the family mediclaim policy related communication shall be directed to the registered details only. When you submit your documents and reports for claim settlement with the TPA, please double check to make sure that all your documents have been submitted. Otherwise it may cause unnecessary delays or even rejection of the claim.
If you are going for planned hospitalization under our health insurance plans for a family, then we would suggest that you get a pre-authorization from our side. This way, when it would come to the stage of settling the hospital bills, you need not pay anything from your pocket.
- How can I buy a family medical insurance policy from your company?
At IFFCO Tokio, we offer you a vast range of options to purchase from any of our health insurance plans for a family.
You can buy family health insurance online from our website. We offer a very user-friendly process for you to get a mediclaim policy for your family online. Just log on to our website, fill in some basic details, follow the instructions, make the premium payment, and sit back to enjoy the benefits of our amazing health insurance plans for a family. If you are an existing policyholder, you can easily renew the family health insurance online through our website.
If you are reluctant to buy family health insurance online, you can walk into any of our well-located offices throughout India and purchase the best health plan for your family.
- During the course of my treatment, can I change the hospitals?
Yes, under our family health insurance plans, after approval from the TPA, you can change hospitals for want of better treatment. But please ensure that the change is done only if required after due consultation with your doctors, and only if the patient is physically capable of undergoing the stress of shifting.
To avoid unnecessary hassles, we would suggest to you select the best hospital from our network as per your understanding. This way you will not face any issues with claim settlement later on for your family health plan.
- What are the situations under which I may be denied cashless hospitalization under your family health insurance plans?
Yes, under certain circumstances, your claim for cashless hospitalization may be denied.So, we suggest that you read them carefully and make sure you do not face such a situation while being covered under the best health plan for your family: -
- You have not submitted the complete documents
- Your contact details registered with us are incomplete
- If the illness or medical condition is not covered under the policy
- If the hospital where the treatment is being undertaken is not on our network
- If the ailment is pre-existing and the waiting period of 4 years is not over
- If the request for pre-authorization was delayed
Even if your cashless treatment request as per the claim on your family health plan is denied, do not worry. You can get the treatment from the hospital, settle the bill from your own funds, get discharged from the hospital and then file for a claim with the TPA or with our concerned department directly. Just make sure that you submit the complete documents in one go so that your claim under health insurance policy for the family can be reimbursed as soon as possible.
- I have a small family and we all are young and healthy individuals. We lead a very healthy lifestyle and have never been to a doctor. Do I still need a family health insurance plan?
Yes, you should definitely get a family mediclaim policy to cover you and your family members against any unforeseen emergency medical conditions. Remember that trouble would never give you any advance warning. The family health mediclaim policy makes sure that you do not end up wiping off all your savings when you or any other family member needs to undergo any major medical procedure. You can also consider our health insurance policy for family as a protection cover against various medical conditions.
- I have a life insurance policy, do I still need a family health plan?
Here you are confusing between life insurance and family mediclaim policy. A life insurance is a policy to indemnify you against death of an insured family member, in which the pay-out is to be made only on the maturity of the policy or death if an insured person Whereas under a family mediclaim policy you are reimbursed for any medical expenses, covered under the purview of our health insurance policy for family, which have to be incurred for treatment of a specified illness.
- Are diagnostic and investigative tests covered under the family Mediclaim policy?
Yes, various diagnostic tests such as MRI, CT-scan, X-Ray, blood Tests etc. are covered under our health insurance plans for family. But the said diagnostic tests must have been prescribed by a specialist medical practitioner and shall be related to the identification and treatment of the ailment for which the claim has been filed.
- Can I buy more than one family health plans?
Yes, you can buy more than one health insurance plans for family, but in case you or any insured family member must file a claim, then the claim shall be reimbursed by both the respective companies in rateable proportions. For instance, if you have mediclaim policy for family from Company A for Rs. 1 Lakh and from Company B for Rs. 1 Lakh, then in case of a claim for Rs 1 Lakh, both the companies will pay in the ratio of 50:50 for the sum assured.
- Who can help me calculate my family Mediclaim policy premium?
You can use our premium calculator for family mediclaim policy available online to get an accurate estimate of the premium payable by you. You can also contact our customer service department executives who will be more than happy to assist you with calculation of your policy premium.
