Individual Health Protector Policy

IFFCO Tokio Individual Health Protector Policy

This Policy provides a health protection cover for you and your family. Here is something to look forward to when buying this policy from IFFCO Tokio:

• Coverage is provided for Ambulance charges.
• Coverage for Critical Illness & Emergency Assistance Services is provided.
• You can also claim pre and post-hospitalization expenses.
• 121 Surgical Procedures are covered under the policy.
• Vaccination and health check-up charges are covered.
• Coverage for alternate treatments like Ayurveda, Homeopathy, Unani, Sidha, etc.
• Policy covers hospitalization expense including the Room Rent, Nursing expenses, Doctor’s fees, medicine expenses, Medical tests fees, etc.

The Policy offers a health protection cover for you and your family for any illness, disease or injury related contingencies like hospitalization, medical expenses, surgical expenses, organ transplantation etc.

Need of Health Insurance

With the comforts of modern day lives come the issues related to it. The fast-paced and non-stop lifestyle that we lead these days leaves us very little time to take care of our health and well-being. This leaves us vulnerable to various forms of severe medical conditions which can have a devastating effect on our life.

But thanks to the rapid progress being made by medical science, new discoveries are being made regarding treatment of various ailments which were previously untreatable. But there is another aspect to this story. In current times of high medicare inflation rates, good quality Medicare services are becoming very expensive.

If you meet any accident or fall victim to any critical illness, you and your family members would want only the best possible treatment for you. But due to the high cost of quality medical care, chances are that you will end up either wiping out all your savings or mortgaging your assets. This is a highly unwelcome situation which can affect the future of your family members and you. With hospitalization and medical expenses becoming dearer with each passing year, failure to subscribe to a comprehensive cashless Mediclaim policy is like inviting a major financial disaster. This would force you to either opt for poorer health care option due to financial constraints or running into debts due to exorbitant medical bills.

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: -

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:

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: -

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: -

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 –

For Normal Room: -

For Intensive Care Unit/Therapeutic Expenses: -

Registration Charges, Service Charges and other similar charges are reimbursed up to a maximum of 0.5% of the sum insured.

In case of any unfortunate incident such as a terrorist attack befalling on any Mediclaim policy holder, we make sure that all expenses related to the treatment are covered as usual.

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: -

You never know when a tragedy might befall you, which is why you should always be prepared for any such eventuality.

Additional Covers

Having gained years of experience in this field, we are perfectly aware that reimbursement for just hospitalization expenses is not sufficient. Many more variables are involved which if not taken into consideration, can mess up your entire estimate. In order to help you meet all your medical expenses, we have made it a point to include them in the coverage of our Mediclaim policy.

This feature comes in very handy when you need to undergo a medical procedure or bear hospitalization expenses, as you get additional coverage over and above the basic sum insured in your Mediclaim. This will help you meet out various expenses without affecting your savings in any way. This feature works in the following way: -

For each claim free year, 5% of the basic sum insured at each renewal will be added as a bonus to your cumulative bonus. This 5% will continue being added each year up to a maximum of 50% of the basic sum insured of the expiring policy.

If you make a claim during the policy period, the cumulative bonus shall be reduced by 5% of the basic sum insured, at the next renewal, if the basic sum insured is maintained.

To be eligible for the cumulative bonus you must make sure that the policy is renewed on time or utmost within thirty days of the expiry date. Otherwise, your cumulative bonus may be forfeited.

Emergency Assistance Services: - In modern times, travelling plays a big part of our lives. Whether you are living with your family or living alone, you might have to travel for work related purpose or family requirements and also need to stay away from home for extended durations. But what happens if you are taken seriously ill there and are not in a position to travel back home? You will have to undergo hospitalization to receive proper treatment for your ailment, but who will take care of all the expenses for you? Does that mean you must wipe out your hard earned savings? What can you do in such a situation because your policy does not offer you the benefit of seeking treatment away from your city? This is where our cashless Mediclaim policy comes to your rescue.

With IFFCO Tokio’s comprehensive Mediclaim policy you need not worry about the hospitalisation and Medicare expenses even if you are travelling away from home because we care for your health and do not want you to put yourself at unnecessary risk just to receive medical attention. That is why we offer you a huge range of emergency medical services, at no additional cost when you are more than 150 km away from your registered home address, within India for a periodof less than 90 days. In cases where it is not possible to ascertain if the situation is an emergency or not, you will get the benefit of the doubt.

