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Health Insurance
Individual Medishield Policy(IMI)

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Individual Medishield Policy

IFFCO Tokio is one of the top insurance providers when it comes to individual medical insurance. Let’s look at some of the reasons you should choose IFFCO Tokio to insure your health:

Coverage for Pre- and Post- Hospitalization Medical Expenses.
No need for medical check-up to the age of 55 years
Up to 121 day care surgeries covered
Coverage for nursing expenses and other related fees
Coverage for Hospitalization expenses of anybody donating an organ to the insured person
Health check up – The cost of health check-up is covered once in a block of four claim-free years @1% of Basic Sum Insured
Daily allowance – This can go up to a maximum of ₹250 for the duration an insured is hospitalized
24*7 Call centre support to provide information and support related to claims
4300+ Network Hospitals where the insured can avail cashless settlement of claims

Our Individual Medishield Policy is a smart way to financially safeguard you from out of pocket expenses on medical treatment for diseases and accidents. The policy provides medical cover for illnesses with an option to extend the cover for critical illnesses like heart surgery, kidney failure, cerebral stroke cancer, major organ transplantation, etc. as the treatment costs are very high for such illnesses.

The Individual Medishield Policy gives you cash-free hospitalization at more than 4300 hospitals across India. So, in case of an unfortunate event where you or your family members meet with an accident or an illness resulting in hospitalization, financial expenses resulting from it are well-taken care of.

What You Should Know

Insurance cover under the Individual Medishield Policy can be availed by any person who is primarily a resident of India as the coverage is available for treatment in India only. Coverage under the health insurance policy is available for persons as young as 3 months and up to 55 years of age. Children between the age of 3 months and 5 years can be covered only if both parents are covered under the health insurance concurrently.

The health policy requires no medical check-up up to the age 55 years. For those older than 55 years, a pre-acceptance medical tests is required to be done for fresh or/and break coverage. The medical tests will check blood sugar, urine and ECG and will not be needed if there is no break in renewal of health insurance.

Individual Medishield Policy also has a provision for Family Package cover. This cover will include spouse, dependent children and dependent parents. There will be discount on premium if the Family Package cover is availed. The dependent children is defined as unmarried children under the age of 23 years.

The hospitalization shall take place in a defined institute for a minimum of 24 hours. This time period is not liable for the 121 listed day care surgeries, where claims would be considered for shorter duration also.

Key Benefits of IFFCO Tokio’s Individual Medishield Policy

Get digitally signed health insurance document immediately Income Tax benefit under Section 80D of Income Tax Act for premium paid on the policy.
Pre-existing disease exclusion is applicable for three years, unlike the most insurance policies in the market that do not cover pre-existing disease for four years.
Large number of network hospitals across the country where cashless claim settlement facility is available.
24x7 helpline for any support relating to claims.
Portability for those who want to switch plan from another insurer’s health insurance policy.
For those undertaking domestic travel, unique medical and personal assistance service is available at no extra cost.
Emergency assistance services in cases of accidents

Unique add-on cover available through the Critical Illness Extension under this Policy

Unique emergency medical and personal assistance is available for all insured persons undertaking domestic travel.

Top Features of Individual Medishield Policy

The health insurance policy provides ten options of sum insured. The options range from ₹50,000 to ₹5,00,000. If the insured desires for a cover beyond the maximum limit available under the policy i.e. ₹5,00,000, he/she can opt for multiple policies to meet his/her requirement.
The insured shall be eligible for cumulative bonus of 5% for every claim free year at the time of health insurance policy renewal. The cumulative bonus shall be limited to a maximum of 50% of the basic sum insured. In an event of a claim being made, the existing cumulative bonus will not be entirely withdrawn but shall get reduced by 10% at the time of next renewal. In case of Family Package Policy, the cumulative bonus shall be calculated separately for each insured person.
Individual Medishield Policy provides coverage for Ayurvedic and Homeopathic hospitalization treatments. But the sum insured is capped at 10% of the basic sum insured limits. This will include pre – and post-hospitalization expenses.
The premium on the health insurance policy shall depend on the basic sum insured opted for and the age of the insured person.
Under the Individual Medishield Policy, critical illness extension can be availed by paying 30% extra on the basic premium. The critical illness extension shall double the sum insured for 10 listed major diseases, including cataract, hernia, sinusitis, and cholecystectomy, among others.
For those availing Family Package cover, there is a provision of discount on premium @ 5% if two persons are to be covered and 10% if more than two persons are to be covered under the policy.
Individual Medishield Policy has a special provision for automatic reinstatement of sum insured in case of a claim made under the policy, to the extent of the claim amount paid. This shall be applicable except for some specified chronic diseases. The reinstatement premium shall be computed on short period basis from the date of hospitalization till the expiry of the policy.