Dos and Don’ts while taking up family Insurance
With the cost of quality healthcare going up with every passing year, it has become a must for every person to have a family medical insurance. In these uncertain times it is a given that at some point or another, you or any of your family members may get affected due to an ailment or injury. If you do not have any health insurance for family covering you against the expenses on hospitalization, there are chances that you might end up exhausting all your savings, and may even end up with debt. It will be a sorry state of affairs if you end up in debt when you could have saved all your savings and still get the best possible treatment for the ailing family member.
If you are living in a joint family comprising of both young and elderly, such uncertainties in life can hit you hard. That is why choosing the best health plan for the family is mandatory for you. When you choose a floating family health protector policy from IFFCO Tokio, rest assured that you have made the correct decision. Our comprehensive range of services makes sure that when you buy family health insurance from us, you enjoy the maximum benefits.
But you are not assured of guaranteed claim settlements or cashless hospitalization benefits just by buying family health insurance online or offline. You need to take care of many factors to make sure that you continue to enjoy the benefits of thebest health plan for the family.
For your reference, we have compiled a list of Do’s and Don’ts that you should follow for a hassle-free experience in terms of your health insurance plan for family.
- If you or any of your family members who are going to be covered under the family medical insurance are suffering from any existing medical conditions, you should disclose the same while filling up the health mediclaim Policy documents. Conditions such as diabetes and hypertension must be disclosed. This will save you from a lot of hassles later on.
- If you want to take the cashless route for payment of your hospitalization expenses under family health insurance policy, then you should intimate the company or the TPA in advance for cashless authorization. In case of emergencies, try and intimate within 24 hours of hospitalization. This way, by the time of discharge, your claim against the mediclaim policy for the family will be easily approved, and you need not pay anything from your pocket.
- Try and select a hospital on our panel, so that you can enjoy the benefits of cashless hospitalization under the best health plans for a family. But, if you want to get a treatment done at a hospital that is not on our panel, then you should collect and safely store all the documents, prescriptions, invoices etc. so that when the time to file the claim comes, you are fully prepared. This way you can file your claim on your health insurance plan for a family in one go, and most likely get it approved without any delays.
- Remember that the more supporting documents you can produce, the higher would be the chances of the claim being approved under the health insurance plans for family, and that too quickly. So, when you or any of your family members are undergoing treatment, keep all the invoices, prescriptions, diagnostic tests, blood test reports, discharge summary and all other documents neatly stored in a folder along with the family health plan documents. This way, when you file your claim with all the supporting documents, it is highly likely that your claim would be settled in one go without any repetitive list of requirements.
- You must ensure that you pay the renewal premium for your health policy for family on time. Though we offer a grace period of 30 days up till which the delay in premium payment is condoned. But do not take chances as once the policy lapses, all your continuity benefits are cancelled, and the accumulated bonus is forfeited.
- If at any point of time there is any alteration in the subject matter of the insurance in your health insurance plan for the family, you are advised to intimate us as soon as possible so that you and your family members can continue to enjoy the benefits of the policy.
- While availing any of our health insurance plans for a family, you should take due note of certain factors that are mentioned below, so that you do not face any issues later on: -
- Pre-existing conditions that are included along with the waiting period
- Reimbursement limits under various subheads
- Diseases that are not covered under your family health insurance
- Inclusions and Exclusions
- Conditions for reinstatement of basic sum insured
- Co-payment clause
- Pre-hospitalization and Post Hospitalization expenses covered under your mediclaim policy for family
Educate yourself regarding a family health plan thoroughly. This way, when you need to file a claim, you will be better prepared to make sure that your claim is approved.
- If this is your first health insurance plan for the family, then you and other family members proposed to be covered under the family mediclaim policy will be required to undergo medical tests. Do not skip these tests at all. Also, you should be aware as to who will bear the cost of these tests.
- You have to pay the premium only after your proposal for mediclaim policy for the family has been accepted. If due to any reasons your proposal for the health mediclaim policy is rejected, any amount which you have paid towards premium shall be refunded after deducting costs for the tests.
- In case of an unfortunate incident, or an opportune time when a new member enters the family, then the information must be conveyed to our customer care center at the earliest so that the necessary changes can be made in the family mediclaim policy.
- We request you to not conceal or misrepresent any material facts related to yours or family members medical conditions. If you conceal any material information, it may lead to forfeiture of premium paid for family’s health policy and leads to cancellation of the policy.
- Do not delay your premium payment for family insurance plan’s Policy renewal by even one day. Otherwise your family’s health mediclaim policy may be redundant.
- Fraudulent claims or falsification of information will lead to cancellation of your health insurance plan for family. So, never attempt to try and defraud the company.
