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This Policy provides a health protection cover for you and your family. Here is something to look forward to when buying this policy from IFFCO Tokio:
Coverage is provided for Ambulance charges.
Coverage for Critical Illness & Emergency Assistance Services is provided.
You can also claim pre and post-hospitalization expenses.
121 Surgical Procedures are covered under the policy. 
Vaccination and health check-up charges are covered.
Coverage for alternate treatments like Ayurveda, Homeopathy, Unani, Sidha, etc. 
Policy covers hospitalization expense including the Room Rent, Nursing expenses, Doctor’s fees, medicine expenses, Medical tests fees, etc.
The Policy offers a health protection cover for you and your family for any illness, disease or injury related contingencies like hospitalization, medical expenses, surgical expenses, organ transplantation etc.
With the comforts of modern day lives come the issues related to it. The fast-paced and non-stop lifestyle that we lead these days leaves us very little time to take care of our health and well-being. This leaves us vulnerable to various forms of severe medical conditions which can have a devastating effect on our life.
But thanks to the rapid progress being made by medical science, new discoveries are being made regarding treatment of various ailments which were previously untreatable. But there is another aspect to this story. In current times of high medicare inflation rates, good quality Medicare services are becoming very expensive.
If you meet any accident or fall victim to any critical illness, you and your family members would want only the best possible treatment for you. But due to the high cost of quality medical care, chances are that you will end up either wiping out all your savings or mortgaging your assets. This is a highly unwelcome situation which can affect the future of your family members and you. With hospitalization and medical expenses becoming dearer with each passing year, failure to subscribe to a comprehensive cashless Mediclaim policy is like inviting a major financial disaster. This would force you to either opt for poorer health care option due to financial constraints or running into debts due to exorbitant medical bills.
Mediclaim policy is an investment you make to keep yourself covered against medical expenses. The sole objective of having the best Mediclaim policy is to take care of any medical expenses that you incur during the term of your insurance policy. One of the biggest follies that people make in the modern times is not availing an appropriate Mediclaim policy, to handle the expenses related to the treatment of an ailment.
Due to our sedentary lifestyles and the 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 cashless Mediclaim policy for family members and self.
Buying Mediclaim policy online from IFFCO Tokio has proved to be life-saving to many. Not only do our plans offer coverage for individuals and their families but also take care of pre-hospitalization and post-hospitalization expenses. We make sure that money is the last thing to come in way of your or your family’s health and wellness.
To help you stay prepared for even the unexpected medical scenarios, we at IFFCO Tokio have introduced some of the best cashless Mediclaim policies for family and individuals, offering comprehensive coverage against expenses related to medical exigencies. Let’s have a look at some of the significant benefits that you will be entitled to, once you buy Mediclaim policy online or offline from IFFCO Tokio: -
For example, you can buy the best mediclaim policy for parents to meet their regular medical expenses without affecting the limit for others. This way if multiple family members fall ill during a policy period or meet an accident then you need not worry about exhausting the floater limit, as every family member has his/her individual cover.
For example, when you buy a best Mediclaim policy for parents, you can choose to enhance the coverage amount every year according to their age, whereas when you buy a mediclaim policy for children, you can defer enhancing the coverage limit for some period.
You and every other individual Mediclaim policy holder in your family can choose a specific critical illness and enjoy the benefits of double policy coverage amount by paying some additional cashless Mediclaim policy premium. Thus, by paying a small amount of money you rest assured of meeting out the expenses of life-threatening critical illness without wiping out all your savings.
We offer some of the best mediclaim policy plans from which you can select the one most suitable for you and each of your family member individually. We understand that “one size fits all” approach cannot be taken in regards to the best mediclaim policy for different family members with varied requirements, which is generally the case under the cashless mediclaim policy for the family. The sum insured for our best mediclaim policy plans range from Rs. 50,000/- to up to Rs. 20,00,000/-. You can easily buy online Mediclaim policy from IFFCO Tokio website
We have empanelled over 4600+ hospitals and are in the process of adding more, across the length and breadth of India, which makes it easier for you and other individual policyholders in your family to receive proper medical care for your ailments through our best Mediclaim policy. No matter which city you stay in, there is a hospital nearby which is on our panel and would be happy to serve you and other policyholders in your family as and when required with the benefits of the bestmediclaim policy.
Day Care surgeries: We understand that domiciliary hospitalization comes with a lot of hassles even if all the expenses are covered under your Mediclaim policy. In order to save you from the unnecessary hassles of hospitalization where unnecessary, our Mediclaim covers more than 121 day care procedures. Thus, you or any other individual policyholder in your family can avail treatment be discharged on the same day and recuperate in the comfort of your home. This helps significantly in reducing the expenses related to overnight stays in a hospital with the help of best Mediclaim policy for individual family members.
Buy Online: We offer some of the cheapest Mediclaim policy plans when you choose to buy online Mediclaim policy. Our website and mobile site have a vast array of cashless Mediclaim policy plans. You can log onto our website, compare the various Mediclaim plans available and then complete the payment procedure online. This way when you buy online Mediclaim policy, your coverage starts right from the minute you have paid the premium.
It is a common misconception amongst young people (below 40 years) that they are immune to all sorts of medical problems and no severe ailment can ever touch them. To be frank, no one ever thinks of falling ill. However, that’s not how life goes. Medical issues are a modern day reality. You can fight them but you cannot escape them altogether.
And if you think about it, falling ill is not the worst part, as you can always check yourself into to one of the hospital across your city and get yourself treated. It is the inability to afford proper medical aid; due to lack of finances or Mediclaim coverage that is the actual issue. As hospitalization expenses have been following an upward trend since last few years, seeking quality medical care without cashless Mediclaim could literally burn a hole in your pocket.
Taking all of this into consideration, it is ideal to buy a health insurance plan at a young age.
As a responsible Insurance Service Provider, we at IFFCO Tokio offer the best Mediclaim policy as it would help you tide over tough times with ease. Here we are listing out various advantages that you can enjoy when you avail a Mediclaim cover at a young age:
When you subscribe to a mediclaim at a young age, your chances of suffering from those ailments are very less. Therefore you can very easily comply with the waiting period requirements. On the contrary, if you were to avail, let’s suppose a new mediclaim policy for senior citizens at an older age, waiting for a few years for particular ailments to get covered can even be life-threatening.
As a result, if you opt for a Mediclaim policy once you are in your late forties, you might already have a few pre-existing medical conditions, which if excluded from the policy coverage, would defeat the whole purpose of it.
Sooner you realise the fact that health costs are only going to increase with time, better it is for you. Get a cashless Mediclaim policy right away to keep yourself financially covered against planned and unforeseen medical expenses.
Even though buying a Mediclaim policy at a young age fetches you extensive benefits, remember that it is never too late to make a start.
If due to any reason you were not able to buy online Mediclaim policy for yourself when you were young, or you are looking for a bestMediclaim policy for parents, then it is absolutely fine.
As a responsible Insurance Service Provider, IFFCO Tokio would like to suggest that you should opt for comprehensive Mediclaim policy for senior citizens at earliest, as it would help you tide over tough times with ease. Here we are listing out various advantages that you enjoy when you avail a Mediclaim policy for senior citizens: -
No matter how many precautions you take, certain age-related conditions are bound to catch up with you as you age, which means a significant rise in medicare expenses. Having a Mediclaim policy for senior citizens would help you take care of hospitalization expenses, unexpected or expected.
