Why choose IFFCO TOKIO Individual Health Insurance Policy
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: -
- Individual coverage for all family members: - You can buy individual Mediclaim policy for different family members with different features and benefits from us.
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.
- Easy enhancement of policy amount: - When you buy an individual Mediclaim policy for every family member from IFFCO Tokio as compared to cashless Mediclaim policy for family, you can easily decide if you want to keep the amount of sum insured for them same as yours or higher. This will also make sure that you can select desired coverage limit for individual family members according to their age and do not end up paying high premiums unnecessarily.
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.
- Coverage for Critical Illness: - Our best cashless Mediclaim policy offers you the option to pay a basic amount over and above the Mediclaim policy premium to enjoy coverage for specified critical illness.
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.
A wide range of plans to choose from
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
Best Cashless Mediclaim Policy for family
We have empanelled over 4200 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.
- In-House Claim Team: All claims filed under the best Mediclaim policy for individuals are directly attended to by our in-house team. This helps you in saving vital time and money while filing claims for hospitalization expenses under the cashless Mediclaim policy for family. Our in-house team aims to settle all your claims and queries related to the Mediclaim policy on a timely basis. By removing the need for a TPA in claim settlement processes, we are able to offer better premium rates to our customers, making our Mediclaim policy, one of the best Mediclaim policies in the market.
- Portability: In modern times customers want the option of choice for every purchase decision that they must make. Similarly, as per the guidelines of IRDA, you are free to switch your online cashless Mediclaim policy from one insurance company to another.
We understand that you might already have a Mediclaim policy with another insurance company and might not be happy with the benefits being extended there. We at IFFCO Tokio offer you the option to port your cashless mediclaim policy for family members individually to us and continue enjoying the amazing benefits offered by us. Be rest assured that all your accumulated benefits under the previous individual cashless mediclaim policy for family members would remain intact under our best mediclaim policy plans.
- 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.
- Additional Benefits: In addition to coverage against hospitalization expenses, when you buy mediclaim policy for yourself or your family members, you also enjoy many other benefits. Some of these additional benefits that make our plan, the best Mediclaim policy are: -
- Pre and Post Hospitalization Expenses – for 45 and 60 days respectively
- Daily Allowance – up to 0.15% of sum insured up to a maximum of Rs. 1000/-
- Ambulance Charges – up to 0.75% of the amount insured up toa maximum of Rs. 2500/-
- Vaccination Expenses – up to 7.5% for a single person and 15% for the whole family after two claim free periods.
- Health Check-up cost covered – 1% of the amount insured after four continuous claims free family health plan period
- Cumulative Bonus – 5% of basic sum insured up to a maximum of 50% of claim free cashless Mediclaim policy for family
- Emergency Assistance service – up to 150 km from residential address for a period of 90 days
- Lifelong Renewability: We understand the importance of continued insurance coverage in the modern times, where frantic schedules, rising pollution, food contamination have led to health becoming a chief concern for everybody. Therefore, all our offline and online cashless Mediclaim policy plans come with the option of lifelong renewability. This offers you and other individual policyholders in your family, peace of mind as you know that in the present times when health care costs are rising every day, you have the best Mediclaim policy to take care of any hospitalization related expenses, for you.
- Grace period: We also offer you a grace period of 30 days in case you fail to pay the premium for your online cashless Mediclaim policy, on time. Paying the due premium within 30 days from the date of policy expiration will ensure the continuity of insurance benefits accrued over the years.
However, do note that in case of misrepresentation, fraud or concealment of material facts, the Mediclaim policy can be canceled by the company.
- Cumulative Bonus: As a token of respect for the trust placed in us by our Mediclaim policyholders we offer attractive benefits for them. For every policy period, during which no claim has been filed, you get a cumulative bonus.
The cumulative bonus serves as an extra cushion against any medical emergency faced by you during the period your policy is effective.
- Income Tax benefits: When you buy a separate cashless Mediclaim policy for different family members as compared to cashless Mediclaim policy for family, there are higher income tax benefits that can be enjoyed. Under a cashless Mediclaim policy for family, the premium is paid from one individual member’s account wherein only he/she gets the benefit, under Sec 80D of the Income Tax Act, up to the maximum permissible limit.
But when every individual member pays for his/her cashless Mediclaim policy, each of them receives the benefit of Income Tax deduction, for the amount they have paid as the premium. This results in significantly higher tax savings.
- 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.
Right Age for Buy a Mediclaim Policy
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:
- Low Premiums: - The best part about buying a Mediclaim policy online at a young age is that you get a large cover for a relatively lesser premium, as most insurers calculate their premium based on your age. For example, if you get a cashless Mediclaim policy at the age of 25, the premium that you would pay would be much lower as compared to getting a new policy at the age of 45.
- Extended Coverage: - Opting for a cashless Mediclaim policy at a young age enables you to get coverage for a wider number of medical conditions at lower premiums as compared to coverage for the same ailments at an older age. The cost of adequate mediclaim coverage is only going to increase with time, so it is better to start early and continue enjoying the benefits for longer durations.
- Lower chances of rejection: - When you buy online Mediclaim policy at a young age, the chances of you being rejected for the coverage is very low. When you are young, there are many more productive years ahead of you and you are less susceptible to age-related medical conditions. Therefore, there are very minuscule chances of your application for cashless Mediclaim policy being rejected.
- Waiting Periods: - The time period after which certain illnesses are deemed to be covered under a Mediclaim policy is known as the waiting period. The waiting period for specific illnesses differs from one insurance company to another and the difference could be anything from a few months to a few years.
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.
- Pre-existing conditions: - Most insurance companies exclude certain pre-existing conditions from the Mediclaim plan coverage. When you are young, your chances of suffering from chronic ailments are relatively lower. Hence, when you opt for a cashless Mediclaim policy very few ailments shall be excluded from the protection of policy.
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.