IFFCO Tokio is the first company in India to introduce this coverage with the following benefits, that too without any sub-limit: -

Emergency Medical Evaluation: - You will have access to fully functional operations centre with multilingual staff working 24x7, 365 days a year to deal with emergency situations. Qualified medical personnel are there for consultation and evaluation of your situation and then refer the case to suitable doctors in the vicinity.

Emergency Medical Evacuation: - If according to the attending physicians or consultants, there is a medical emergency and no other suitable medical facility is nearby for your treatment, then our representative will arrange for you emergency evacuation to the nearest medical centre with required facilities, through appropriate means of transport.

Medical Repatriation: - If necessitated by your medical condition according to our physicians and consultants, we will arrange to repatriate you to the registered address as per the policy schedule through suitable means of transportation as suggested by our doctors for travelling. If it is not possible to repatriate using normal air carrier, we shall arrange for the repatriation through air ambulance along with medical supervision.

Emergency Message Transmission: - Our representative will act as the point of contact between your family members if you are unable to do so due to your medical condition. We will arrange for sending the message to and fro, as and when required.

Transportation to join the patient: - We will provide a nominated family member or friend with a round-trip economy class fair through a common carrier to the airport nearest to the hospital. This facility will be available if you had been travelling alone and had been hospitalized for over one week continuously. If required, we shall also arrange for a suitable accommodation for the travelling person. But it should be noted that it would be the responsibility of the travelling friend or family member to arrange for the necessary travel documents and meet the cost of accommodation arranged by us.

Emergency Cash Coordination: - If there is an emergency need for cash and you have arranged for the funds but do not know how to transfer them urgently, then our representative will organize the transfer of cash. It should be noted that arrangement of the funds is your responsibility.

Transportation and Care for minor children: - If due to your serious medical condition, your minor children have been left unattended, our representative shall arrange for shifting the minor children to the house of a nominated friend or family member living in the same city. If required, we shall also arrange for an attendant to accompany the children during transportation.

Return of Mortal Remains: - In an unfortunate scenario of death of any insured person, our representative will pay for all the expenses necessary to return the mortal remains to the registered address. Our representatives will offer all possible assistance necessary for the transportation including obtaining all legal clearances, completing all documentation, obtaining a death certificate and arranging for a casket for safe transit. Once the body reaches the local airport, we shall arrange for transportation of the dead body to the local funeral home or any other destination as per your preference.

Conditions ‘prior to the entitlement to benefits’ under Emergency Assistance Services

But it should be noted that unless agreed upon by us or our representative, no claims for reimbursement shall be entertained regarding any services arranged yourself.

Eligibility and Prerequisites

As you must have understood by now that having a Mediclaim policy is not a luxury but is rather a necessity in the present-day world, and you should avail IFFCO Tokio’s cashless Mediclaim policy for your family members. There are numerous benefits that you get from opting for the coverage of our Mediclaim plan.

But before you opt for an individual cashless Mediclaim policy, you must understand the eligibility criteria and pre-requisites for our best cashless policy carefully so that you can draw maximum benefits offered by the coverage of our policy.

Eligibility

Entry Age: - There is no minimum entry age requirement for subscribing to our Individual Mediclaim policy, and even minor children are eligible to have an independent Mediclaim policy. If you have an existing cashless Mediclaim policy with some other insurance company, even then you or any of your family members with individual policies can opt for IFFCO Tokio’s best Mediclaim policy as per your requirements.

In case you have an existing Mediclaim Policy or Mediclaim policy for senior citizens from any other insurer, and want to switch over to IFFCO-Tokio for the extensive coverage offered, then you can expediently do so. You will enjoy the benefits of continuous coverage without any waiting period or pre-existing condition exclusions.

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.

Online Channels

Company Website – You can avail the benefits offered by our online cashless Mediclaim policy through our company website. Here you can find all the details about the various options available to you with regards to the best cashless Mediclaim policy for family and individuals, based on your requirements, in addition to all the details about the policy.

You can choose from among the various riders available along with any additional benefits you require. You can also opt for the critical illness cover to enhance your protection against any of the named critical illness. As there are no middlemen involved, you can rest assured to get the lowest premium prices for our Mediclaim policy on our website.

In case you have any doubts or queries, you can freely contact our customer care representatives for further information. Our customer service executives are well versed with all our policy features and will be definitely able to help you out.