Many insurance companies offer this option, which means that you can get the best possible preventive care as well as post-discharge care which is a must in old age. This coverage gives you the confidence to meet out any unexpected medical expenses also.
Having a comprehensive Mediclaim for senior citizens would help you maximize your limited income and savings as you would not be spending exorbitantly, out of your own pocket.
No matter what your age is, we have a suitable Mediclaim policy of senior citizens. Leave all your hospitalization related worries to us and just focus on maximizing your life.
Good health is one of the most precious gifts anyone can have. We all try to lead a healthy lifestyle and stay away from all types of illness. But not everything is under our control; a sudden bout of illness can leave you or any of your family members bed-ridden while eating into your hard-earned savings. This is where a selection of the best Mediclaim policy becomes imperative.
There is a famous saying regarding Mediclaim Insurance “You must buy a Mediclaim policy when you feel that you do not need it, because most probably you may not get it when you need it.”
To help you meet any expected or unexpected hospitalization and medical expenses, IFFCO Tokio has introduced a comprehensive cashless Mediclaim policy with amazing benefits to make sure that all your medical exigencies are taken care of.
Take a look at some of the features of our Mediclaim policy that make buying a Mediclaim cover from IFFCO Tokio a sensible decision: -
Hospitalization Expenses: - Our cashless Mediclaim policy, ensures that you do not worry about the monetary aspect of the treatment, when you are admitted to a hospital for treatment of any ailment. All hospitalization expenses including room charges, doctor fees, nursing expenses, diagnostic tests etc. are covered under our individual Mediclaim policy.
Therefore, under our best cashless Mediclaim policy for family memebers and individuals we reimburse expenses related to alternative treatments such as Ayurveda, Unani, Homeopathy and Sidha.
Sometimes, our parents do not want allopathic treatments and want alternate treatments for their chronic ailments; as such having the coverage of our Mediclaim policy for senior citizens will save you from spending any money on the treatment from your pocket.
Our best cashless Mediclaim policy for family also takes care of vaccination expenses for both kids and adults to help boost immunity against contagious diseases.
Life Long Renewability: - Our Mediclaim policy comes with lifelong renewal option, which extended much beyond the threshold of 60years, making it an ideal Mediclaim policy for senior citizens too. This helps us make sure that you or your parents need not worry about the exorbitant hospitalization expenses once you are covered under our best cashless Mediclaim policy for family and individuals.
Room, Boarding and Nursing charges are reimbursed as per our existing policy, up to a maximum of 20% of the total sum insured, according to which –
For Normal Room: -
For Intensive Care Unit/Therapeutic Expenses: -
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 any Mediclaim policy holder, we make sure that all expenses related to the treatment are covered as usual.
The intricacies of modern lifestyle have made our bodies susceptible to various critical ailments. Although medical science has made rapid progress in last few years and now there is treatment available for most of the ailments that were earlier untreatable, the cost of such treatments is significantly high. In the absence of an adequate Mediclaim cover, the cost of treatment could actually wipe out your entire savings.
Now you might think that you have a healthy lifestyle and no critical illness could ever affect you, however chances are that this might be far off from the actual truth.
Imagine how the lack of a Mediclaim policy could rattle your easy-going life and strain your finances, in the event of a critical illness. To help you stay prepared for any such eventuality, we offer you the opportunity to opt for a Critical Illness Cover on payment of a little extra amount.
Following are the medical conditions which have been identified as critical ailments, under our individual health protector plan: -
You never know when a tragedy might befall you, which is why you should always be prepared for any such eventuality.
Additional Covers
Having gained years of experience in this field, we are perfectly aware that reimbursement for just hospitalization expenses is not sufficient. Many more variables are involved which if not taken into consideration, can mess up your entire estimate. In order to help you meet all your medical expenses, we have made it a point to include them in the coverage of our Mediclaim policy.
Similarly, recuperating from a medical procedure after discharge from the hospital also often involves expenditure including visits to the doctor, occupational therapy and medications. To save you from all these, we cover the Nursing and Medical expenses during the post-hospitalization period up to 60 days, provided these expenses are related to the ailment for which treatment was received in the hospital.
Not only our Mediclaim policy takes care of your hospitalization expenses, to ease your burden, but you are also entitled to an additional daily allowance of 0.20% of the sum insured value 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 policy reimburses the cost incurred for medical check-up(s) 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.
Other than the 121 listed day care surgeries, if you or any other individual policyholder in your family has to stay in the hospital for more than 12 hours but less than 24 hours, you will be reimbursed all hospitalisation related expenses. But the room rent, in that case, will be a capped at a maximum of 50% of the room rent per day. But please make sure that you get the pre-authorization for the treatment and the line of treatment undertaken by your doctors has been agreed upon by our panel of specialists.
In this case, no pre-hospitalisation expenses shall be allowable and post hospitalisation expenses shall be limited to 15 days from discharge.
After a block period of two consecutive claim-free policies (365 days + 365 days or 366 days in case of a leap year), you or another cashless mediclaim policy holder in your family are entitled to a maximum of 10% of the premium paid (excluding taxes). It must be noted that this benefit is available only when you renew the policies on time without any break.
This feature comes in very handy when you need to undergo a medical procedure or bear hospitalization expenses, as you get additional coverage over and above the basic sum insured in your Mediclaim. This will help you meet out various expenses without affecting your savings in any way. This feature works in the following way: -
For each claim free year, 5% of the basic sum insured at each renewal will be added as a bonus to your cumulative bonus. This 5% will continue being 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, 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 you must make sure that the policy is renewed on time or utmost within thirty days of the expiry date. Otherwise, your cumulative bonus may be forfeited.
Emergency Assistance Services: - In modern times, travelling plays a big part of our lives. Whether you are living with your family or living alone, you might have to travel for work related purpose or family requirements and also need to stay away from home for extended durations. But what happens if you are taken seriously ill there and are not in a position to travel back home? You will have to undergo hospitalization to receive proper treatment for your ailment, but who will take care of all the expenses for you? Does that mean you must wipe out your hard earned savings? What can you do in such a situation because your policy does not offer you the benefit of seeking treatment away from your city? This is where our cashless Mediclaim policy comes to your rescue.
With IFFCO Tokio’s comprehensive Mediclaim policy you need not worry about the hospitalisation and Medicare expenses even if you are travelling away from home because we care for your health and do not want you to put yourself at unnecessary risk just to receive medical attention. That is why we offer you a huge range of emergency medical services, at no additional cost when you are more than 150 km away from your registered home address, within India for a periodof less than 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 the doubt.
IFFCO Tokio is the first company in India to introduce this coverage with the following benefits, that too without any sub-limit: -
Emergency Medical Evaluation: - You will have access to fully functional operations centre with multilingual staff working 24x7, 365 days a year to deal with emergency situations. Qualified medical personnel are there for consultation and evaluation of your situation and then refer the case to suitable doctors in the vicinity.
Emergency Medical Evacuation: - If according to the attending physicians or consultants, there is a medical emergency and no other suitable medical facility is nearby for your treatment, then our representative will arrange for you emergency evacuation to the nearest medical centre with required facilities, through appropriate means of transport.
Medical Repatriation: - If necessitated by your medical condition according to our physicians and consultants, we will arrange to repatriate you to the registered address as per the policy schedule through suitable means of transportation as suggested by our doctors for travelling. If it is not possible to repatriate using normal air carrier, we shall arrange for the repatriation through air ambulance along with medical supervision.
