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    Individual Medishield Policy


    IFFCO Tokio stands at the top when it comes to Individual Medical Insurance. Let’s look at some of the reasons you should choose IFFCO Tokio to insure your health:

    1. 1. Coverage is provided for Pre Hospitalization & Post Hospitalization Medical Expenses.
    2. 2. Coverage for Hospitalization expenses of anybody donating an organ to the insured person
    3. 3. No medical checkup is required up to 45 years.
    4. 4. 121 listed day care surgeries are covered under this policy.
    5. 5. Coverage for nursing expenses and other related fees

    In an unfortunate event of you or your family members meeting with an illness or accident resulting in hospitalization, IFFCO Tokio’s Individual Medishield Insurance Policy gives you cash free hospitalization benefit in more than 4300 hospitals across India. The Policy also reimburses expenses incurred during pre-hospitalization and post-hospitalization stages of the treatment.

    What the Policy covers
    • Nursing expenses, including that incurred during pre and post hospitalization periods (only if qualified nurse is employed on advice of Medical practitioner).
    • Daily Allowance @ 0.1% of Basic Sum Insured, subject to maximum Rs. 250 per day, for the duration of hospitalization.
    • Hospitalization expenses of persons donating organs during organ transplantation of insured person, within the overall and individual limits of Sum Insured specified under the Policy.
    • Cost of health check-up, once at the end of four claim free years block @ 1.0% of average Basic Sum Insured.
    What the Policy does not cover
    • Any pre-existing disease, for a period of 3 years of continuous coverage from inception of Insured’s first Medical Policy.
    • An initial 30 day waiting period for newly incurred diseases (not accidents).
    • One year exclusion period for few specified diseases only, as listed in the Policy.
    • Cost of spectacles, contact lens or hearing aids.
    • Dental treatment, unless requiring hospitalization.
    • Convalescence, general debility, congenital diseases/defects, sterility.
    • All claims arising from or related to pregnancy, other than ectopic pregnancy.
    • Any domiciliary or out-patient treatment.
    • Cost of external medical equipments.
    • Claims arising out of participation in dangerous sports/activities.
    • Claims arising from or related to HIV/AIDS.
    • War, terrorism and nuclear risks.
    • All non medical expenses, including personal comfort and convenience item services.
    • Treatment of obesity, hormone replacement therapy, sex change.
    • Genetic disorders, stem cell implantation and surgery.
    • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies.
    Other features of the Policy
    • Person of any nationality can be covered, but should be primarily a resident of India, since coverage is available for treatment in India only. Coverage is available for persons between 3 months and 80 years of age. Children between 3 months and 5 years can be covered only if both parents are covered concurrently.
    • No medical checkup is required up to 45 years. Beyond that age, pre-acceptance medical tests (Blood Sugar, Urine & ECG) are required to be done for fresh and break coverage only (not for continuous renewals). For persons beyond 55 years, additional tests (LP & KFT) have also to be done for fresh/break coverage.
    • There is provision of Family Package cover, including spouse, dependent children and dependent parents, with premium discount facility. Dependent children have to be unmarried and under 23 years of age. Otherwise, separate Policies without premium discount can be issued to them.
    • Hospitalization has to take place in defined institutions for a minimum 24 hours period, except for treatments pertaining to 121 listed day care surgeries, when claims would be considered for shorter duration stay also.
      Sum Insured and Premium
      • There are ten Sum Insured options available under the Policy from Rs. 50,000 to Rs. 500,000. However, if Insured desires cover beyond Rs. 500,000 (up to Rs. 2,000,000), multiple Policies can be issued to meet his requirement.
      • Cumulative Bonus (i.e. free enhancement of Sum Insured) of 5% is granted per claim free year on renewal, subject to maximum 50% of Basic Sum Insured. In the event of a claim, existing Cumulative Bonus is not entirely withdrawn, but gets reduced by 10% at next renewal, subject to the stipulation that expiring Basic Sum Insured shall be maintained. Under a Family Package Policy, the Cumulative Bonus is computed separately for each insured person i.e. all other persons (who did not have a claim) will continue to get Sum Insured increase by 5% on renewal.
      • For Ayurvedic and Homeopathic hospitalization treatments, coverage is available under the Policy, but Sum Insured is capped at 10% of Basic Sum Insured limits, including pre and post hospitalization expenses.
      • Premium depends on the Basic Sum Insured opted for and age of the insured person. The premium rates are on all-India basis, except for Gujarat, where it is different.
      • The optional Critical Illness Extension (for doubling of Sum Insured in respect of 10 listed major diseases) can be taken under the Policy, on payment of extra 30% on the basic premium.
      • For Family Package covers, there is provision of premium discount @ 5% if two persons are covered and 10% if more than two persons are covered under the Policy.
      • A special premium discount scheme is available under this Policy, if the Insured has effected his Motor Two Wheeler Insurance Policy with IFFCO Tokio, or if he is covered simultaneously as an employee/member under any Group Medical Policy issued by IFFCO Tokio.
      Key Benefits
      • Digitally signed Policy document can be issued immediately at IFFCO Tokio offices, POS centers, or for online purchases.
      • Income Tax benefit is available to the main Proposer u/s 80D of the I.T. Act, for premium paid under the Policy.
      • Pre-existing Disease Exclusion is applicable for only three years and not four years, as under most Policies in the market. Also, only a few diseases are excluded for the first year of Policy coverage. There are no two year or four year disease exclusions, as under most Policies in the market.
      • Special provision is available for automatic reinstatement of Sum Insured in the event of a claim under the Policy, to the extent of the claim amount paid, except for some specified chronic diseases. The reinstatement premium is computed on short period basis, from date of hospitalisation till expiry of Policy and deducted from the claim amount itself. This ensures that the Insured does not have any worries about getting the benefit of full Sum Insured again for any subsequent claims, unlike the standard Policies available in the market, where Sum Insured gets reduced by the claim amount for the balance period under the Policy. This facility is available under IMI Policies with Sum Insured Rs.150,000 or more.
      • Unlike most Policies in the market, there is no provision for any Excess or Co-pay under this Policy and accordingly, the full eligible claim is paid, without any deductions.
      • There is no dependence on any external TPA for claims and the entire activity of servicing and processing claims is handled by an expert in-house team comprising of doctors and other paramedical personnel.
      • There are a large number of network hospitals all across the country (exceeding 3000), where cashless claim settlement facility is available. There is also a 24x7 call centre service in place, for any support relating to claims.
      • Portability facility is available for all persons desiring to switch in from covers under other Insurer’s Policies, whereby transfer of credit gained by the Insured for Cumulative Bonus and time bound Exclusion Clauses is effected, at the time of renewal through IFFCO Tokio’s Policy. 
      • Unique add-on cover available through the Critical Illness Extension under this Policy, on payment of a small extra premium.
      • Unique emergency medical and personal assistance available for all insured persons undertaking domestic travel, through the Value Added Services available under this Policy, at no extra cost.

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