Easy Claim Process

The Individual Medishield Policy by IFFCO Tokio has a simple claim process. The claim under the policy can be settled:-

On reimbursement basis, if the treatment is availed at a non-network hospital. Such claims will require a completed claim form, cash memos of the chemist along with the prescription, pathological test reports and receipts bills, etc.
Cashless basis, if the treatment is availed at a network hospital.

Inclusions

Nursing expenses, including those incurred during the pre- and post-hospitalization of the insured, within the limits of the sum insured specified in the policy.
Daily allowance @ 0.1% of Basic Sum Insured. This amount is subject to maximum Rs.250 per day for period of hospitalization.
In case of organ transplant, the policy will cover hospitalization expenses of the donor, within the overall limit of the sum insured specified in the health policy.
Any cost of health check-up, once at the end of four claim free years @ 1.0% of average Basic Sum Insured.
Ambulance charges in connection with any admissible claim. This amount is limited to 1.0% of the Basic Sum Insured or ₹1500/- whichever is less for each claim.
The Individual Medishield Policy will cover Ayurvedic hospitalization. This will include pre- and post-hospitalization expenses. The amount shall be limited to 10% of the Basic Sum Insured.

Exclusions

The Individual Medishield Policy will not cover:-

Pre-existing disease for a period 3 continuous years of coverage, from the start of the insured first health policy.
There will be a 30 day waiting period for newly acquired/diagnosed diseases. This will not in involve accidents.
One year exclusion for certain specified diseases listed in the policy.
Any expenses incurred on spectacles, contact lenses or hearing aids.
Any Dental treatment, unless it requires hospitalization.
General debility, congenital diseases/defects, sterility.
All claims that arises from or are related to pregnancy
Any out-patient or domiciliary treatment.
Any expenses on external medical equipment.
Any claim that arises due to participation in dangerous sports/activities.
Any claim that arises or is related to HIV/AIDS
Claims related to war, terrorism and nuclear risks.
All non-medical expenses incurred, including those for personal comfort and convenience.
Claims for expenses on treatment of obesity, hormone replacement therapy or sex change procedure.
Expenses incurred on naturopathy, experimental or alternative medicine. Also, acupressure, acupuncture, magnetic and similar therapies.

Frequently Asked Questions

Coverage amount is the maximum amount payable in case of claim. Coverage amount is also known as “sum insured” The premium for the health insurance will dependent on the coverage amount chosen.

In case of hospitalization, the patient or his/her family will have to pay for the hospitalization expenses. But under the cashless hospitalization the patient has no need to settle the medical care expenses at the time of discharge from hospital. Cashless hospitalization benefits the insurer by lifting the burden of finding the financial resources to pay the medical bills, along with an easy claim settlement process.

A Third Party Administrator, commonly referred to as TPA, is an IRDA (Insurance Regulatory and Development Authority) authorized specialized health care service provider. A TPA provides the insurance providers with a variety of services. Networking with hospitals, arranging for cashless hospitalization, claims processing and timely settlement are some of the services provided by TPA.

At the time of purchasing insurance, you should be aware of any disease(s) you are suffering from and undergoing treatment for. When filing the proposal form for insurance you asked to provide details of the illnesses you have suffered during your lifetime. The insurance provider refers to all mentioned health issues to their medical panel. This panel differentiates between pre-existing and newly acquired illnesses. Remember, it is vital that you disclose any disease you might be suffering from before purchasing health insurance. Insurance is contract that is based on good faith and any willful non-disclosure of facts can lead to problems in the future.

You are allowed to make any number of claims during the policy period. However, the sum insured will be the maximum limit under the policy.

When you purchase new health insurance policy, there will be 30 day period that starts from the day policy starts. During this 30 day period any hospitalization charges will not be paid by the insurance provider. However, this is shall not applicable to hospitalization occurring due to an accident. The 30 day waiting period shall not be applicable when the health insurance is renewed.

Yes, there is no provision that stops individuals from purchasing two or more health insurance policies. In case of a claim, insurance companies will contribute to the settlement amount in the ratio of the sum insured.

For example, a person holds two policies with a cover of ₹2 Lakh and ₹1 Lakh. If the person makes a claim of ₹50,000, the insurance companies will pay ₹33,333 and ₹16,666 respectively as the claim amount.

What do you mean by coverage amount?
What do you mean by Cashless Hospitalization? What are its benefits?
Who is a Third Party Administrator and what are its functions?
How will the insurance company decide if a disease was a pre-existing one or not?
How many numbers of claims can I make over a year?
Is there a waiting periods when my medical expenses will not be settled, in case of a contingency?
Can I purchase more than one Health Insurance policy?

**To understand exactly about the policy coverage, exclusions etc, please read the Policy Wording carefully.**

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.