Emergency Message Transmission: - Our representative will act as the point of contact between your family members if you are unable to do so due to your medical condition. We will arrange for sending the message to and fro, as and when required.
Transportation to join the patient: - We will provide a nominated family member or friend with a round-trip economy class fair through a common carrier to the airport nearest to the hospital. This facility will be available if you had been travelling alone and had been hospitalized for over one week continuously. If required, we shall also arrange for a suitable accommodation for the travelling person. But it should be noted that it would be the responsibility of the travelling friend or family member to arrange for the necessary travel documents and meet the cost of accommodation arranged by us.
Emergency Cash Coordination: - If there is an emergency need for cash and you have arranged for the funds but do not know how to transfer them urgently, then our representative will organize the transfer of cash. It should be noted that arrangement of the funds is your responsibility.
Transportation and Care for minor children: - If due to your serious medical condition, your minor children have been left unattended, our representative shall arrange for shifting the minor children to the house of a nominated friend or family member living in the same city. If required, we shall also arrange for an attendant to accompany the children during transportation.
Return of Mortal Remains: - In an unfortunate scenario of death of any insured person, our representative will pay for all the expenses necessary to return the mortal remains to the registered address. Our representatives will offer all possible assistance necessary for the transportation including obtaining all legal clearances, completing all documentation, obtaining a death certificate and arranging for a casket for safe transit. Once the body reaches the local airport, we shall arrange for transportation of the dead body to the local funeral home or any other destination as per your preference.
Conditions ‘prior to the entitlement to benefits’ under Emergency Assistance Services
But it should be noted that unless agreed upon by us or our representative, no claims for reimbursement shall be entertained regarding any services arranged yourself.
Eligibility and Prerequisites
As you must have understood by now that having a Mediclaim policy is not a luxury but is rather a necessity in the present-day world, and you should avail IFFCO Tokio’s cashless Mediclaim policy for your family members. There are numerous benefits that you get from opting for the coverage of our Mediclaim plan.
But before you opt for an individual cashless Mediclaim policy, you must understand the eligibility criteria and pre-requisites for our best cashless policy carefully so that you can draw maximum benefits offered by the coverage of our policy.
Eligibility
Entry Age: - There is no minimum entry age requirement for subscribing to our Individual Mediclaim policy, and even minor children are eligible to have an independent Mediclaim policy. If you have an existing cashless Mediclaim policy with some other insurance company, even then you or any of your family members with individual policies can opt for IFFCO Tokio’s best Mediclaim policy as per your requirements.
In case you have an existing Mediclaim Policy or Mediclaim policy for senior citizens from any other insurer, and want to switch over to IFFCO-Tokio for the extensive coverage offered, then you can expediently do so. You will enjoy the benefits of continuous coverage without any waiting period or pre-existing condition exclusions.
Once you have understood all the statutory requirements and checked your eligibility for subscribing to a cashless Mediclaim policy for family and individuals, we shall explain to you the process to be followed to buy mediclaim policy from our company.
Where to buy
For the sake of your convenience, we offer multiple options from where you can compare and select the best cashless Mediclaim policy for family or your own hospitalization and Medicare needs. You have the option to buy the policy through both online and offline channels depending on your comfort level. No matter through which channel you have purchased the policy from, the efficiency of the coverage remains the same.
Here we have explained the detailed procedure to buy mediclaim policy online so that you do not face any hassles.
Online Channels
Company Website – You can avail the benefits offered by our online cashless Mediclaim policy through our company website. Here you can find all the details about the various options available to you with regards to the best cashless Mediclaim policy for family and individuals, based on your requirements, in addition to all the details about the policy.
You can choose from among the various riders available along with any additional benefits you require. You can also opt for the critical illness cover to enhance your protection against any of the named critical illness. As there are no middlemen involved, you can rest assured to get the lowest premium prices for our Mediclaim policy on our website.
In case you have any doubts or queries, you can freely contact our customer care representatives for further information. Our customer service executives are well versed with all our policy features and will be definitely able to help you out.
Marketplaces
For the sake of your convenience, we also offer our best cashless Mediclaim policy through various online insurance marketplaces and platforms. There you can compare the benefits offered by our company as compared to others and then take an informed decision. They also provide you with the option of purchasing the Mediclaim Policy for senior citizens online. If you are facing any hassles, just fill out the query form and the customer service executives will guide you through the process.
You can rest assured about the safety of your data as the online aggregators would direct you to our website only, and the whole procedure would be completed on our secure servers. But the premium, in this case, can be slightly higher as compared to buying the cheapest Mediclaim policy directly from our website.
Offline/Retail Channels
We understand that completing the whole procedure to buy Mediclaim policy online is not convenient for everyone. You might be reluctant to fill out your details online or do not have the facility to complete the payment procedure online or do not have the facility to scan and upload the required documents. Whatever may be the reason, you need not fret over it.
We have developed a wide spread network of retail dealers and agents spread throughout the length and breadth of the country, who are more than willing to help you with the whole process in selecting the best cashless Mediclaim Policy and make sure that you only select the cheapest Mediclaim Policy for yourself.
Company Offices
We have our offices present across all key locations in the country, where our staff members are always willing to help you with purchasing a cashless Mediclaim policy for family or individuals. You can simply walk-in to any of our offices, sit down with our customer care executives and discuss your requirements in detail.
They will help you select the best plan based on your requirements and budget. Once you have decided as to which is the best cashless Mediclaim Policy for family and you, they will help you complete all the necessary formalities including filling the form and payment of the premium. All these services are absolutely free of cost, and you need not pay anything to anybody.
Customer Care Department
In case you have any doubts regarding the procedure to buy the cheapest Mediclaim Policy online, our highly knowledgeable customer service executives are always ready to help you out. They are well trained to take care of any possible issues that you may be having while taking a decision to buy the best Mediclaim policy for parents or yourself. You can discuss all your requirements with them in detail, and then they can help you choose the best Mediclaim plan for yourself and also walk you through the online purchase procedure.
If you require we can also arrange for our sales executives to visit your place, sit down with you and explain the benefits of various Mediclaim plans offered by our company. Our executives will also help you fill up the forms, arrange the documents, prepare the premium cheque and select the best plan according to your requirements. Our Sales representatives possess complete knowledge about the various plans available and will help you make an informed purchase decision. You can openly raise any queries that you may have, and we assure you that all your concerns will be addressed to.
Getting a comprehensive Mediclaim policy to meet out your hospitalisation and Medicare expenses is hugely important. You can choose whichever medium you choose to subscribe to the cheapest Mediclaim Policy plans offered by us, online or offline, you will enjoy the same benefits, and all the subsequent procedures will remain same.
Pre-Existing Medical Conditions
This is a very important section that you should handle very carefully. If you are suffering from any existing medical conditions that might have an impact on your health later on, such as hypertension, diabetes etc., you must disclose those pre-existing medical conditions at the time of subscribing to the Mediclaim policy. If you willingly or unwillingly withhold any critical information and that is brought to our notice, later on; it would lead to cancellation of your cashless Mediclaim policy. Once you disclose the pre-existing medical conditions in the form, thereafter you are free from the worries regarding any issues that might come up when you file a claim subsequently.