- Freedom to choose: - When you are young and decide to opt for a Mediclaim, you will be in a better position to dictate your own terms and exercise yourpower to pick from among the multiple options available in the market. When you cross the age of 40, the number of options available to you decreases significantly and you might have to choose a cashless Mediclaim policy which might not serve all your requirements.
- Lifelong renewability: - You also have the option for lifelong renewability of your cashless Mediclaim policy for familyand self, which would ensure that your insurance coverage remains on going for the rest of your life if you continue to pay your premiums on time.
- Financial Planning: - When you decide to buy Mediclaim policy at a young age, you not only get greater coverage for a lower amount, but you also get the freedom to plan your finances in a better way. Having an assurance of medical coverage, you get to better utilize your finances and even make long-term investments.
- Cumulative Bonus: - When you do not make claims during a policy period, no claim bonus is added to your Mediclaim policy. When you are young, there are extended periods over which you need not make any claims, as such your cumulative bonus would be added. This will offer you extended coverage over and above the sum insured, which will come in handy when you get old and need to file claims for hospitalization.
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.
Why should you buy a Mediclaim policy for senior citizens?
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: -
- Increasing Medical Expenses: - When you or your parents are on the verge of becoming senior citizens, then it is advisable that you opt for a comprehensive 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.
- Frequent Hospitalization Expenses: - That age spares no one is actually a universal truth. As you grow older with time, you become more susceptible to illnesses that you never once thought you could suffer from. Having a Mediclaim policy for senior citizens would help take care of the frequent hospitalization expenses which can otherwise become a financial burden and stop you from seeking best possible Medicare for yourselves.
- Pre-hospitalization and post-hospitalization expenses: - While choosing the best Mediclaim policy for parents you should make sure that all the diagnostic, pre-hospitalization and post-hospitalization expenses are covered under the policy.
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.
- Reimbursement for ambulance service: - If you are an old person living away from your children, then you have to be dependent on your neighbors or other relatives to take you to and fro to the doctor or hospital. With a Mediclaim for senior citizens, you get the option for reimbursement for ambulance expenses or another suitable mode of transportation. This will result in significant savings which would otherwise cost you dearly.
- No dependency on others: - There is no greater feeling than financial freedom in old age. With a comprehensive Mediclaim for senior citizens, you enjoy the comfort of a significant insurance cover to take care of your hospitalization and related expenses. This reduces your financial dependency on your children or relatives, which is an amazing feeling in itself.
- Maximize you Limited Income: - By the age of 60 most of the senior citizens are living a retired life with a little income in the form of pension and some savings to tide over their day to day expenses. If in such a situation you have to face a medical emergency without a Mediclaim policy for senior citizens, then your savings might be entirely wiped out.
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.
- Plan your future: - Having the best medical policy for parents would make sure that you need not worry about any medical expenses and just focus on living your life to the fullest.
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.
Features of IFFCO Tokio Individual Health Protector Policy
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.
- Flexibility to choose: - Selecting a comprehensive Mediclaim was never this convenient. You can choose from various available options based on the benefits intended and premium payable. You can just log on to our website, fill out some basic details and buy an online Mediclaim policy.
- Cashless Hospitalization: - Another amazing advantage of buying our Mediclaim policy comes in the form of a cashless facility. Herein, you or any other insured member of your family with an individual protector plan can avail cashless hospitalization at any of our 4200+network hospitals. This feature helps make sure that you do not worry about the costs involved in the treatment of an ailment, and simply focus on getting better.
- Pre-Hospitalization Coverage: - When you buy Mediclaim policy online or offline from IFFCO Tokio, another great benefit that you get is, reimbursement of pre-hospitalization expenses. This covers all expenses that have been borne out of your own pocket for diagnosing and investigating about a particular medical condition for which hospitalization was required. Expenses such as doctor consultation, diagnostic tests etc. are taken care of by this best Mediclaim policy offered by our company.
- Post-Hospitalization Coverage: - We also make sure that you do not cut corners while recuperating after discharge. Another amazing feature of our Mediclaim policy for individuals includes the reimbursement of expenses which are incurred post discharge from the hospital, till you have regained your health, as per a registered medical practitioner recognized under Mediclaim policy.
- Coverage for senior citizens: - With our Mediclaim policy for senior citizens, we make sure that you or your parents do not have to fret about every medical expense that must be borne, due to age-related ailments and conditions. Buying our best Mediclaim policy for parents is one of the better ways that you can show your love towards your parents.
- Free-look period of 15 days: - Even though our existing customers can vouch for the efficiency of our cashless Mediclaim policy for family members and individuals, in case you feel doubtful about any aspect of our policy, you have a free-look period of 15 days. During this period you can cancel the Mediclaim policy for senior citizens at your discretion and get your premium refunded.
- Coverage of alternate therapies: - We also understand that no matter how much progress modern science makes to improve allopathic treatments, the various traditional healing sciences will keep on holding their fort.
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.
- Vaccination and Check-up Coverage: - We believe in the age-old axiom that “Prevention is better than cure”. Hence, as a part of our cashless Mediclaim policy for family and individuals, we encourage you to take preventive measures so that there is no need to face the hassles of hospitalization.
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.
- Tax Benefits: - Making the experience even better for you, all the premiums paid for our Mediclaim plans are tax deductible, under Sec. 80D of the Income Tax Act.
- Life Long Renewability: - Our Mediclaim policy comes with lifelong renewal option, which extended much beyond the threshold of 55years, 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.
The extent of Benefits under the Individual Health Protector Policy
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 –
- If sum insured is above Rs. 5, 00,000/- then actuals as per the Invoice
- If sum insured is Rs. 5, 00,000/- and below: -
For Normal Room: -
- Class A cities: - up to 1.75 % of the sum insured
- Other cities : - up to 1.50 % of the sum insured
For Intensive Care Unit/Therapeutic Expenses: -
- Class A cities: - up to 3.00% of the sum insured
- Other cities : - up to 2.50% of the sum insured
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.