Marketplaces

For the sake of your convenience, we also offer our best cashless Mediclaim policy through various online insurance marketplaces and platforms. There you can compare the benefits offered by our company as compared to others and then take an informed decision. They also provide you with the option of purchasing the Mediclaim Policy for senior citizens online. If you are facing any hassles, just fill out the query form and the customer service executives will guide you through the process.

You can rest assured about the safety of your data as the online aggregators would direct you to our website only, and the whole procedure would be completed on our secure servers. But the premium, in this case, can be slightly higher as compared to buying the cheapest Mediclaim policy directly from our website.

Offline/Retail Channels

We understand that completing the whole procedure to buy Mediclaim policy online is not convenient for everyone. You might be reluctant to fill out your details online or do not have the facility to complete the payment procedure online or do not have the facility to scan and upload the required documents. Whatever may be the reason, you need not fret over it.

We have developed a wide spread network of retail dealers and agents spread throughout the length and breadth of the country, who are more than willing to help you with the whole process in selecting the best cashless Mediclaim Policy and make sure that you only select the cheapest Mediclaim Policy for yourself.

Company Offices

We have our offices present across all key locations in the country, where our staff members are always willing to help you with purchasing a cashless Mediclaim policy for family or individuals. You can simply walk-in to any of our offices, sit down with our customer care executives and discuss your requirements in detail.

They will help you select the best plan based on your requirements and budget. Once you have decided as to which is the best cashless Mediclaim Policy for family and you, they will help you complete all the necessary formalities including filling the form and payment of the premium. All these services are absolutely free of cost, and you need not pay anything to anybody.

Customer Care Department

In case you have any doubts regarding the procedure to buy the cheapest Mediclaim Policy online, our highly knowledgeable customer service executives are always ready to help you out. They are well trained to take care of any possible issues that you may be having while taking a decision to buy the best Mediclaim policy for parents or yourself. You can discuss all your requirements with them in detail, and then they can help you choose the best Mediclaim plan for yourself and also walk you through the online purchase procedure.

If you require we can also arrange for our sales executives to visit your place, sit down with you and explain the benefits of various Mediclaim plans offered by our company. Our executives will also help you fill up the forms, arrange the documents, prepare the premium cheque and select the best plan according to your requirements. Our Sales representatives possess complete knowledge about the various plans available and will help you make an informed purchase decision. You can openly raise any queries that you may have, and we assure you that all your concerns will be addressed to.

Getting a comprehensive Mediclaim policy to meet out your hospitalisation and Medicare expenses is hugely important. You can choose whichever medium you choose to subscribe to the cheapest Mediclaim Policy plans offered by us, online or offline, you will enjoy the same benefits, and all the subsequent procedures will remain same.

Pre-Existing Medical Conditions

This is a very important section that you should handle very carefully. If you are suffering from any existing medical conditions that might have an impact on your health later on, such as hypertension, diabetes etc., you must disclose those pre-existing medical conditions at the time of subscribing to the Mediclaim policy. If you willingly or unwillingly withhold any critical information and that is brought to our notice, later on; it would lead to cancellation of your cashless Mediclaim policy. Once you disclose the pre-existing medical conditions in the form, thereafter you are free from the worries regarding any issues that might come up when you file a claim subsequently.

Selection of Sum Insured

Selection of the sum insured is also a very crucial decision that you must make. Best Mediclaim policy plans from IFFCO Tokio offer extensive coverage against a vast array of medical conditions and critical illness. This helps you meet any unexpected health-related emergencies without affecting your savings. Ideally, you should consider the cost of quality Medicare facilities in your city and your lifestyle to ascertain the amount of Mediclaim you require.

If you go for a coverage amount lower than what is needed, then it would result in unaffordable quality health care, and you will be forced to choose a sub-standard healthcare provider. If you choose a very high amount, depending on your age and medical condition, then you will end up paying a much higher premium than what is necessary and lose out on better investment opportunities.