Selection of Sum Insured
Selection of the sum insured is also a very crucial decision that you must make. Best Mediclaim policy plans from IFFCO Tokio offer extensive coverage against a vast array of medical conditions and critical illness. This helps you meet any unexpected health-related emergencies without affecting your savings. Ideally, you should consider the cost of quality Medicare facilities in your city and your lifestyle to ascertain the amount of Mediclaim you require.
If you go for a coverage amount lower than what is needed, then it would result in unaffordable quality health care, and you will be forced to choose a sub-standard healthcare provider. If you choose a very high amount, depending on your age and medical condition, then you will end up paying a much higher premium than what is necessary and lose out on better investment opportunities.
These situations are called under insurance and over insurance, both of which must be avoided at all costs. Let’s have a brief look at these two phenomenon: -
Under-Insurance: - It is a situation which occurs when you underestimate your insurance requirements and end up with lower than required coverage. This leaves you vulnerable to a lot of uncertainties in life, and the worst part is that you do not realise this, until it’s too late. A lot of reasons could be attributed to the rampant practice of under-insurance in India, such as: -
Whatever be the reason, under insurance is a very serious issue which might come to hurt you back when you are least prepared for it. Just imagine yourself falling victim to a critical illness like cancer which is treatable but needs you to be admitted into one of India’s best hospital, which will cost a huge sum of money. But due to your mis judgement at the time of availing the policy you forgot to select the critical illness cover and now have no other option than to just spend all your savings. This is a very sorry situation but one which is entirely possible. There is a very simple way to avoid facing such serious and embarrassing situations, IFFCO Tokio’s cashless Mediclaim policy with optional critical illness cover which offers you extensive coverage against a vast range of medical ailments by paying an optimum amount of premium.
IFFCO Tokio is committed to saving you from falling victim to this serious oversight of under insurance. That is why our customer care representatives and channel partners are always ready to help you assess your insurance requirements and willing to help you subscribe to the adequate insurance cover as per your requirements. Do not look at Mediclaim insurance as an investment for immediate returns, think of it as an investment to safeguard your future.
Over-Insurance: - Although a very rare phenomenon in India, but it is still prevalent in major urban centres. This is a situation where you end up buying a Mediclaim policy with coverage amount which is much more than what you or the insured family member requires. As a result, you end up paying too much money in premium which could otherwise have been used by you for some other investment opportunity. This can happen when you try to overcompensate for a previous error of judgement, where you opted for inadequate insurance cover and ended up spending some money from your pocket.
There are various reasons that could lead you towards over-insurance, such as: -
As you would have been able to analyse from the above concepts of Under-insurance and Over-insurance, choosing the optimum coverage is very important to be safe against any future medical exigencies.
Therefore, it becomes very important for you to carefully consider the following factors, before opting for the amount insured that you require: -
Age: - Your age has a very important determinant for the extent of coverage you require. If you are young and healthy, you can start from a low sum insured and increase it gradually over the years, whereas if you are in your 40’s, then you need higher sum insured to take care of increasing medical expenses.
Health: - You should also take your current status of your health into consideration while deciding on the coverage you need. If you are young and enjoying excellent health, then you may start with a lower coverage amount as you may not get hospitalized regularly. Whereas if your health condition is not very good and you feel that in the future you may need to undergo certain medical procedures, then you should choose the policy coverage amount accordingly.
Existing Ailments: - If you are suffering from certain ailments that require regular visits to doctors, then you should opt for higher policy coverage to take care of your medical expenses. Sometimes you know that with age, your ailment will worsen further, and your medical expenses are going to increase further. Hence, it would be wise for you to opt for a higher coverage amount and increase it gradually every year so that your premium payments do not increase suddenly.
Surroundings: - The city and environment that you live in also need to be taken into consideration while deciding on the policy coverage that you must have. If you are living in a metropolitan city such as Delhi and Mumbai, then you are likely to face pollution and stress on a regular basis and are more likely to need regular medical attention. Medical facilities in these cities are also relatively expensive, making higher policy coverage a necessity. In comparison, if you live in a smaller town with clean surroundings and low pollution levels, then your medical expense will be little lower as the medical facilities here are relatively cheaper.
Income: - Your income level should also be considered as an important parameter while deciding the extent of Mediclaim coverage required for you. Although good Mediclaim Policy with high coverage is desirable for everyone, affordability is also an important factor, as you must take care of other routine expenditure as well. So carefully analyse your income level and medical requirements and then take a balanced decision which satisfies all your requirements.
Financial planning: - Analyse your future requirements such as the extent of Mediclaim coverage required, investments you need to make and commitments you need to honour carefully and then according to your income level, allocate a proper percentage to each of these heads so that all your future requirements are well taken care of.
As your trusted insurance partners, we at IFFCO Tokio suggest you introspect and analyse carefully before opting for cashless Mediclaim policy.
To ease the process of calculating the premium even for the cheapest Mediclaim policy desired, we have introduced a comprehensive online cashless Mediclaim policy premium calculator for you. Here you just have to fill out the basic details such as: -
Once you enter all these details, you will be able to see the premium amount you must pay for the desired coverage. If you find it satisfactory, you can proceed ahead to the payment page and get yourself insured against any medical emergencies, there and then.
Here is the link to the Cashless Mediclaim policy for individual’s premium calculator page: -
https://www.online.iffcotokio.co.in/itgiwebportal/
In case you are unable to access the online cashless Mediclaim policy premium calculator for any reason, you can contact our customer care at 1-800-103-5499. Our representatives will be more than happy to assist you with the whole process and answer any queries that you may have.
Payment of Premium
After you have taken a decision regarding the amount of coverage, the benefits you require, and the additional riders you want, comes the next most important step, i.e. payment of premium to begin your insurance coverage.
In case you have an existing cashless Mediclaim policy in effect, then please do make sure that you make the premium payment for renewal on time. This way your policy will remain in force protecting you against the medical uncertainties. In case you delay the payment more than 30 days, then your cashless Mediclaim Policy would be null and void, all your accumulated benefits forfeited, 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 with regards to the continuation of your cashless Mediclaim Policy so that you stay protected against any medical emergency.
Hence to help make things convenient for you, we accept payment for your premium through a host of options. You can choose between online as well as offline payment methods to pay your policy premium.
Following are the acceptable payment methods: -
Online Options
If you want to pay your renewal premium, 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 https://www.iffcotokio.co.in/customer-services/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 best cashless Mediclaim policy. With our seamless payment interface, premium payment was never so easy.
Following are the accepted online modes of payment: -
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: -
Drop-Box: - We have conveniently fixed drop-boxes at strategic locations to make it easy for you to make the premium payments without travelling to the branch. You can pay by 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 best cashless Mediclaim policy for family members.
It is our suggestion that you set a reminder to keep your policy renewal dates recorded. It is very important to pay the renewal of the premium prior to expiry dates. The premium should at least be paid within 30 days from the date of policy expiration and not later.
The premium payment of your Mediclaim policy is critical, as the failure to make the payment within the right time will mean policy cancellation for you. This will render the protection that you had under the policy useless, and you will lose all cover. This situation is not desirable as the policy will be cancelled irrespective of whether the previous payments were made or not.
There are a lot of reasons because of which a policy can be cancelled, so it is important to keep note of them. In the following section, we have explained the ways and the process involved.
Cancellation of Policy from your side
If for any reason you should want to cancel your Mediclaim Policy, the following steps will have to be followed:-
If the risk has begun to be covered, then the deductions will be then the expenses that we incur for the examination of medical details and the duty paid for the stamp as well as a proportionate premium for Mediclaim policy. All three of these will be deducted before the refund is made.