Critical Illness Cover
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: -
- 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
- 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, which is why you should always be prepared for any such eventuality.
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.
- Pre and Post Hospitalization Expenses: - You are only admitted to a hospital under the guidance of your consultant physician or expert as they feel that the ailment is not possible to be cured by prescription medicines and needs domiciliary hospitalisation. But in order to reach this decision, your consultant medical practitioner needs to investigate the cause of the medical condition using various diagnostic and investigative procedures, which can cost a lot. All pre-hospitalization expenses incurred during a period of 45 days before hospitalization will be covered if you have bought this 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.
- Ambulance Charges: - Certain ailments are so grave that they require the patient to opt for ambulance services, to be delivered to the hospital. When you are already burdened by medical bills, even the cost of ambulance services could seem too much. Therefore our Mediclaim policy reimburses ambulance charges up to a maximum of 1% of the sum insured or Rest. 2,500/- (Two Thousand Five Hundred Only) for each episode of hospitalization.
- Day Care Surgeries: - We understand that for treatment of certain conditions or minor surgical procedures, there is no need for hospitalization. Therefore, we have identified 121 medical procedures as day care procedures, following the treatment for which you can be discharged immediately from the hospital and recuperate at home. All the expenses incurred due to any of these 121-day care procedures will be fully reimbursed insurance plan. This saves you all the hassles involved with admission and discharges even for some minor procedure.
- Daily Allowance: - We understand that when you or any other insured family member undergoes treatment at a hospital, there are other monetary losses that occur as a result because there are various other expenditures involved in addition to the hospitalization and medical expenses. Additionally, there is also the possible loss of income, if the person undergoing treatment was working and had to take a leave of absence due to the hospitalization.
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.
- Hospitalization Expenses if the stay is for less than 24 Hours: - We understand that not all treatments require an extended stay at a hospital.
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.
- Vaccination: - We believe that prevention is better than cure. Although many critical illnesses have rapidly progressed, affecting millions of individuals, medical science has also made significant development simultaneously. Today we have various new vaccines that help control the spread of many such diseases. In order to make sure that you receive all necessary vaccines to safeguard your health against serious ailments, our best cashless Mediclaim policy for family members and individual, also covers the cost of vaccination, received from a registered medical practitioner.
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.
- Cumulative Bonus: - Do not think that if you have not made any claims against the premium paid for your Mediclaim, in a particular year then it would go waste. We reward our customers with cumulative (no-claim) bonus feature, which adds a particular amount to your insurance coverage, over and above the sum insured, with each claim free year.
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
- Travelling for undergoing a medical treatment
- Injuries resulting from attempted suicide or self-inflicted injuries
- Services are sought outside the geographical boundaries of India
- Involvement in an unlawful act
- Consumption of narcotics or drugs or any medication other than those prescribed by the physician or overdose of prescribed medication
- Injuries resulting from participation in a war or insurrection
- Students at their hostels or campus away from home
- Transferring insured person from one medical facility to another, where both facilities have same capabilities and provide a similar level of care
- If you had been travelling away from your registered address for over 90 days without any intimation to us.
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.
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.
Subscription of a Policy
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.
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.
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.
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.
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: -
- Unnecessary overconfidence: – You might think that as you are leading a healthy lifestyle and haven’t fallen sick in ages, there is no need for spending money on a Mediclaim policy.
- Reluctance to pay high premiums: - You might think of Mediclaim policy premium as an unnecessary expense and try to subscribe to a Mediclaim policy with the lowest premium and bare minimum coverage.
- Only for tax saving purpose: - You might opt for only that much policy amount which is well-suited to your tax saving requirements and financial planning.
- Miscalculation of future Medicare requirements: - You might miscalculate your future health-related requirements and inadvertently opt for a low amount for your policy coverage.
- Unaware of benefits: - You might not be aware of the extensive benefits offered by a Mediclaim policy other than just covering for the hospitalisation expenses.
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: -
- Miscalculation of future requirements: - It is possible that you are too worried about your future medical requirements and end up buying a policy with considerably more coverage than is required at your age or your child’s age.
- Lack of Knowledge: - In case you do not educate yourself about the availability of various optional riders, which offer higher coverage for a smaller premium, you end up buying a policy with higher coverage against a higher premium.
- Lack of Financial Planning: - Sometimes it may happen that you do not plan enough about your future finances. You simply end up investing more than necessary in your Mediclaim policy while you could have invested it better elsewhere, had you planned it all better.
- Only for tax saving benefit: - It might be possible that to take advantage of the tax exemption offered under the Sec. 80D of the Income Tax Act, you decide to subscribe to a policy with premium as much as the exemption limit is, irrespective of whether or not you need that much coverage.
- Group Mediclaim Policy: - You might already be covered under a group Mediclaim policy offered by your employer and need not opt for a relatively higher amount of coverage from an individual Mediclaim policy. But you might not be aware of the group Mediclaim policy details and end up subscribing for higher Mediclaim coverage than required.
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.
Premium Calculator for the Best Cashless Mediclaim Policy for Family Members
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: -
- Personal details like name, age, occupation etc.
- Insurance Coverage required
- Any Existing Medical Conditions
- Any optional Riders (for critical illness)
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: -
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: -
- 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 and upload the necessary documents.
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: -
- 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 charges or surcharges for online payment of premiums. It is advisable that once you have made the payment successfully, keep a copy of the payment acknowledgment for future reference.
- Mobile Portal: - You can use our interactive mobileportal to make your premium payments online through following modes: -
- Credit Cards: - You can make the premium payment through your Master/Visa/American Express card.
- Debit Cards: - You can make payment through 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.
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: -
- Branch: - You can drop into any of our branches, located conveniently throughout India, and our staff will be really happy to assist you with the payment procedure. You can use the following modes of payment: -
- Demand Draft
- Credit/Debit Cards
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.