These situations are called under insurance and over insurance, both of which must be avoided at all costs. Let’s have a brief look at these two phenomenon: -

Under-Insurance: - It is a situation which occurs when you underestimate your insurance requirements and end up with lower than required coverage. This leaves you vulnerable to a lot of uncertainties in life, and the worst part is that you do not realise this, until it’s too late. A lot of reasons could be attributed to the rampant practice of under-insurance in India, such as: -

Whatever be the reason, under insurance is a very serious issue which might come to hurt you back when you are least prepared for it. Just imagine yourself falling victim to a critical illness like cancer which is treatable but needs you to be admitted into one of India’s best hospital, which will cost a huge sum of money. But due to your mis judgement at the time of availing the policy you forgot to select the critical illness cover and now have no other option than to just spend all your savings. This is a very sorry situation but one which is entirely possible. There is a very simple way to avoid facing such serious and embarrassing situations, IFFCO Tokio’s cashless Mediclaim policy with optional critical illness cover which offers you extensive coverage against a vast range of medical ailments by paying an optimum amount of premium.

IFFCO Tokio is committed to saving you from falling victim to this serious oversight of under insurance. That is why our customer care representatives and channel partners are always ready to help you assess your insurance requirements and willing to help you subscribe to the adequate insurance cover as per your requirements. Do not look at Mediclaim insurance as an investment for immediate returns, think of it as an investment to safeguard your future.

Over-Insurance: - Although a very rare phenomenon in India, but it is still prevalent in major urban centres. This is a situation where you end up buying a Mediclaim policy with coverage amount which is much more than what you or the insured family member requires. As a result, you end up paying too much money in premium which could otherwise have been used by you for some other investment opportunity. This can happen when you try to overcompensate for a previous error of judgement, where you opted for inadequate insurance cover and ended up spending some money from your pocket.

There are various reasons that could lead you towards over-insurance, such as: -

As you would have been able to analyse from the above concepts of Under-insurance and Over-insurance, choosing the optimum coverage is very important to be safe against any future medical exigencies.

Therefore, it becomes very important for you to carefully consider the following factors, before opting for the amount insured that you require: -

Age: - Your age has a very important determinant for the extent of coverage you require. If you are young and healthy, you can start from a low sum insured and increase it gradually over the years, whereas if you are in your 40’s, then you need higher sum insured to take care of increasing medical expenses.

Health: - You should also take your current status of your health into consideration while deciding on the coverage you need. If you are young and enjoying excellent health, then you may start with a lower coverage amount as you may not get hospitalized regularly. Whereas if your health condition is not very good and you feel that in the future you may need to undergo certain medical procedures, then you should choose the policy coverage amount accordingly.

Existing Ailments: - If you are suffering from certain ailments that require regular visits to doctors, then you should opt for higher policy coverage to take care of your medical expenses. Sometimes you know that with age, your ailment will worsen further, and your medical expenses are going to increase further. Hence, it would be wise for you to opt for a higher coverage amount and increase it gradually every year so that your premium payments do not increase suddenly.

Surroundings: - The city and environment that you live in also need to be taken into consideration while deciding on the policy coverage that you must have. If you are living in a metropolitan city such as Delhi and Mumbai, then you are likely to face pollution and stress on a regular basis and are more likely to need regular medical attention. Medical facilities in these cities are also relatively expensive, making higher policy coverage a necessity. In comparison, if you live in a smaller town with clean surroundings and low pollution levels, then your medical expense will be little lower as the medical facilities here are relatively cheaper.

Income: - Your income level should also be considered as an important parameter while deciding the extent of Mediclaim coverage required for you. Although good Mediclaim Policy with high coverage is desirable for everyone, affordability is also an important factor, as you must take care of other routine expenditure as well. So carefully analyse your income level and medical requirements and then take a balanced decision which satisfies all your requirements.

Financial planning: - Analyse your future requirements such as the extent of Mediclaim coverage required, investments you need to make and commitments you need to honour carefully and then according to your income level, allocate a proper percentage to each of these heads so that all your future requirements are well taken care of.

As your trusted insurance partners, we at IFFCO Tokio suggest you introspect and analyse carefully before opting for cashless Mediclaim policy.

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: -

Once you enter all these details, you will be able to see the premium amount you must pay for the desired coverage. If you find it satisfactory, you can proceed ahead to the payment page and get yourself insured against any medical emergencies, there and then.

Here is the link to the Cashless Mediclaim policy for individual’s premium calculator page: -

https://www.online.iffcotokio.co.in/itgiwebportal/

In case you are unable to access the online cashless Mediclaim policy premium calculator for any reason, you can contact our customer care at 1-800-103-5499. Our representatives will be more than happy to assist you with the whole process and answer any queries that you may have.

Payment of Premium

After you have taken a decision regarding the amount of coverage, the benefits you require, and the additional riders you want, comes the next most important step, i.e. payment of premium to begin your insurance coverage.