We take it as our duty to make sure that your Mediclaim policy is not cancelled for any reason whatsoever. However, there are circumstances and situations under which our company may make the decision to cancel the policy. The major reasons due to which your Mediclaim policy can be cancelled are listed below: -
Moral Hazard or Misrepresentation: - Your cashless Mediclaim Policy may be cancelled by us, on the grounds of moral hazard or misrepresentation from your side. For this process, we will send a 30 (thirty) days’ notice using registered post to your last known address. The only thing that you will be entitled to, in such a case is a pro-rata refund of premium for the unexpired period that remained of the Mediclaim policy. This would be with respect to such insured person(s) for the likes of whom there has been no claim.
Fraud or Non-Disclosure: - In case there has been a fraud or non-disclosure of pertinent facts on your side, we have the right to cancel the Mediclaim policy. This would be done by us sending a 30 (Thirty) day written notice, through registered post to your registered address. There will also not be a refund for the premium which has been paid in such a case.
Non-Cooperation: - Your cashless Mediclaim may also be cancelled in case you do not cooperate with the company. You will be notified in such a case with the help of a 30(Thirty)-day written notice, regarding the issue of your non-cooperation, at your registered address. You will receive a refund for the premium on a pro-rata basis, only if there has been no claim made for the Mediclaim policy.
Reinstatement of Policy
When or if you make a claim under your cashless Mediclaim policy, then there is a slight chance that the amount that was insured will be completely exhausted. There remains a risk in such a situation, as you will be without any further coverage at that moment until the cashless Mediclaim period expires. In such a case, there is a method to be followed for the reinstatement of the basic sum previously insured.
The sum insured of your health policy will be restored to its original amount, after an appropriate premium has been charged for the same. This process will ensure that the full amount of the basic sum that was insured is available to you for the remainder of the period that is due to the policy: -
After reinstatement, the basic sum insured cannot be claimed for expenses incurred due to Domiciliary Hospitalization of Unani, Ayurvedic, Sidha or Homeopathic treatments.
Exclusions
Following are the exclusions in case of which our company will not be able to compensate your claims:
If any of the following conditions are present in you, then at the time of subscribing to the first insurance policy, these medical conditions will be considered as a pre-existing condition and shall be subject to a waiting period of 48 months before being covered under the policy are: -
During the first 30 days of a new health insurance plan, any expense incurred on account of medical issues, costs for hospitalization for any diseases, shall not be covered under the health insurance plan. However, this exclusion shall be overlooked or waived off when and if you have an existing medical policy with some other insurance company in India and have completed at least 12 months with the same insurance.
If the following conditions which are aggravated by hypertension are present in the insured person, at the time of subscribing to the first insurance by the insured person, will be considered as a pre-existing condition and shall be subject to a waiting period of 48 months before being covered: -
The treatments for erectile dysfunctions, sex change operations, unnecessary cosmetic and aesthetic treatment of any sort, are excluded from the insurance.
If the following conditions are present in the insured person, at the time of subscribing to the first insurance with us, these will be considered as a pre-existing condition and will be subject to a compulsory waiting period of 48 months, before being covered under our your medical insurance: -
Your medical expenses will not be covered by the insurance company during the first thirty days after the commencement of your policy, with us. However, this will only stand true for those insurance policies that are new, for older or those insurance policyholders with multiple policies with other insurance companies or for a period of more than 12 months, this waiting period will be waived off, and the claims will be processed as per the usual guidelines.
The list of hospitals listed and covered under our network is revised from time to time, and our list of blacklisted hospitals is updated regularly, which is why you should make it a point keep checking it from time to time. If you, as an insured person, go through some medical treatment at a hospital that is blacklisted or not covered by us, you may not get your medical claim in case of claims and cashless benefit cannot be availed unless the hospital falls under our network. It is recommended that you get in touch with our customer care by calling 1-800-103-5499 to know about your hospital.
If any of the following conditions are present in the insured person, during the time of subscribing to the first Mediclaim Policy with us, it shall be considered as a pre-existing condition and shall be subject to a compulsory waiting period of 48 months before being covered by the family health insurance:
The medical claim for the first insurance plan will not be processed during the initial 30 days. However, you will be entitled to coverage for medical bills, costs, and other expenses once the first 30 days elapse. Other than this, if you have medical insurance with any other Indian company, you can get your claims processed easily. Furthermore, it does not stand true for your renewed insurance policies.
It is very important that you follow the right course of action that needs to be followed to make you should keep in mind the dos and don’ts of Mediclaim. In this section, we have discussed in detail the complete guidelines that policyholders should know, to have a clear idea. It covers cashless Mediclaim as well as post-hospitalization reimbursement claim procedures.
General Guidelines
Following are the guidelines that are common to all the categories irrespective of the time of the claim settlement. These points need to be followed to word to avoid rejection of claim afterwards: -
Check you Documents: - Keep all your necessary documents organised in a separate folder so that you do not forget at the last minute and need to go back to it again. The documents you will need are Membership ID card; a government approved ID (AADHAR or Voter’s ID or driver’s license) and a copy of the Mediclaim policy. Keep the original documents of the first two documents as well as a photocopy, as the hospital might want them to keep a record.
In case you do not have or have not received your Member ID cards yet, kindly choose any of the following procedures for the same: -
Here are some specific guidelines to make the procedure of claim settlement smooth for you, in both cashless claim facility as well as reimbursement policy.
Cashless Claims
At IFFCO-Tokio, we try our best to serve our clients and help them with cashless hospitalization at all times. But there certainly are certain situations in which your cashless claim can get rejected or delayed. Here are some of the: -
There can be many other reasons as to why your cashless claim might get delayed or denied. We, at IFFCO-Tokio, give authenticity the topmost priority.
If your cashless claim has got delayed, we can still help you by reimbursing the amount if your claim is legitimate. The only drawback is that you have to settle the hospital bills out of your own pocket. But once you have submitted all the necessary documents and fulfilled the conditions, and our officials at IFFCO-Tokio find your claim to be valid, you will be reimbursed fully up to the permissible amount as per the terms of your policy.
At IFFCO Tokio, we look forward to serving you the best service in terms of cashless Mediclaim policy. But it will help you better if you follow the rules and guidelines and are a bit more attentive towards the proper maintenance of your policy.
Reimbursement Claims
As mentioned before, you can claim for reimbursement if for some reason your cashless Mediclaim was not settled. If your claim is valid and all the documents are in order and conditions fulfilled, then we will reimburse your hospital bill, up to the right amount. Here are the guidelines you need to follow, to apply for a reimbursement: -
Dos and Don’ts while taking up Insurance
The cost of health care continues to rise every year, which is why it is a must for every person to get themselves a Mediclaim policy and plan for their well-being. A Mediclaim plan will keep you secured during uncertain times and during illnesses and injuries that come unannounced.
There are two kinds of insurance plans that you can choose from, when you come to IFFCO Tokio. We offer you the option of purchasing the plan, where we pay all the expenses for your medical treatment and then there is another variant, called co-insurance or co-pay, wherein you pay some of the expenses incurred during the treatment, and we pay the rest.
*The kind of Mediclaim plan and the other authorizations are predetermined, and are discussed during pre-authorization.
To purchase the right Mediclaim plan settled, there are certain dos and don’ts that you must know.
Do’s
In case of emergencies, you should intimate us, with all the details. The details should be given to our customer care and should be done as early as possible for us to take the necessary steps.