Cancellation of Policy
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:-
- Through Notice: - You may cancel the cashless Mediclaim policy through written notice. To do this send the written notice within 30 days to us using standard method of registered post. A refund will be issued using the following scale as a measure. The exception to this rule is for that insured person (s), who has preferred their claim on us for the policy of the current period:
Period of cover up to
Refund of Annual Premium - Rate (%)
Exceeding 6 (six) months
- Cancellation during Free-look period: – This policy at IFFCO Tokio for a Mediclaim has attached to it a period of 15 days during which you are allowed to take a free-look. This means that for this policy you are allowed a period of time during which you can cancel the policy owning to any issue with the terms and conditions, should you think it necessary, without being penalized in any manner.
However, when you are filing for the cancellation of the policy, you are required to state your reason for doing this. There are exceptions to this option, as it will not be applicable during policy renewals. If you qualify, then you will be refunded on cancellation of the policy by the following basis: -
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.
- Automatic Cancellation: - If by chance you do not pay the premium that is required for the Mediclaim policy renewal in time for the due date or utmost within 30 days beyond the due date then it is assumed that you have no interest or are not willing to continue with the policy and the Mediclaim will be cancelled immediately. There may be a claim for a refund, but that will be processed using the company policy that is active at the time of claim.
Cancellation of Policy by IFFCO-Tokio
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: -
- Basic Sum Insured can be reinstated only to the level of the amount that has been claimed and paid for it.
- The reinstatement of policy premium which is paid will also be deducted from the amount.
- Upon reinstatement, the policy will hold true for a period of time, which generally extends from the first date of hospitalization when the claim was made to the last expiry date.
- The reinstated amount cannot be used for paying for the expenses incurred while treating the particular diseases, illnesses or injury which was the reason for the hospitalization of the person, which again led to reinstatement. On the other hand, it can be used to make payments for the expenses that are incurred while treating an illness that is similar to any other disease except those which are excluded. These are valid for as long as the illness is not caused by the relapse of the disease within 45 days of initial hospitalization for which the person had made the original claim.
- The reinstated basic sum will be used to pay for any and all claims which come during the initial hospitalization period. This means that if they sustain any other injury or illness other than the reason for their hospitalization, the basic sum can be used to pay for it.
- The premium which has to be paid for the reinstatement of the cashless Mediclaim will be recovered. This recovery is from the claim amount of settlement, and the basic sum insured shall be reinstated within the time that the insured person suffers hospitalization.
- Mediclaim policies having a basic sum insured of Rs. 3 Lacs or above will only be able to avail this option.
- The premium calculation for the Mediclaim policy has to be done using a pro-rata basis of the proportion of annual premium and the sum percentage claimed of the basic sum insured.
- Once the Cashless Mediclaim has been reinstated, thesum that was insured cannot be used to claim expenses for the following chronic ailments, where the initial claim under the same policy has been filed: -
- Perpetual limb paralysis
- Specific severity coma;
- Open Chest CABG;
- Specified Severity Cancer;
- Major Bone Marrow or Organ Transplant;
- Regular Dialysis requiring kidney failure;
- Specific severity initial Heart Stroke
- Permanent Symptoms causing stroke;
- Permanent Symptoms causing Motor neuron disease
- Persisting Symptoms accompanying Multiple Sclerosis
- Heart Valves repair or Open-Heart transplant;
Once the Mediclaim policy has been reinstated it cannot and shall not qualify for any cumulative bonus or even for an extension on critical illness.
After reinstatement, the basic sum insured cannot be claimed for expenses incurred due to Domiciliary Hospitalization of Unani, Ayurvedic, Sidha or Homeopathic treatments.
Following are the exclusions in case of which our company will not be able to compensate your claims:
- Frenuloplasty, Circumcision, Preputial Dilatation, Preputioplastyand Removal of SMEGMA
- 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 positive existence of ailment/sickness /injury/disease and there is no further indication of any treatment being administered. Disease or injury directly or indirectly caused due to nuclear materials or weapons
- Behavioural, Mental and Psychiatric ailments
- Vaccination or Inoculation (other than post-bite treatment and for medical treatment for therapeutic reasons)
- Cosmetic or plastic surgery (other than necessary as a result of an illness or an accident)
- Unless necessitated due to accidental injuries warranting hospitalization, dental treatment or surgery are not payable. (Dental implants are not payable)
- 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
- Congenital External Defects /Anomalies and Conditions
- Biologicals, Oral Chemotherapy and Immunotherapy, other than when given as an in-patient, indicated clinically and warranted due to hospitalization.
- 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
- Deliberate injury to oneself
- 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.
- Sexually Transmitted Diseases and Venereal Diseases
- Expenses that come up due to any condition indirectly or directly 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 for 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.
- Substance abuse, consumption of intoxicating substances, smoking, drugs / alcohol, and tobacco chewing
- Treatment is arising from or traceable to family planning, pregnancy, miscarriage childbirth, abortion and complications due to any of these conditions (other than ectopic pregnancy).
- Treatment for Assisted Conception, Sub-Fertility, and or other associated complications caused due to the same conditions
- Surgical or Medical treatment of the genetic and endocrine disorder and Sleep apnoea, Expenses incurred for Bariatric Surgery or weight management services comprising of surgical procedures for medical treatment of obesity.
- Medical conditions caused directly or indirectly or attributable to act of foreign enemy, war, warlike operations or invasion, whether there is a war declaration or not)
- The run-down condition, Nutritional deficiency state, convalescence, rest cure or general debility.
- Experimental, Untested, Unproven and Unconventional therapies.
- Expenses incurred on Refractive Error Correction treatments such as Lasik Laser, treatment for disorders of eye requiring intra-vitreal injections and other related complications.