In case you have an existing cashless Mediclaim policy in effect, then please do make sure that you make the premium payment for renewal on time. This way your policy will remain in force protecting you against the medical uncertainties. In case you delay the payment more than 30 days, then your cashless Mediclaim Policy would be null and void, all your accumulated benefits forfeited, which can lead to serious consequences later on.

Various Acceptable Modes of Payment

We at IFFCO Tokio understand the importance of timely payment of insurance premium with regards to the continuation of your cashless Mediclaim Policy so that you stay protected against any medical emergency.

Hence to help make things convenient for you, we accept payment for your premium through a host of options. You can choose between online as well as offline payment methods to pay your policy premium.

Following are the acceptable payment methods: -

Online Options

• 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.

Offline Options

For those of you, who are not comfortable with the online methods of payment or do not use any such methods, do not worry. We have a host of offline options available for your convenience: -

Drop-Box: - We have conveniently fixed drop-boxes at strategic locations to make it easy for you to make the premium payments without travelling to the branch. You can pay by Cheque/Demand Draft,

Post: - You can also mail your cheque and demand draft to make the premium payments conveniently.

You are free to choose a payment method as per your convenience, but do remember to make your payments well in advance, to continue enjoying the benefits of your best cashless Mediclaim policy for family members.

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 (%)
1 Month	75%
3 Months	50%
6 Months	25%
Exceeding 6 (six) months	NIL

• 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: -

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.

Exclusions

Following are the exclusions in case of which our company will not be able to compensate your claims:

If any of the following conditions are present in you, then at the time of subscribing to the first insurance policy, these medical conditions will be considered as a pre-existing condition and shall be subject to a waiting period of 48 months before being covered under the policy are: -

During the first 30 days of a new health insurance plan, any expense incurred on account of medical issues, costs for hospitalization for any diseases, shall not be covered under the health insurance plan. However, this exclusion shall be overlooked or waived off when and if you have an existing medical policy with some other insurance company in India and have completed at least 12 months with the same insurance.

If the following conditions which are aggravated by hypertension are present in the insured person, at the time of subscribing to the first insurance by the insured person, will be considered as a pre-existing condition and shall be subject to a waiting period of 48 months before being covered: -

The treatments for erectile dysfunctions, sex change operations, unnecessary cosmetic and aesthetic treatment of any sort, are excluded from the insurance.

If the following conditions are present in the insured person, at the time of subscribing to the first insurance with us, these will be considered as a pre-existing condition and will be subject to a compulsory waiting period of 48 months, before being covered under our your medical insurance: -

Your medical expenses will not be covered by the insurance company during the first thirty days after the commencement of your policy, with us. However, this will only stand true for those insurance policies that are new, for older or those insurance policyholders with multiple policies with other insurance companies or for a period of more than 12 months, this waiting period will be waived off, and the claims will be processed as per the usual guidelines.

The list of hospitals listed and covered under our network is revised from time to time, and our list of blacklisted hospitals is updated regularly, which is why you should make it a point keep checking it from time to time. If you, as an insured person, go through some medical treatment at a hospital that is blacklisted or not covered by us, you may not get your medical claim in case of claims and cashless benefit cannot be availed unless the hospital falls under our network. It is recommended that you get in touch with our customer care by calling 1-800-103-5499 to know about your hospital.

If any of the following conditions are present in the insured person, during the time of subscribing to the first Mediclaim Policy with us, it shall be considered as a pre-existing condition and shall be subject to a compulsory waiting period of 48 months before being covered by the family health insurance:

The medical claim for the first insurance plan will not be processed during the initial 30 days. However, you will be entitled to coverage for medical bills, costs, and other expenses once the first 30 days elapse. Other than this, if you have medical insurance with any other Indian company, you can get your claims processed easily. Furthermore, it does not stand true for your renewed insurance policies.

Claims Procedure

It is very important that you follow the right course of action that needs to be followed to make you should keep in mind the dos and don’ts of Mediclaim. In this section, we have discussed in detail the complete guidelines that policyholders should know, to have a clear idea. It covers cashless Mediclaim as well as post-hospitalization reimbursement claim procedures.

General Guidelines

Following are the guidelines that are common to all the categories irrespective of the time of the claim settlement. These points need to be followed to word to avoid rejection of claim afterwards: -

• 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.