- Never make small and frequent claims against your mediclaim policy for family, this will not only lead to increase in your premiums but eventually to cancellation of the health insurance policy for the family.
- Do not file the claim under your health policy for family unless you have all the details and documents ready. Incomplete files will be rejected if the required information is not furnished urgently. If there is any delay from the hospital in handing over the documents, please let us know in advance so that we can place your file on hold.
- If you are looking for comprehensive health insurance plans for a family, do not delay your decision indefinitely. You should look at all the available options, compare them and then take a decision. The more you delay, the more is the probability of your family not being covered for medical exigencies.
Just remember these points that we have mentioned above, and you can be assured that all your genuine claims related to your family health insurance will be duly honored by us at IFFCO Tokio.
These are the general terms and conditions governing our health insurance plans for a family. You should go through them carefully to understand the implications for each of them.
- Reasonable Precaution:It is expected that you and the insured family members take the necessary precautions to prevent injury and ailments to minimize the claims under health insurance plans for a family.
- Notice:It is expected that you or any of the insured family members shall address every communication in written to our office or customer service center as mentioned in your policy document or our website.
- Free Lookup Period: Every new family health plan for family medical insurance comes with a free-lookup period of 15 days. During this period of 15 days, you are free to cancel the policy for any issues that you may have with the terms and conditions. While filing the request for cancellation of the health insurance policy for family, you must specify the reason for doing so.
This option is not applicable for renewal policies. You will be entitled to refund of premium on the following basis: -
- If the risk cover has not commenced, expenses incurred by us on account of medical examination and stamp duty charges will be deducted from the refund amount.
- If the risk cover has commenced, then a deduction for expenses incurred by us on account of medical examination, stamp duty charges and proportionate premium for mediclaim policy for a family shall be made before processing the refund
- Change in Circumstances:It is expected that if there are any material changes in the information furnished by you during subscription of the policy which may now affect the insurance coverage of health insurance plan for the family, you or your authorized representative shall convey the same to us at the earliest.
- Payment of Premium:Any premium that is payable shall be paid before the commencement of risk coverage under mediclaim policy for the family. The receipt of payment of premium shall be valid only if signed by our authorized representative on the company stationary. Similarly, no waiver of any conditions, terms, endorsements, and provisions of this mediclaim policy for a family shall be valid unless they are in written and duly signed by our authorized representative.
- Claim Procedure and Requirements:
- A claim must be intimated to usassoon as possible or within a maximum of 24 hours after hospitalization and commencement of treatment, and at least 12 hours before the scheduled discharge of the insured family member from the hospital or nursing home, wherever the treatment has been administered under the mediclaim policy for the family.
- A duly filledclaim form along with the written application regarding the claim being made under the mediclaim policy for a family shall be submitted to us within 30 days of the discharge from the hospital or completion of the treatment, whichever comeslater. The claim form and application shall be accompanied by all the supporting documents and reports.
In cases where you might have suffered extreme hardships, the above limitation on a family health plains extended to 90 days, another reason why customers rate IFFCO Tokio Family Health Protector as the best health plan for family. Make sure you update your insurer about the circumstances you or your insured family members were stuck in, that none of you could file the claim within the prescribed limit of 30 days.
If you or any of your representatives or family members do not file the claim form along with all the necessary supporting documents within the time frame of 90 days, then your claim shall be rejected and inadmissible.
- After you submit the duly completed claim form along with the supporting documents, we shall raise further queries or seek clarifications regarding the claim documents submitted by you. You are expected to respond satisfactorily to all the queries and produce all the requested documents within 15 days of any such query being raised. You must submit all original certificates, prescriptions,invoices, receipts, evidence and information from the attending medical practitioner, hospital authority, pharmacist, laboratory in charge as may be required by us in the prescribed format. Our representative will have the authority to obtain information or examine and collect information pertaining to the injury or ailment which required medical treatment after hospitalization. They are authorized to conduct their investigation as they may deem perfect as per the family health plan you have purchased.
- All benefits and entitlements under the health insurance plan for family shall be forfeited if you or the insured family members do not comply with the provisions of the policy document under this policy or in any of the policy documents. The policy shall also be discontinued, and the claim rejected if you do not co-operate with the company representative and furnish the information as required.
- Intimation about discharge from Hospital/Nursing Home: In order to ensure that the discharge formalities under the mediclaim policy for a family are completed smoothly, it is expected that you let the company, as well as the hospital authorities, know about the discharge time. Ideally, the discharge time should be conveyed at least 4 hours before the intended discharge time. Any expenses arising out of the delay shall be your responsibility.