- Hospital registration charges, record charges, telephone charges, admission charges, or any other such charges
- Chondrocyte Implantation, Intraarticular injection therapy, Stem cell Therapy, and Procedures using Platelet Rich Plasma
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: -
- Diabetic Angiopathy;
- Diabetic Retinopathy;
- Diabetic Nephropathy;
- Diabetic Foot or Wound;
- Diabetic Ketoacidosis or Hyper Hypoglycaemia;
- Hypoglycemia; and
- Diabetic Neuropathy
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: -
- 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
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: -
- 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
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:
- Cataract, Benign Prostatic Hypertrophy, DUB
- Uterine Fibroids/PV Bleeding like Hysterectomy, Myomectamyetc
- A hernia, Hydrocele
- Gall Bladder, Biliary, Renal and Urinary Stones
- Knee replacement/Joint Replacement/Hip replacement (other than caused by accident)
- Any type of benign growth/Cyst/Nodules/Polyps/Tumour/Lump
- Inter-vertebral Disc disorder like Spondylitis, Spondylosis, prolapse, etc. (other than caused by accident)
- Chronic Renal failure
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.
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: -
- Excluded/Blacklisted Hospitals and Doctors: - We do not take any responsibility of claims if the medical procedure on the insured, is performed in any blacklisted/excluded hospital or doctor. We constantly keep the list of such doctors and hospitals updated so that our clients can check it before getting admission. You can also contact our customer care executives for the same information. Neither cashless nor reimbursement will be done in such cases.
- Timely Information: - It is requested that clients intimate us about the proposed hospitalization and the nature of treatment at least 48 hours before the scheduled time. In case of emergencies, the same should be done within 24 hours of admission. This is to help us serve you better and let you have a hassle-free treatment at the hospital while we take care of the cashless facilities or reimbursement.
- 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: -
- You can make a call to our customer care number and mention your policy number ID along with your personal details. Your card will be mailed to your registered address as soon as possible.
- If it is an emergency scenario, you can get a print out of your E-card from our customer portal. All you need to do is log in with your credentials to the portal.
- Always submit complete documents: - Keep your contact details updated on your Mediclaim account and in case of any change, intimate us as soon as possible. Also, keep all your medical records regarding hospitalization compiled together so that when you submit them for claims, there is no discrepancy or lack of sufficient proof.
- Choose the Hospital Judiciously: - To file a claim under your Mediclaim Policy including Mediclaim for senior citizens, you have to get admitted into a hospital which is on our list of network hospitals. If you have any questions regarding this or want to know which hospitals nearby, falls under that category, simply give our customer care department a call. Also, as general advice, choose the venue of medical treatment carefully. Just because a hospital is very expensive and looks state-of-the-art, does not mean it is offers quality healthcare.
- Negotiate Hard: - To grab the most reasonable health package fora specific treatment under your cheapest Mediclaim policy including Mediclaim for senior citizens, negotiate hard with the hospital authority. Leave no stone unturned to manage the best possible deal. Even though you will be covered by cashless facility or reimbursement, a less expensive bill will save valuable sum insured which you can utilise at a later period under your Mediclaim policy including Mediclaim for senior citizens.
- Choose the Room Carefully: - Even the best Mediclaim policy has certain upper limit to the hospital room rent. If the room you settle for crosses that limit, the extra amount of money will have to be borne by you. An upgrade in room of choice means the charges of nursing, doctor fees and all other services will also go up at the same time. In case you are unaware of the room rent ceiling, you can always call up our customer care executives to be sure.
- Do not try to be a doctor yourself: - Thanks to the internet, we have the world’s information at our fingertips, and that often makes us think we actually have detailed knowledge about every discipline – we do not. It is best to leave things like health and medicine to the professionals, who actually have the qualifications and experience to offer the right treatment. Making things worse with your trialling might turn against you, make your health deteriorate and cost more money.
- Common Ailments not covered: - When your buy Mediclaim policy, learn about all the diseases and disorders that the policy will cover, or will not cover. There are certain common ailments the treatments for which are not covered by our policies. It is best that you, as our client be aware of that beforehand, to avoid any displeasure afterwards. Refer to our website or contact the customer service helpline for detailed information.
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.
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: -
- Delay in Intimation of hospitalization or claim submission from your side
- Lack of insurance details for the previous years
- Inadequate details about the medical condition
- Hospital or doctor is not on our list or is blacklisted/unauthorized
- Cases where admission is only for observation and no actual treatment
- The medical condition is excluded from our policy
- When the hospitalization is for less than 24 hours other than mentioned day care procedures.
- If our records do not match with the documents and details, you have submitted
- If you misrepresent or do not disclose some significant piece of information regarding the treatment
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.
- We only settle cashless claims for treatments carried out in hospitals which are on our list, at the time of admission. We repeatedly advise our clients to keep themselves updated about the eligible hospitals where they can get cashless medical treatment. If this is not taken care of, right at the admission, you might lose your claim later on, because we do not entertain bills from any hospital other than those mentioned.
- If there is any delay in settlement of your cashless hospital treatment, get in touch with the our customer care team and make sure that no documents are still pending for the completion of the application process. If there is, submit the necessary papers immediately to begin the process.
- It might take up to 4 hours to get an application for cashless Mediclaim approved. It is preferred that clients intimate us about the date and time of discharge beforehand, right after consulting with the doctor or hospital authorities. This is to help you get a seamless discharge procedure and hassle-free settlement of bills.
- Even if you are not paying the bill out of your own pocket, or maybe only a portion of it that exceeds the limit of the sum insured, always check the bill thoroughly during discharge. Clarify with the hospital staff if you find any discrepancy. Saving sum insured means keeping them for a future emergency.
- Collect the copies of the invoice, payment receipt, discharge papers and everything else and keep them secured in your medical file at home.
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.
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: -
- File your reimbursement claim within 30 days of completion of a procedure or within 90 days of 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 original. Please make sure that the discharge summary and Invoice are as per guidelines specified by IRDA. You can download the format from our site.
- During the discharge, make sure you collect all the necessary documents from the hospital, because you will need them when filing the reimbursement claim. Pharmacy bills, test reports, doctor’s prescriptions, discharge summary, hospital bills – all these should be available with you in original. Also, the discharge summary and invoices should be as per the IRDA specified guidelines, which you can download from our website.