Cashless Claims

At IFFCO-Tokio, we try our best to serve our clients and help them with cashless hospitalization at all times. But there certainly are certain situations in which your cashless claim can get rejected or delayed. Here are some of the: -

There can be many other reasons as to why your cashless claim might get delayed or denied. We, at IFFCO-Tokio, give authenticity the topmost priority.

If your cashless claim has got delayed, we can still help you by reimbursing the amount if your claim is legitimate. The only drawback is that you have to settle the hospital bills out of your own pocket. But once you have submitted all the necessary documents and fulfilled the conditions, and our officials at IFFCO-Tokio find your claim to be valid, you will be reimbursed fully up to the permissible amount as per the terms of your policy.

At IFFCO Tokio, we look forward to serving you the best service in terms of cashless Mediclaim policy. But it will help you better if you follow the rules and guidelines and are a bit more attentive towards the proper maintenance of your policy.

Reimbursement Claims

As mentioned before, you can claim for reimbursement if for some reason your cashless Mediclaim was not settled. If your claim is valid and all the documents are in order and conditions fulfilled, then we will reimburse your hospital bill, up to the right amount. Here are the guidelines you need to follow, to apply for a reimbursement: -

• 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.

Do’s

• 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.

Don’ts

General Conditions

These are some general terms and conditions governing our Mediclaim plans, including the best Mediclaim policy for parents as well as individuals. You should go through them carefully, to understand the implications associated with each of them.

• 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.
• Subrogation:
• 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.

• Cancellation:
• 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 (%)
1 Month	75%
3 Months	50%
6 Months	25%
Exceeding 6 (six) months	NIL

• 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.

FAQ’s

1. What do you mean by Individual Health Policy?

2. What is Health Insurance?

3. What kinds are Health Insurance policies offered by IFFCO-Tokio?

4. Why is a Health Mediclaim Policy important?

5. What kinds of Family Health Insurance plans are available?

6. Is cashless facility available under Mediclaim Policy for me?

7. What are the tax benefits I get if I opt for health insurance?

8. What are the factors that affect the Family Health Insurance premium?

9. What does a Health Insurance policy not cover?

10.Is there any Waiting Period for claims under a health plan?

11.How is a pre-existing condition defined under health insurance policy?

12.If my policy is not renewed in time before the expiry date, will I be denied for renewal?

13.Can I transfer my health insurance plans from one insurance company to another without losing the renewal benefits?

14.How do I get my insurance claim?

15.What is the maximum number of claims allowed over a year?

16.Does your Health Insurance plan for cover everything from accident, surgery, normal hospitalization?

17.What are the advantages of sticking to one Insurance company for a long time?

18.What is the key to a successful claim for health insurance plans for myself, in case of emergency or planned hospitalization?

19.How can I buy a medical insurance policy from IFFCO Tokio?

20.During the course of my treatment, can I change the hospitals?

21.What are the situations under which I may be denied cashless hospitalization under your health insurance plans?

Glossary

Proposal - “Proposal” is one of the most important documents when a person buys an insurance policy. This document contains all the relevant information about the person who is looking to buy an insurance policy from the company. It may include age, sex, occupation, the person’s medical history, etc.

Policy - Policy or Mediclaim policy means the terms and conditions applicable to the insurance plan so chosen by the person. The policy will contain all the details of terms, inclusions in the policy, the term plan and other relevant details to the insurance policy.

Basic Sum Insured - Basic sum insured in common terms, is the amount of money/coverage the insured person will get under the chosen policy without adding any discounts or bonuses.

Sum insured - The sum insured for a Mediclaim policy for senior citizens or individuals is the maximum sum standing at the end of one year that your insurance company will pay in case you are hospitalized. However, the company will not pay anything above the sum insured.

Extended Sum Insured - The extended sum insured for a health insurance policy means that it is an extension of the existing policy including bonuses and other extensions.

We/Our/Us - It means IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED.

You/Your - It means the person who buys the medical insurance.

Insured Person - The insured person here means the person under whose name the insurance policy has been bought.

Period of Insurance - Period of insurance is the time period of the insurance, meaning from the starting date of the insurance plan to the end date of the same insurance plan.

Hospitalization - This means being admitted into a recognized medical institution or nursing home or hospital for at least a minimum of 24 hours for any kind of treatment, for an ailment that you/insured person suffers from. Some insurance providers even offer you day care services and cashless Mediclaim Policy allowing you to get your treatment without any cash.

