Claim Procedure for IFFCO Tokio Family Health Protector 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.

General Guidelines

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 the rejection of a claim.

In case you have not received your Member ID cards, kindly choose any of the below-mentioned procedures: -

Call our customer service call center and quote your policy ID along with the details of the member for whom the card has not been received. We will mail the cards to your registered address immediately.

You can log into your account on our customer portal and print the required E-card immediately.

Excluded/Blacklisted Hospitals and Doctors

From time to time, we revise the list of excluded/blacklisted Hospitals and Doctors for our health insurance plans for the family. You are advised to carefully read the list, or contact our customer care department before deciding to get admitted for a treatment or consultation. We will not provide any cashless facility nor reimburse any claims related to a medical procedure performed at any such hospital, or by any such medical practitioner on any of the insured family members otherwise covered under the policy.

Timely Information

To ensure that the hospitalization is hassle-free, you are requested to intimate us at least 48 hours before the proposed hospitalization, and within 24 hours after admission in case of emergencies. This would ensure timely authorization of cashless facilities, and you can simply concentrate on the treatment of the admitted family member.

Check your Documents

Before going to the hospital, make sure that all your documents are in place to avoid any last-minute panic. This also means reading through the terms and conditions stated in health insurance plans for the family. You should ensure that you carry The Membership ID card, a government-approved ID (such as AADHAAR) and a copy of the policy for the insured person being hospitalized. Carry a photocopy of all these documents along as you shall be asked by the hospital authorities for the same when required, and there is no point running around for it later.

Always submit complete documents

Make sure that you always keep your contact details up to date in our records for your health insurance plan for the family, so that all communication regarding the policy is received smoothly. Always make sure to maintain the complete medical record and keep all documents related to the hospitalization handy.

This way when you submit claims against your health insurance policy for family, they will be approved much quicker without any need for clarifications.

Choose the Hospital Judiciously

We would like to advise you to carefully choose the hospital where you or any of the family members have decided to undergo the required medical procedure carefully. Just because a hospital is expensive does not necessarily mean it is the best option for your family. Also, make sure that the hospital is part of the network of hospitals covered under your policy. If you have any doubts you can contact our customer care department for clarification. Utilize your health plan for the family in the best possible manner.

Negotiate

When it comes to family health insurance, negotiate well with the hospital authorities and doctors to get the best deal or package for the treatment. This way, you will save more money on the sum insured, which might come in handy for other family members later on.

Choose the Room Carefully

Refer to your policy documents to understand the limit of room rent allowable under your policy. If you have any doubts, you can contact the customer care department as well. Most of the policies have a room rent ceiling, and if you choose a room beyond your permissible limit, it can become too expensive for you. This is because, with an upgrade in the room selection, all other charges such as nursing charges, doctor fees, and diagnostic charges also increase, and you might have to pay the difference from your own pocket.

Do not try to be a Doctor yourself

With the plethora of information available on the internet, some of us might think of ourselves at the same level as medical experts. But believe us, it is best to leave the job to the doctors, as they have the requisite qualifications and experience to handle even the most complex scenarios. Remember to follow the instructions of the doctor, and make sure to do follow-up visits even if you feel that the illness has been cured.

Common Ailments not covered

There are some ailments or procedures that might not be covered under your mediclaim policy for family. So, in order to avoid any aggravations, later on, we would advise you to check out our website or get in touch with our customer care department for detailed information regarding the availability of coverage for the particular ailment.

These are a few basic suggestions that you should definitely consider, to make sure that your experience with the settlement of the insurance claim is a smooth one.

Cashless Claims

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 the family, but only in the most fair and transparent manner.