- Make sure that there are no discrepancies in the doctor’s prescriptions and the diagnostic bills, pharmacy bills or lab reports. If there are any, it might become difficult for you to claim reimbursement.
- Download the sample claim filing form from our website and get the same filled by the hospital authorities.
- Following are the documents that you should have for smooth claim settlement: -
- Copy of Mediclaim policy
- Photocopy of government-approved ID card
- Properly filled and duly signed claim form
- Test reports
- Original copies of Hospital bills, Hospital receipts, Pharmacy Bills, Diagnostics Bills, and other bills as available.
- Documents related to medical history
- Discharge summary in the specified template of IRDA
- KYC form, if the claim is above one lakh
- Hospital’s Registration Certificate in confirmation with state authorities
- Any other hospital-related document
- If we need more information or need to clarify something, our executives will reach you via telephone or mail or both. You will be expected to revert within 15 days along with the necessary supporting documents.
- Your policy ID and phone number should be a constant in every communication you make. That is our main system of client identification. In case you have changed your phone number or email address, convey the same to us as early as possible.
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.
- If you suffer from some pre-existing diseases, you should disclose the same at the time of purchase of your Mediclaim plan. Diseases such as diabetes and hypertension should be mentioned beforehand; this will save you a lot of trouble. Your claims and settlement may not be processed in case of non-disclosure.
- If you want to opt for cashless claims, you must intimate the company during pre-authorization. This is important to avail cashless services. You must intimate the hospital or the TPA in advance to get your cashless services. Other than this, in case of emergencies, you should intimate the hospital and the TPA within 24 hours of hospitalization. If you do this, our services will be available to you by the time you are discharged.
- The best way to get the best of our services such as cashless services, you should select a hospital from within our panel or falling in our network. If you want to enjoy the best cashless Mediclaim policy treatment, the hospitals covered under our network will be able to provide much better services. We do not provide cashless services at hospitals that are not covered under our network, but we do provide for and process medical claims arising out of treatments availed at one of our network hospitals. Also, make sure you inform us within the stipulated time, any delay or expense arising because of your delay in informing us will not be our responsibility.
- When it comes to settling your claims and getting your expenses settled, we expect full disclosure, as well as all the medical evidence that you can provide. Our services will be extended to you only when all the relevant and necessary documents have been provided by us. Remember that the more supporting documents you attach to your claim form, higher are the chances of your claim getting processed easily. You should keep all invoices, prescriptions, test reports and other relevant documents to attach to your Mediclaim form.
- Payment of premiums on time ensures timely reimbursement of claims and other settlements. The same goes for your renewal premium. However, if for some reason, you miss out on paying the same, you will have 30 days from the last due date for premium payment for renewal. If you fail even then, then you will not be able to renew your medical plan with us.
- At any given point, if there is an alteration to be made, or if there are some changes on your end, then you should intimate the same, to any of our officials or representatives.
- Here is a list of things you need to disclose when you get medical insurance with us, so that it does not cause any problems for you in future: -
- Pre-existing conditions that are included along with the waiting period
- Conditions for reinstatement of basic sum insured
- Reimbursement limits under various subheads
- Inclusions and Exclusions
- Diseases that are not covered under your Mediclaim policy
- Pre-hospitalization and Post Hospitalization expenses covered under your insurance
- Co-payment clause
Educate yourself on all the details of your insurance plan and make sure you read the terms and conditions mentioned herein properly.
- Our health insurance plans require all interested parties to undergo a medical test. The tests and the costs for the same are covered on our end, so make sure that you go through these tests.
- You don’t need to pay anything more than your proposal. You will be required to pay only the amount provided. However, if your proposal for Mediclaim plans gets rejected, your payment will be refunded without any issues.
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.
- We recommend you not conceal material facts or misrepresent any necessary detail when you purchase your insurance policy with us. Concealment and misrepresentation of facts will lead to cancellation of the policy, with us.
- We advise you to not delay your premium payments for your insurance policy. The failure to pay your premium, within the stipulated time could risk cancellation of your policy.
- Fraudulent or fake claims or claim settlements initiated with fake documents will also lead to the same action of cancellation of your policy, with us. You may even get blacklisted.
- You should not make frequent claims. Frequent claims of low amount not only make your insurance premium rise but also lead to cancellation of the policy.
- Filing for claims without complete documents should not be done. You should have all your documents ready. Incomplete files will lead to no settlement.
- Read through all the terms and conditions, well. Do not delay the purchase of an insurance plan. You should read through all the Mediclaim insurance requirements as well as what the plan has to offer and get in touch with us as soon as possible.
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.
- Reasonable Precaution: It is expected that the insured takes all the necessary steps to maintain their health and keep their injuries and ailments to a bare minimum.
- Notice: In case of requirement of any cover or claim, we expect intimation from the insured person in written at our office or communication to our customer care, stating all the required details as mentioned for the insurance policy.
- Free Lookup Period: Every new medical insurance policy or Mediclaim Policy including the best Mediclaim policy for parents comes with a 15-day look up period. This period allows you to test out our policy and see whether it works for you or not. In case of any issue regarding the terms and conditions of the policy, the insured person can simply choose to cancel the policy. During the cancellation of policy, it must be remembered, that the insured person will have to give proper reasons for doing so. This option is not available for the renewal of existing policies. You will be entitled to refund of the premium on the following basis:
- If the coverage of risks of the insured, under the policy has not commenced, then the costs and charges for stamp duty, medical examination and other charges incurred by us, will be deducted from the refund.
- If the coverage of risks has commenced, then a proportionate deduction as a result of your medical examination, stamp duty and other charges under your insurance policy, will be made before when we refund your premium.
- Changes in Circumstances: If there are any material changes in the information that you have furnished to us, at the time of purchase of the Mediclaim Policy, including the best Mediclaim policy for parents, we expect you to relay the same to us, well beforehand and as soon as possible.