Pre-Hospitalization Medical Expenses - This means that all the expenses that have been borne by the insured person before being admitted into a recognized hospital or medical institution; or borne by the insured person’s friends or family, whatever the case may be. This kind of expenditure will be reimbursed by the insurance company given -

Post-Hospitalization Medical Expenses - These expenses cover all the expense that arises right after the medical treatment or hospitalization of the insured person. These expenses are of medical nature and are borne by the insured person after being discharged from the hospital. These expenses will be reimbursed by the insurance company, us, provided:

Medical Practitioner - A medical practitioner or a registered medical practitioner is a person or a doctor, who possesses a valid license, for practising medicine and providing medical services to people, authorized by The Medical Council of India or by any other statutory authorities of the State Government or Central Government. All of the actions of the medical practitioner should fall under the jurisdiction and the scope defined and mentioned in the license of the medical practitioner.

Qualified Nurse - The qualified nurse can be a male or female, who possesses the valid registration from the Nursing Council of India or from any other statutory authority in any state in India.

Domiciliary Hospitalization - In simple terms “domiciliary Hospitalization” means that the insured person is given standard medical care for their illness, disease or injury in their house when the insured person is confined to their house for prevailing or existing reasons. However, the circumstances under which our company provides for the medical care and takes care of the insured sum are following:

Pre-existing Condition - A pre-existing condition can be described as the medical condition of which the insured has been either been showing symptoms or has received treatment for in the past four years or 48 months prior to the medical insurance availed.

Day Care Treatment - Daycare treatment refers to the medical attention (can be surgical) given to the insured person by a registered practitioner for less than 24 hours. The coverage of such procedures under our health insurance policy will depend on the following:

*Note - Normal treatment or medical attention administered to the patient on an outpatient basis is not covered under our daycare procedures.

Provider Network –The term covers all the medical institutions, nursing homes, health care providers or hospitals that offer authorized medical care and treatment as enlisted by the Insurance Company and offer treatment to the insured person on a cashless basis.

Non- network hospitals - These hospitals are not enlisted by the company to offer the cashless medical facility to the insured person. In simple terms, it is any hospital that is not in the “Provider Network” of the company.

Emergency Assistance Service Provider - The emergency assistance service provider is any entity or body that is offers medical support and care in case of emergency, to the insured person under their Mediclaim policy, when they are 150 kms away from the insured person’s domicile address, provided that the entity or the body comes under Indian territories.

Medical Assistance Services - The medical assistance services are the emergency medical treatment or services offered by the emergency assistance service provider during situations of emergency, while the insured person’s registered domicile address is only 150 kms away. However, the terms and conditions for the medical assistance service are similar to the emergency assistance services.

Medical assistance services include - medical consultation, medically supervised repartition, medical evacuation and medical referrals.

Co-Payment - A part of the expense of the medical care and medical treatment is taken care of by the insured person themselves, while the remaining part of the medical treatment or care is offered by us. This term can be used interchangeably with “co-insurance.”

Emergency Care - Emergency care means the urgent and the immediate medical care provided to the insured person in case of severe injury or ailment by a medical practitioner.

Grace Period - The grace period refers to a period of 30 days, offered by the company to the insured person of the Mediclaim plans, immediately after the due date of their premium payment. During this time, the insurance premium for your Mediclaim policy must be paid to ensure the safe running of your policies and plans. The failure to pay the insurance money during this time, i.e., during the grace period of 30 days, shall lead to the expiration or cancellation of your insurance policy with the company.

Inpatient Care - This can be described as the medical treatment that is given to the insured person in the hospital. However, this treatment lasts less than 24 hours. If such treatment comes under day care procedures as mentioned by policies, then these medical services will fall under in-patient care.

Outpatient Treatment - This kind of treatment means that the insured person visits a particular department or a medical facility or a hospital or a nursing home in order to get some medical care regarding a diagnosis or medical condition the insured person is already facing by a medical practitioner. Here the insured person is not admitted to the hospital, or treated under in-patient and daycare categories.

Day Care Centre - The day carecentre is an institute, which has been set-up to offer day-care treatments to the insured person for ailments covered under the Mediclaim plans of the insured person. Proper departments that are set up under a recognized hospital also fall under this category. These day-care facilities must be registered under statutory authorities of India and must be run by or should be supervised by qualified medical practitioners. The day-care centre must follow the following criteria:

• 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.