- Fraud: All benefits under the mediclaim policy for a family shall be forfeited if it is discovered that the claim being made is fraudulent or is supported by fraudulent documents. You may or may not be aware of any fraud, but it is expected that you should have acted responsibly to avoid such an instance.
- Limit of Indemnity: Our liability under the mediclaim policy for a family shall not exceed the total sum insured opted for by you under the indemnity clause. But this condition shall be waived off in case of indemnification related to critical illness if the same had been opted by you by paying the additional premium.
- Electronic Transaction:
You and/or insured person(s) agree(s) to follow and fulfill all such terms and conditions as may be prescribed from our side time to time.You and/or insured person(s) hereby approve(s) and authorize(s) that all communications achieved by or through facilities for conducting remote dealings including the call centers, internet, electronic data interchange, tele-service operations (whether voice, video, data or combination thereof),world wide web or through automated machines, computer networks, or through other means of telecommunication recognized by or on behalf of us for and in respect of the policy or its terms or our other products and services, shall constitute lawfully obligatory and binding dealings when done inobservance to and in compliance with our terms and conditions for such facilities, as may be prescribed from time to time. However, such terms and conditions shall not supersede provisions of any law(s) or legal rules including provisions of IRDA guidelines for fortification of mediclaim policy for family.
- No Constructive Notice:Any information or evidence of any situation(s) or condition related with you or the insured family member(s), in control of any of our representative,shall not be considered as a notice or bind us or prejudicial impact us nonetheless ensuing receiving of the premium on your family health plan.
- Multiple Policies: If you or any of the insured family members take out an additional mediclaim policy for the family to indemnify against the cost of the treatment during the validity of existing family health insurance policy, we shall not be applying the contribution clause. But you or the insured family member has the right to demand a settlement of your claim in terms of either of your mediclaim policy for the family.
- In all such instances, our company will be obligated to satisfy your claim without asserting on the contribution clause, but it is given that the said claim is well within the limits of the sum insured and satisfies the terms and conditions of the mediclaim policy for a family chosen by you.
- If the claim amount is in excess of the sum insured under a single mediclaim policy for family, after accounting for the co-pay payments and other deductibles, then you or the insured family member must decide through which insurer you want the claim to be settled. Under such circumstances, contribution clause shall be invoked by the insurer to settle the claim.
- Excluding benefit policies, in situations where you or the insured family member have mediclaim policy for the family from more than one insurer, to indemnify against the same risk, you and the insured family member shall only be reimbursed the hospitalization costs in agreement with the terms and circumstances described in the policy.
- You shall agree to do everything necessary for the enforcement of criminal or civil remedies and rights or obtaining indemnity or relief from other parties to which the company shall be entitled or subrogated on payment of any claim under the mediclaim policy for family, post indemnification;
- You or the insured family members shall do anything that may prejudice our Subrogation rights;
- You agree that any recoveries made from the subrogation shall firstly be used to indemnify any money paid out by our company or by somebody on behalf of our company against the claim or expenses done on the recovery of such amount.
We will not refuse renewal of the mediclaim for the family until and unless it is justified on the grounds of moral hazard, fraud, misinterpretation or non-cooperation by the insured. This is provided that you apply for the renewal of the family health plan and pay the required premium for the mediclaim for the family before the expiry of the said policy.
The health insurance plans for the family must be renewed within the expiry date or within the maximum of 30 days of the expiry date. Beyond this, the continuity benefits, like pre-existing disease exclusion, cumulative bonus earned, 30 days waiting period and first-year disease exclusions, will not be granted. Any health insurance plans for family purchased after this will be treated as a fresh cover, and we will not be liable to pay any claims occurring within the first 30 days of the renewal date of the mediclaim for the family.
The portability of family health plan is governed by the Health Insurance Regulation, 2013, dated 16th February 2013.
Following are the rights and obligations of the insurer and the insured:
- A policyholder for family medical insurance who is willing to port his mediclaim for the family to another insurance company must apply to such insurance company and request to port the family medical insurance policy and all the related members, if any, at least 45 days before the date of premium renewal of the existing mediclaim for the family.
- In case the policyholder for family health insurance does not approach the insurance company for portability at least 45 days before the date of premium renewal, the insurer may not be able to offer portability for a family medical insurance policy.
- A family medical insurance policyholder can only opt for portability in the way that is suggested in (a) and not otherwise.