Don’ts
General Conditions
These are some general terms and conditions governing our Mediclaim plans, including the best Mediclaim policy for parents as well as individuals. You should go through them carefully, to understand the implications associated with each of them.
Renewal: Our Company does not refuse or cancel the renewal of policies, unless justified on the grounds of fraud, misrepresentation and other reasons such as non-cooperation of the insured person. However this only holds true, when the insured person applies for renewal of the insurance policy in the stipulated time frame, as mentioned by our company and pays the required premium, before the expiration of the term.
The insurance plan, as per our policies and rules, must be renewed within the 30 days of the expiry of the initial insurance. The continuity of benefits such as the exclusion of pre-existing diseases, bonuses, and other things will not be granted after the expiration of these 30 days. For any other health insurance plan, our company is and will not be liable to pay for any covers or claims within the first 30 days of the renewal date of the insurance policy.
If the insured person decides to continue their insurance plan with IFFCO Tokio, the person can do so. The insured person only needs to intimate us, and we will help them continue the insurance plan with us.
FAQ’s
1. What do you mean by Individual Health Policy?
Individual health policy is a coverage that the insured person purchases on their own to maintain their health and take care of medical care whenever required by the insured person. A medical insurance premium is required to be paid before claiming your cover.
Other than this, every company has a certain number of days, for which the company does not provide a cover for. Our company does not offer you a medical cover for the claims raised in the first 30 days immediately after purchase.
2. What is Health Insurance?
A health insurance policy, including Mediclaim policy for senior citizens, is a binding and enforceable contract between IFFCO Tokio and yourself. We agree to indemnify you for any hospitalization expenses incurred while you are under the coverage of insurance policy and your Mediclaim will be processed as per our rules and regulations when you furnish all the required documents. Our insurance policy covers all hospitalizationand other related costs to your medical treatment.
3. What kinds are Health Insurance policies offered by IFFCO-Tokio?
At IFFCO Tokio, we understand the value of good health and well-being for a person. And this is why we offer you two kinds of health insurance, one for your family and the other for you personally. Any of these insurance plans including Mediclaim Policy for senior citizens can be chosen and used as per your requirement. However, make sure that you comply with all of our needs and requirements from you.
4. Why is a Health Mediclaim Policy important?
Health insurance is somewhat of a necessity in our modern-day world. With all kinds of pollution and dangerous ailments right around the corner, it is a luxury for most people to find a balance between perfect health and their personal life. With Mediclaim policy and various kinds of plans, you get to relax a bit about your health. The correct Mediclaim plan will allow you to find good quality of medical service and care. Although there are some required procedures to be followed when it comes to finding the treatment that will be covered by your insurance plan, you can rest easy with insurance. The absence of such plans and policies including Mediclaim policy for senior citizens will leave all the costs on your shoulders and may risk your savings totally.
With the perfect mediclaim plans you can get a reimbursement for your costs and other medical expenses once you show the evidence for the same.
5. What kinds of Family Health Insurance plans are available?
At IFFCO Tokio, we understand that every person needs a different kind of plan to meet their requirements, for them. We make sure that you find the perfect Mediclaim policy to fit your needs. We offer you two broad kinds of individual health insurance plans. One out of these is where you sign the papers and authorize us to take up the full responsibility of your expenses. However, our reimbursement will not exceed the full sum insured to you, in any case. Apart from this, we offer you the option of co-pay insurance plans as well. Here according to the papers you sign, half of the expenses for your medical care are borne by us and the other half of it is borne by you. The rates and the percentages of such expense sharing are predetermined, and is signed by the insured person during the purchase of the insurance.
Get in touch with our customer care department to learn more.
6. Is cashless facility available under Mediclaim Policy for me?
At IFFCO Tokio, we have tie-ups with 4600+ hospitals, medical institutions, nursing homes and medical care providers to offer cashless treatment to the insured person or persons. Our cashless service, including Mediclaim policy for senior citizens, is available for a vast range of ailments, medical conditions, and injuries. All the hospitals that are covered under our network offer you the benefit of the best cashless Mediclaim policy treatment, where the insured person does not need not to pay any money or pay for any charges as charged by the hospital or the medical institution, all expenses are taken care of directly by us. However, these cashless payments by us are also subject to certain limits; we do not pay for expenses exceeding these limits.
We recommend all our clients to obtain a pre-authorization in the cases where the ailment is not life-threatening, including Mediclaim policy for senior citizens, to make sure that their cashless proceedings for such issues are streamlined and taken care of.
7. What are the tax benefits I get if I opt for health insurance?
Investing your money in health insurance is a good method of saving up on tax. Under the section 80D of the Income Tax Act, you get a deduction upto Rs. 30,000 on premiums paid for Mediclaim policy including Mediclaim policy for senior citizens.
8. What are the factors that affect the Family Health Insurance premium?
The premium for your insurance plan depends on a variety of factors including: -
At IFFCO Tokio, we aim to provide everyone with a chance to take care of your health, which is why we offer you attractive plans including Mediclaim policy for senior citizens along with affordable premium options.
9. What does a Health Insurance policy not cover?
There are certain pre-existing conditions that are not covered by our Mediclaim insurance policies (including Mediclaim policy for senior citizens). You can click here to access the list of exclusions under our policies.
Our plans and policies, including Mediclaim policy for senior citizens, do not cover any kind of optional cosmetic surgeries and treatments. Apart from this, there are certain medical conditions that are only available for cover after a waiting period of 24, 48, etc. months, as the case may be. For more information, please click here or call our customer care centreat1-800-103-5499.
10.Is there any Waiting Period for claims under a health plan?
When you buy an insurance or Mediclaim policy for the first time for yourself or Mediclaim for senior citizens, there is a waiting period of 30 days, starting from the commencement date, after which you can file your first medical claim under the policy. During the initial 30 days, you will not be eligible to file any claims and receive any help from the company. However, once the 30 days are over, you will be able to file claims and get reimbursement.
Policies including Mediclaim for senior citizens that are pending for renewal do not have such waiting period options; the claims are processed as per normal requirements.
11.How is a pre-existing condition defined under health insurance policy?
A pre-existing condition refers to any kind of disease or ailment that the insured person has been suffering from, before having bought an insurance policy at our company. The coverage for such diseases under our Mediclaim policy including Mediclaim for senior citizens is offered to you only after 48 months have elapsed since the commencement of your Mediclaim policy with us. But in case you port your policy including Mediclaim for senior citizens, from some other company and have been covered under the same policy for a while, we will consider the coverage for such pre-existing diseases.
12.If my policy is not renewed in time before the expiry date, will I be denied for renewal?
The time period for renewing your insurance policy including Mediclaim for senior citizens with our company is 30 days from the expiry of the policy. We suggest that you make your payment for renewal of your existing Mediclaim plans with us before the date expires. However, for some reason, if you are unable to do so, we implore you to do the same within 30 days of the expiry.
In case of failure to do so, the renewal of your plan including Mediclaim for senior citizens will fail, and you will not be allowed to renew your Mediclaim insurance.
13.Can I transfer my health insurance plans from one insurance company to another without losing the renewal benefits?
As per the guidelines by IRDA, customers and policyholders of our Mediclaim plans including Mediclaim for senior citizens can easily transfer their insurance plans without losing their bonuses and renewal benefits.
At, IFFCO Tokio we have a large array of Mediclaim plans for everyone (including Mediclaim for senior citizens), out of which you can choose the plan you like.