- Payment of Premium: Premiums paid for your Mediclaim policy, including the best Mediclaim policy for parents will be admissible only when a representative of our company or an authorized signatory of our company, signs the receipt of the payment. Other than this, premium for your insurance plan should be paid well beforehand and also before the commencement of risk coverage. Additionally, no waiver of any condition, term or other provision and endorsement shall be valid, unless written and duly signed by an authorized representative of our company.
- Claim Procedures and Requirements:
- Any claim filed against your mediclaim insurance policy, including our cheapest Mediclaim policy, must be intimated within the first 24 hours, or as early as possible, after the hospitalization of the insured person and after the commencement of the medical treatment of the insured person. Other than this, the intimation should also be done at least 12 hours before the discharge of the insured person from the hospital, medical institution or nursing home.
- A claim form, duly filled out and signed, should be submitted to us, regarding the claim to be made under the Mediclaim policy, including best Mediclaim policy for parents. This form should be submitted to us within 30 days from the date of discharge of the insured person, from the hospital or completion of the medical treatment received, whichever is later. Furthermore, all necessary documents regarding the same and supporting the medical treatment completed, alongside all reports and medical documents should be submitted with the claim form.
In cases where the insured person suffers extreme difficulties, the above-mentioned limitation is extended to 90 days. But it becomes the responsibility of the insured person to intimate us and satisfy our company with reasons explaining the circumstances due to which the insured was held back. Also, a valid and understandable reason for not being able to file a claim, within the stipulated 30 days should also be provided.
If the claim for your medical insurance is made, without being supported by relevant papers, documents and reports alongside the claim form, your claim will be rejected.
- After the insured person submits the duly completed claim form, with us along with all the required documents supporting the form, filed under your Mediclaim policy, including our cheapest Mediclaim policy, we will further raise queries from our end and seek clarifications regarding your claims and documents provided to us. We expect full cooperation on your end and expect you to respond in an agreeable manner, to all of our queries and produce all the required documents, if further asked, within 15 days of our request. You must submit original documents, certificates, prescriptions, invoices, receipts and any other kind of evidence and information as asked, in the stipulated period of time. Our representative, will have the authority to obtain information or examine and collect all the relevant data and information, required during medical treatment after hospitalization, regarding your injury or ailment. Our representatives are authorized to investigation their own.
- All benefits and entitlements of your insurance policy with us, shall stand forfeited or cancelled if you do not comply with our rules and regulations, and fail to cooperate with us whenever asked. The Mediclaim policies, including our cheapest Mediclaim Policy, shall stand discontinued and the claim shall stand rejected, if you refuse to furnish all the necessary documents to support your claims, and/or cooperate with our representatives. All information provided by you should be true and fair, to avoid cancellation or rejection of claims.
- Intimation about discharge from Hospital/Nursing Home: To help ensure that your discharge facilities under the Mediclaim policy, including our cheapest Mediclaim policy, are met properly and you are taken care of well, it is advised that you inform the company as well as the hospital staff, about the discharge time or inquire about the same from the hospital. The time should be intimated to us, at least four hours before the actual discharge, of the insured person. Any expense or cost arising out of the delay in intimation by you will not be our responsibility.
- Fraud: All benefits of your medical policy, including our cheapest Mediclaim Policy, stand rejected or forfeited, should you furnish fake or fraudulent documents and reports, supporting your claim form. Awareness or non-awareness of the commitment of fraud, on your end is not our responsibility, whatever the case may be, fraudulent information pertaining to your medical claims, will get your claim rejected.
- Limit of Indemnity: The maximum liability on our end for your Mediclaim policies, including our cheapest Mediclaim policy, will be up to the total sum insured. Our liability does not exceed this sum under indemnity clause, and the claim to be processed from our end, will be made only as per what the insured person has opted. Furthermore, this condition can be waived off, only if the indemnification related to the critical condition or inclined, had been opted by the insured person and the person had been paying an additional premium.
- Electronic Transaction: The insured person agrees to follow and fulfill any such terms and conditions, as may be prescribed by our company from time to time. Furthermore, the insured person hereby approves and authorizes that, all further communications shall be achieved by or through remote dealing initiated by call centres, internet, electronic data interchange, tele service operation (whether voice, video, data or combination thereof), world wide web or any kind of automated machines, computer networks or any other means of telecommunication available and recognized by or us. With respect to our policies and its terms, all kinds of communication shall be obligatory and binding in nature. Compliance on the end of the insured person will be required as per our terms and conditions, and such terms and conditions shall not be in violation or shall not supersede provisions of any law/laws in force at the time being under the given provision of IRDA.
- No Constructive Notice: Any kind of information received by us, from you or from any other related person regarding your condition and medical issues shall not be considered legally binding on our end, unless we receive payment of premium, before the commencement of risk cover for your policy.
- Multiple Policies: If you, the insured person, have more than one policy for medical insurance from different insurers or us, we expect to get prior information from you for the same. Along with this, we expect to attain all details of the same from you. In case of claiming for your medical claim, the claim raised on your end is less than or equal to the sum you are insured for, then contribution clause for your Mediclaim policy will not be applicable. However, if you are claiming more than that, contribution clause may be applicable.
- The insured person shall allow or agree to permit to everything necessary for the enforcement of civil or criminal remedies and rights for obtaining indemnity or relief pertaining to their medical claims and Mediclaim plans;
- The insured person shall do anything that may be prejudiced to our subrogation rights;
- When you sign up for insurance with us, you agree that any of the recoveries made due to subrogation shall be used to indemnify any money that may be paid or had been paid by our company or by somebody on our behalf to you against the claims and expenses done to recover such amounts.
- 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.
- Portability: The portability of your insurance plan is governed by the Health Insurance Regulation, 2013.
The following are the rights and obligations of the insurer and the insured:
- A policyholder can easily port their insurance from our company to another company. However, do note that this must be done well before 45-days of the premium to be paid for the existing plan.