- A family medical insurance policyholder may be able to port the mediclaim for the family even if he applies after the minimum 45 days clause, only if the insurer is willing to consider it.
- In case the outcome of acceptance of portability is still pending from the new insurer, in that case,
- On the request of the family medical insurance’s policyholder, the existing family health plan must be extended for a short period of atleast one month on a pro-rate premium.
- The existing family medical insurance policy shall not be cancelled until the confirmed family health insurance policy from the new insurer is received, or the insured requests it.
- The new insurer shall match the date of commencement of family medical insurance policy and the date of expiry of the expiry of the short period, whichever is applicable.
- If the insured decides to continue the family medical insurance policy with the existing insurer, he/she should be allowed the same, without any new conditions and at the regular premium.
- Your mediclaim for the family policy may be cancelled by us on the grounds of misrepresentation, hazard, non-cooperation and fraud, by sending a 30-day notice by registered post to your last known address. In such a case, you can claim a pro-rata refund of premium paid against the family insurance plans for the unexpired period for the insured person(s) for whom no claim has taken place. This is valid in all cases except for illegality and fraud.
- You can cancel the mediclaim policy for the family by sending a written notice through registered post. We will then refund the premium as per the guidelines
- Notice of Change:
We will not be entitled to take effect any notice of charge, assignment, trust or lien relating to the mediclaim policy for the family. The receipt from the insured person acts as an effective discharge to us.
If any dispute or difference arises in terms of the quantum to be paid under a health insurance plan for family, such a dispute, independent of all other questions, shall be referred to a sole arbitrator that will be appointed by the parties. If the parties are not able to decide upon a single arbitrator within the 30 days of any party invoking the arbitration, such a case will be referred to a panel of three arbitrators. In this panel, one arbitrator each will be appointed by the party and the third one will be agreed upon by these 2 arbitrators. Such arbitration will be conducted in accordance with and under The Arbitration and Conciliation Act, 1996. During this time, the insured has the right to communicate directly with the leading or issuing office of the family health plan.
- Disclaimer Clause:
If we disclaim our liability for any claim against a policy covering Mediclaim insurance for family, and such a claim is not contested or made subject matter in the court of law within the next 12 months from the date of disclaimer, then the claim shall be considered as to have been abandoned and not recoverable under this policy.
- Withdrawal & Alteration of Policy Conditions:
The terms and conditions of the mediclaim policy for the family may undergo changes as prescribed by IRDA Health Regulation. In such a case, you shall be duly notified at least three months prior to the date of revision by registered post to your last known address. The timelines for revision and the related rates will be as per IRDA Health Regulation.
It may also happen that some family insurance plans be withdrawn with the approval of the Authority. In such a case, the information of withdrawal of family health plan will be provided to you in advance with all the other options that you may opt. If we do not receive any intimation from you for withdrawal, the existing product will be withdrawn on the renewal date, and you will have to opt for a new mediclaim policy for family, subject to portability conditions.
- Policy Disputes:
The parties of the mediclaim policy for family expressly agree that the laws of the Republic of India shall govern the interpretation, validity, construction and effect of the policy. Any dispute arising out of the interpretation of the terms and conditions, limitations and/or exclusions mentioned here, is understood and agreed by the insured and the insurer. All the disputed matters shall be dealt according to the law and practice of the law of court with the Indian Territory.
- Protection of Policy Holder’s Interest:
If an insured makes a claim and the same is found admissible under the family health plan, we shall make the offer of settlement or rejection with the 30 days of receipt of all the required documents and assessments. Once the claim against mediclaim policy for a family is approved, the proceeds shall be paid within 7 days of your acceptance of the offer. In case of a delay, we shall be liable to pay interest at the rate of 2.0% above the bank rate prevalent at the beginning of the financial year in which the claim against family health plan is received by us.
- All claims against health insurance plans for a family shall be payable in the Indian currency,and the geographical scope of this policy will be India
- The Medical and Personal Emergency Assistance Services are not available on a reimbursement basis for mediclaim policy for the family.
- If any Emergency Medical or Personal Assistance Services are extended to you, during the period of health insurance plans for a family, by Emergency Assistance Service Provider, it does not imply that your claim against hospitalization expenses is admissible under the mediclaim policy for the family.
- Any grievances and complaints regarding the mediclaim policy for the family can be registered at our website www.iffcotokio.co.in as well as by visiting our branches. You can contact the grievances officer at our corporate office if your grievances have not been resolved at the branch level.
**To understand exactly about the policy coverage, exclusions etc, please read the Policy Wording carefully.**