14.How do I get my insurance claim?
When filing for a claim or cover under the cheapest Mediclaim policy, including Mediclaim for senior citizens, you need to remember that you will need to furnish required documents within 30 days. All kinds of relevant documents, papers, certificates and other prescriptions and papers will be required to be duly filed along with the claim form.
However, in case you are in grave condition, you will be given an extension of 15 days besides the above-mentioned stipulated time. But you will be required to submit all of your documents stating the reasons for failure to submit the details within time under the Mediclaim plan including Mediclaim for senior citizens. If we are satisfied with your answers, we will process your claim.
15.What is the maximum number of claims allowed over a year?
When you buy a Mediclaim Policy from us, you can make claims under the Mediclaim policy as many times as you want. However, you will not be covered for any costs of medical expenses if your basic sum insured has been exhausted.
16.Does your Health Insurance plan for cover everything from accident, surgery, normal hospitalization?
Health plans from IFFCO Tokio for individuals covers everything, from hospitalization, surgeries, injuries and even day-care procedure for some ailments.
However, you must remember that our policy will allow you an insurance claim only if your treatment is done by a registered medical practitioner.
17.What are the advantages of sticking to one Insurance company for a long time?
Sticking to only one Mediclaim plan or policy has many benefits. The biggest benefit of sticking to single insurance is security. If you do not miss out on payments of your premiums you will have back up, for your untimely medical bills. Other than this, for long-running plans, including Mediclaim for senior citizens, there are some exclusive benefits that are available only after 48 months elapse.
Other than this, sticking to a single insurance plan allows you to rack up bonus and enjoy some exclusive benefits. Besides, your coverage will increase over time and also you might get some extra discounts for all Mediclaim policies including Mediclaim for senior citizens.
When you stick to only one Mediclaim plan, including Mediclaim for senior citizens, you may get loyalty discounts, and the claim settlement is faster when you have a long-standing track record with the company, as all the waiting period requirements would be satisfied by then.
18.What is the key to a successful claim for health insurance plans for myself, in case of emergency or planned hospitalization?
When you file for a claim under your cheapest Mediclaim policy, including Mediclaim for senior citizens, you need to understand that you will need to organize all of your medical documents and evidences of your medical history. All of these documents must be submitted to your insurance provider, that’s us. We will examine your documents and then process the claim accordingly.
You should keep all your communication details accessible, and only submit those details that are registered under your name and are still functional. When you submit your claim form, make sure to double check and make sure that all your documents have been duly attached. Any discrepancy here will require you to re-submit the missing documents within the next 15 days.
In case of planned hospitalization under your cheapest Mediclaim policy, including Mediclaim for senior citizens, you should state the same during pre-authorization. This will help you save a lot of time and allow us to help you in every way we can.
19.How can I buy a medical insurance policy from IFFCO Tokio?
You can get yourself a mediclaim policy from our website. Our online procedure to buy insurance is easy and simple. Log on to our website, fill out your basic details, follow the instructions as mentioned on the website, make the premium payment and sit back to enjoy the benefits of our amazing Mediclaim plans for individuals. You can renew plans online as well without any problems.
If you are not okay with the online processes, walk into one of our branches with all the relevant documents and get your insurance today.
20.During the course of my treatment, can I change the hospitals?
You can easily change your hospitals while undergoing treatment under your mediclaim plan. You are entitled to receive the best care there is and if shifting hospitals helps, then by all means, do so. We will cover your expenses. However, you will need to undergo consultation with your doctor before doing so. To avoid unnecessary issues, choose a hospital that is covered under our network and get speedy help.
21.What are the situations under which I may be denied cashless hospitalization under your health insurance plans?
There are certain circumstances, when your claim for cashless hospitalization may be denied under your cheapest Mediclaim Policy. Here is why it may happen, read through the following to understand the working behind the denial of your cashless hospitalization claims:
Even if your claims are denied, do not worry; you can still try to make a claim for the costs incurred on your end and fill out the claim form duly.
Apart from this, settle the bill on your end and get in touch with us within the stipulated time for making a claim, we will help you out. Other than this, when you run into some problems or are hospitalized, you should get in touch with our customer care straight away to receive immediate help.
Glossary
Proposal - “Proposal” is one of the most important documents when a person buys an insurance policy. This document contains all the relevant information about the person who is looking to buy an insurance policy from the company. It may include age, sex, occupation, the person’s medical history, etc.
Policy - Policy or Mediclaim policy means the terms and conditions applicable to the insurance plan so chosen by the person. The policy will contain all the details of terms, inclusions in the policy, the term plan and other relevant details to the insurance policy.
Basic Sum Insured - Basic sum insured in common terms, is the amount of money/coverage the insured person will get under the chosen policy without adding any discounts or bonuses.
Sum insured - The sum insured for a Mediclaim policy for senior citizens or individuals is the maximum sum standing at the end of one year that your insurance company will pay in case you are hospitalized. However, the company will not pay anything above the sum insured.
Extended Sum Insured - The extended sum insured for a health insurance policy means that it is an extension of the existing policy including bonuses and other extensions.
We/Our/Us - It means IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED.
You/Your - It means the person who buys the medical insurance.
Insured Person - The insured person here means the person under whose name the insurance policy has been bought.
Period of Insurance - Period of insurance is the time period of the insurance, meaning from the starting date of the insurance plan to the end date of the same insurance plan.
Hospitalization - This means being admitted into a recognized medical institution or nursing home or hospital for at least a minimum of 24 hours for any kind of treatment, for an ailment that you/insured person suffers from. Some insurance providers even offer you day care services and cashless Mediclaim Policy allowing you to get your treatment without any cash.
Pre-Hospitalization Medical Expenses - This means that all the expenses that have been borne by the insured person before being admitted into a recognized hospital or medical institution; or borne by the insured person’s friends or family, whatever the case may be. This kind of expenditure will be reimbursed by the insurance company given -
Post-Hospitalization Medical Expenses - These expenses cover all the expense that arises right after the medical treatment or hospitalization of the insured person. These expenses are of medical nature and are borne by the insured person after being discharged from the hospital. These expenses will be reimbursed by the insurance company, us, provided:
Medical Practitioner - A medical practitioner or a registered medical practitioner is a person or a doctor, who possesses a valid license, for practising medicine and providing medical services to people, authorized by The Medical Council of India or by any other statutory authorities of the State Government or Central Government. All of the actions of the medical practitioner should fall under the jurisdiction and the scope defined and mentioned in the license of the medical practitioner.
Qualified Nurse - The qualified nurse can be a male or female, who possesses the valid registration from the Nursing Council of India or from any other statutory authority in any state in India.
Domiciliary Hospitalization - In simple terms “domiciliary Hospitalization” means that the insured person is given standard medical care for their illness, disease or injury in their house when the insured person is confined to their house for prevailing or existing reasons. However, the circumstances under which our company provides for the medical care and takes care of the insured sum are following:
Pre-existing Condition - A pre-existing condition can be described as the medical condition of which the insured has been either been showing symptoms or has received treatment for in the past four years or 48 months prior to the medical insurance availed.
Day Care Treatment - Daycare treatment refers to the medical attention (can be surgical) given to the insured person by a registered practitioner for less than 24 hours. The coverage of such procedures under our health insurance policy will depend on the following:
*Note - Normal treatment or medical attention administered to the patient on an outpatient basis is not covered under our daycare procedures.