- It must be remembered that if you do intimate the company 45 days before the due date for premium payment, then your insurance policy will not be eligible for port from this company to any other company of your choice.
- The insurance plan for your medical plan will not be imitated in any other method.
- A person may be able to port their insurance from one company to another company if you, in fact, apply for the portability of the 45-day clause. However, it depends on your insurer.
- Here is what to do if your portability request is still pending:
- On the request of the policyholder, the insurance plan may be extended for a month on a pro-rata basis.
- The existing insurance plan will not be cancelled unless confirmation from the insurer has been duly received.
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.
- The insurance plan shall be cancelled by IFFCO Tokio only on the grounds of misrepresentation, fraud, hazard on moral grounds and other reasons such as non-cooperation, on the end of the insured person. We will send you a 30 days’ notice prior to cancellation, by a registered post to your last registered address with us.
- In case you want to cancel your insurance policy with us, then you can do so by sending us a written notice. Our company will make a refund to you, on the basis of interest as mentioned below, in case no claim has been raised:
Period of cover up to
Refund of Annual Premium - Rate (%)
Exceeding 6 (six) months
- Notice of Change: IFFCO Tokio will not be entitled to take effect any assignment, trust or notice of the charge, trust or lien relating to your policy. The receipt from the insured person acts as an effective discharge to our company.
- Arbitration: In case any kind of dispute or difference that arises with regards to the quantum to be paid for your insurance policy, then such a dispute, independent of all other questions, shall be taken to a sole arbitrator, who will be appointed as per the choice of the parties involved. In case where the parties involved are not able to decide upon a single arbitrator within the 30 days of the arbitration being invoked, then such a case will be taken to a panel of three arbitrators.
In this panel, two arbitrators will be appointed by the parties, separately and the third one will be agreed upon by the 2 chosen arbitrators. Such arbitration will be done in accordance with the regulations and rules mentioned in The Arbitration and Conciliation Act, 1996. At this time the insured person has the right to communicate directly with the office for any requirements.
- Disclaimer Clause: When our disclaimer clause is made against a policy covering any kind of Mediclaim policy,and such a claim is not made as the subject matter in any court of law within the next 12 months from the date of issuance of such disclaimer, then claim shall be considered as non-recoverable under the policy or shall be called abandoned.
- Withdrawal & Alteration of Policy Conditions: The terms and conditions of your policies may undergo some or many changes as prescribed by IRDA Health Regulation, from time to time. In this case, the insured person shall be duly notified at-least 3months before the date of revision, by written notification through a registered post, to the last known address of the insured person. The revision and any other related rates for insurance plans will be as per IRDA Health Regulation.
It may also happen that some the insurance plans by our company and many others may be withdrawn with the approval of the same authority. In such a case, the information of withdrawal of the insured person’s plan will also be provided to them in advance and in writing, with all the other options that you can opt for. If our company does not receive any intimation from you or any communication regarding the renewal, then your insurance may stand subject to portability.
- Policy Disputes: Any dispute arising out of interoperation of the medical insurance policy’s terms and conditions, liabilities, inclusions, exclusions or any other thing, is mentioned here and is agreed upon and understood by the insured person and the insurer. The disputed matters for insurance and its policies shall be dealt with, according to the law practiced within the Indian Territory.
- Protection of Policy Holder’s Interest: If an insured makes a claim and the same is found admissible under the insurance plan for the individual medical plan, we will make an offer for settlement or rejection within 30 days of receiving all the required documents and assessments, and in case there are any discrepancies, we will ask for the missing documents. Once the claim against your Mediclaim policy is approved, the proceeds of the same shall be paid within 7 days of your acceptance of the offer. In case of any delay in the payment of the sum, we will be held liable to pay interest at 2.0% above the bank rate, prevalent at the beginning of the financial year when the claim was received by us.
- All payments for the Mediclaim policies shall be payable in the Indian currency, and the geographical scope of this policy will be India.
- The Medical and Personal Emergency Assistance Services will not be available in cases of reimbursement of individual Mediclaim plans and policies.
- If any Emergency Medical or Personal Assistance Services are extended to you, during the period of insurance, by Emergency Assistance Service Provider, it does, in no way, imply that your claim against hospitalization expenses is admissible by us under your insurance plan.
- Any grievances and complaints regarding your insurance plan can be registered at our website www.iffcotokio.co.in and also by visiting one of our branches near you. Additionally, the insured person or anyone on the person’s behalf can contact the grievances officer at our corporate office, if your grievances have not been resolved at the branch level.
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 4200+ 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: -
- Your age
- Previous medical History
- Existing Medical Conditions
- Optional Critical Illness cover
- Optional Additional benefits
- Claim free years
- Your physical health
- Your financial history
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:
- Your documents are incomplete and are not what we require
- Your contact details registered, do not work or are incomplete as of now,
- Your medical condition is not covered under our medical policy;
- The hospital where you are receiving treatment is not under our network;
- Your illness is of the pre-existing illness type and the stipulated time is not over yet;
- If the request for pre-authorization was delayed
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.
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 -
- The treatment was given to the insured person by a registered practitioner;
- The treatment for such ailment is according to the terms and conditions of the Mediclaim policy.
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:
- The medical treatment was given by a registered medical practitioner.
- The hospital charges and the claim is as per the terms and conditions set for the Mediclaim policy, offered by us.
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:
- The insured person cannot be transferred to a hospital due to their condition;
- The insured person has to be treated at home due to the non-availability of hospital beds in the medical institution or
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:
- If the treatment is given under general or local anaesthesia and did not require the insured person to be admitted in the medical institution, because of advanced medical facilities; then the day care procedures should be listed under our medical plan to avail any kind of benefit.
*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:
- The operations of the medical facility must be supervised by a registered medical practitioner;
- The facility must have an adequately educated staff;
- The medical facility must have and maintain daily records of the patients;
- The medical facility must have all the surgical equipment for conducting surgeries at any given point in time;
- The facility must share the maintained records with the authorities when demanded to do so.
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.