Provider Network –The term covers all the medical institutions, nursing homes, health care providers or hospitals that offer authorized medical care and treatment as enlisted by the Insurance Company and offer treatment to the insured person on a cashless basis.
Non- network hospitals - These hospitals are not enlisted by the company to offer the cashless medical facility to the insured person. In simple terms, it is any hospital that is not in the “Provider Network” of the company.
Emergency Assistance Service Provider - The emergency assistance service provider is any entity or body that is offers medical support and care in case of emergency, to the insured person under their Mediclaim policy, when they are 150 kms away from the insured person’s domicile address, provided that the entity or the body comes under Indian territories.
Medical Assistance Services - The medical assistance services are the emergency medical treatment or services offered by the emergency assistance service provider during situations of emergency, while the insured person’s registered domicile address is only 150 kms away. However, the terms and conditions for the medical assistance service are similar to the emergency assistance services.
Medical assistance services include - medical consultation, medically supervised repartition, medical evacuation and medical referrals.
Co-Payment - A part of the expense of the medical care and medical treatment is taken care of by the insured person themselves, while the remaining part of the medical treatment or care is offered by us. This term can be used interchangeably with “co-insurance.”
Emergency Care - Emergency care means the urgent and the immediate medical care provided to the insured person in case of severe injury or ailment by a medical practitioner.
Grace Period - The grace period refers to a period of 30 days, offered by the company to the insured person of the Mediclaim plans, immediately after the due date of their premium payment. During this time, the insurance premium for your Mediclaim policy must be paid to ensure the safe running of your policies and plans. The failure to pay the insurance money during this time, i.e., during the grace period of 30 days, shall lead to the expiration or cancellation of your insurance policy with the company.
Inpatient Care - This can be described as the medical treatment that is given to the insured person in the hospital. However, this treatment lasts less than 24 hours. If such treatment comes under day care procedures as mentioned by policies, then these medical services will fall under in-patient care.
Outpatient Treatment - This kind of treatment means that the insured person visits a particular department or a medical facility or a hospital or a nursing home in order to get some medical care regarding a diagnosis or medical condition the insured person is already facing by a medical practitioner. Here the insured person is not admitted to the hospital, or treated under in-patient and daycare categories.
Day Care Centre - The day carecentre is an institute, which has been set-up to offer day-care treatments to the insured person for ailments covered under the Mediclaim plans of the insured person. Proper departments that are set up under a recognized hospital also fall under this category. These day-care facilities must be registered under statutory authorities of India and must be run by or should be supervised by qualified medical practitioners. The day-care centre must follow the following criteria:
Medical Expense - Medical expenses are the costs incurred for medical advice offered by the registered medical practitioner for a prevailing medical conditions or the emergency medical care as availed by the insured person. However, it must be noted that these expenses should be true and fair and should not be inflated. These prices should match with the actual prevailing prices in the market and should not be overcharged.
Cumulative Bonus - This term means the increase in the basic sum insured granted by us to the insured person without any associated increase in the permit for the insurance plan.
Dental Treatment - Dental treatment is any kind of treatment offered by a registered dental practitioner and may include various kinds of prescriptions, medications for pain management, crowns, implants, filings or any other kind of cosmetic treatment. Unless specified explicitly by the insurance policy, dental treatment is covered by most Mediclaim plans.
Condition Precedent - This term means that the terms and condition of the policies under which the liability of our company is conditional.
Notification of Claim - It refers to the notification provided to our customer care or the TPA (Third-party administrator) regarding all the details and contact details.
Disclosure to information norm - This means that the insured person’s Mediclaim for the insurance policy becomes null and void due to misrepresentation of facts or due to the fraudor concealment of actual medical facts from the company. In such cases, the premium paid by the insured person is forfeited immediately.
Cashless services - These services are included in your Mediclaim plans and policies. Cashless service means that the payment of your medical treatment at a centre will be paid directly by the insurance company. A capping or limit to cashless treatments is predetermined by the insurance company.
Contribution - This is defined as the right of the insurance company to call upon other insurers, who have also offered covers to the same person under different policies, to share the liability on an indemnity claim on the basis of pro-rata for the sum insured.
Renewal - This can be defined as the renewal or re-buying of the insurance policy or Mediclaim Policy by the insured person. The renewal happens with mutual consent. It must be noted that once the existing or the first insurance plan with our company has expired, your renewal process may be subject to a certain number of days of grace period. Failing to renew your policy in the stipulated time would lead to the elimination of the renewal option for the particular Mediclaim plan.
Portability - This is defined as the right of an insured person to transfer their health plan to another insurer or any other insurance company. Through this option, the insured person gains the benefit of enjoying time-bound conditions and other pre-existing conditions, gained under the Mediclaim policy with our company.
Room rent - It is the amount of money charged by the hospital for occupancy of a room for 24 hours and may include other expenses for medical treatment provided by the hospital to the insured person.
Class “A” Cities - Class “A” cities include Mumbai, Kolkata, NCR Delhi, Jaipur, Pune, Lucknow, Ahmedabad, Kanpur, Chennai, Nagpur, and Bengaluru. This list is subject to revision from time to time at the discretion of the company.
Additional Benefits - This includes extra benefits offered to the insured person, above the limit of the basic insured sum after the payment for additional services, apart from the general cover offered by the Mediclaim plan.
Extension - This includes the optional coverage offered to the insured person after the payment of an additional fee other than the policy premium, for an additional benefit under anon-going insurance plan.
Terrorism/Terrorist Incident - These are acts of violence committed with the explicit intention of causing harm and injury to life and property of any person. It includes acts of violence done specifically against a single individual or the entire nation. It also includes those incidents that can be verified by the government as acts of terrorism.
Alternative Treatment - These treatments cover an alternative method of treatment for ailments or injuries or pre-existing health conditions suffered by the insured person. In India, these alternative methods of treatment include treatments covered by Unani, Sidha and Ayurveda, all of which are aimed at eliminating and treating the root cause of the ailment.
"These documents are applicable for health policies incepting from 01/01/2019".
Higher Sum Insured for Critical Illness Higher sum insured for critical illness to cover expenses (as listed in Basic Cover) related to following Critical Illnesses:
We will pay for the additional benefits as mentioned below in accordance with the main-coverage:
Cancellation i. We may cancel the policy on grounds of fraud, moral hazard or misrepresentation or non‐cooperation by the insured, by sending a 30 (thirty) days 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 unexpired period of this policy in respect of such insured person(s) in respect for whom no claim has arisen. ii. You may cancel the policy by sending written notice to us under registered post. We will then allow a refund on following scale, except for those insured person(s) for whom claim has been preferred on us under the current policy: Period of cover up to : Refund of annual premium rate (%) 1 (one)month : 75% (seventy five percent) 3 (three) months : 50% (fifty percent) 6 (six) months : 25% (twenty five percent) Exceeding 6 (six) months : Nil
After occurrence of a claim under the policy, the basic sum insured under the policy will be reinstated by the amount of the claim after charging appropriate premium as per the method for reinstatement of the basic sum insured so that full basic sum insured is available for the policy period : Reinstatement premium will be deducted from the claim amount. The reinstatement of sum insured will not be available for Critical illness extension and cumulative bonus. The reinstatement of sum insured will not be available for Domiciliary Hospitalisation and Ayurvedic and/or Homeopathic and/or Unani and /or Sidha hospitalization.
