Top Features of Swasthya Kavach Policy
Multiple sum insured options – The Swasthya Kavach Health Insurance Policy comes with four floater sum insured options ranging from ₹2,00,000 to ₹5,00,000. However if buyers wishes for a sum insured that extends beyond ₹5, 00,000 up to a maximum of ₹2,000,000, then multiple policies can be issued to meet the said requirement.
Coverage for entire family – This health insurance policy offers coverage to the proposer, their spouse and 3 dependants (children, sibling, nephew, and niece). All dependents must lie in the age group of 3 months to 23 years at the time of initiation of the cover. The cover can be renewed until the oldest member covered under this policy (except the dependants) reaches 80 years of age.
No medical check-up – All buyers of 60 years of age or less do not need to undergo any medical check-up when buying this plan. For buyers beyond that age, pre-acceptance medical tests (Urine, Blood Sugar & ECG), especially in case of fresh and break coverage will be needed. Buyers of over 60 years of age will need to take a few extra medical tests (LP & KFT) too.
Premium – The premium for this health insurance plan shall depend on the sum insured and plan opted for, number of members covered and the age of the oldest member in the family.
Insured – The Swasthya Kavach Policy can be bought by anyone, given they are residents of India.
24-hours hospitalization – As per the plan, hospitalization of the insured must extend up to a minimum of 24 hours and in any of the network hospitals of the Insurance Company, to be covered. Treatments for 121 listed day care surgeries are however excluded from this and can be considered despite a shorter stay.
Critical Illness Extension - The optional Critical Illness Extension (for doubling of Sum Insured in respect of 10 listed major diseases) can be taken only under the Wider Plan (and not under the Base Plan), on payment of extra 30% on the basic premium.
Key Benefits of this Family Floater Health Insurance
Automatic reinstatement of Sum Insured – 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 a subsequent claim in respect of any family member covered under the Policy, unlike the standard policies available in the market, where Sum Insured gets reduced by the claim amount for the balance period under the policy.
Wide range of network hospitals – IFFCO Tokio has a large number of network hospitals all across the country (exceeding 5000+), where cashless claim settlement facility is available. There is also 24x7 customer support service in place, for any support relating to claims.
Unique add-on covers - Unique add-on cover available through the Critical Illness Extension under the Wider Plan option of this Policy, on payment of a small extra premium.
Portability facility – Portability facility is available under the Wider Plan option, for persons desiring to switch in from covers under other Insurer’s Policies.
Emergency medical and personal assistance – Unique emergency medical and personal assistance available for all insured persons undertaking domestic travel, through the Value Added Services available under both the Plan options of this Policy,
Cumulative Bonus – 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 of any family member covered under the Policy, 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. The facility of Cumulative Bonus is available only under the Wider Plan and not under the Base Plan of this policy.
Special premium discount scheme –
A special premium discount scheme is available under this Policy, if the Insured has affected his Motor Insurance Policy
with IFFCO Tokio, or if he is covered simultaneously as an employee/member under any Group Medical Policy issued by IFFCO Tokio.
Apart from the above, a digitally signed policy document can be issued immediately.
The Swasthya Kavach policy offers coverage for an expansive range of hospital expenses for you and your family. Included in these expenses are –
Room Rent – The standard coverage offered for room rent is up to 1.0% of basic sum insured and up to 2.0% in case of ICU/ITU.
Nursing expenses – This plan pays for all the nursing expenses, even those incurred during pre and post hospitalisation, given a qualified nurse is employed on advice of Medical practitioner.
Medical Practitioner’s fee – It also covers the fees of all kinds of medical practitioners, right from consultants and anaesthetists to surgeons.
Ambulance charges–The plans also offers compensation for expenses related to ambulance services
Daily allowance – Policyholders are liable to receive a daily allowance of up to ₹150 for the duration of their hospitalization.
Domiciliary hospitalization expenses– Expenses for medical treatments, for over three days which would require hospitalization but had to be taken at home due to certain reasons, is what domiciliary treatment refers to. For all such treatments, you shall receive compensation upto a maximum sub-limit of 20% of basic sum insured.
Pre and post hospitalization expenses– Medical expenses incurred during a period of 30 days before and 30 days after hospitalization.
Organ transplantation – The policy will also take care of the expenses for organ transplantation, lying within the overall and individual limits of sum insured.
Other hospital charges such as Registration charges, Service Charges, Surcharges etc. subject to a maximum of 0.5% of Basic Sum Insured will also be paid for under the plan.
Cost of medicines, blood, oxygen, anaesthesia, diagnostic and pathological tests, operation theatre charges, cost of chemotherapy, dialysis, pacemaker, artificial limbs etc. are also covered.
Prescribed package charges of hospital for specific treatments, subject to a maximum of 80% of Sum Insured or 80% of actual expenses, whichever is less, is covered under the plan.
The overall expense limit is capped for certain diseases/treatments, based on the Sum Insured under the Policy.
As per the policy scope, there are certain expenses that are not covered under the Swasthya Kavach Health Insurance Policy.
Cost of hearing aids, spectacles and contact lenses.
Dental treatments that do not require hospitalization
Expenses relating to or arising out of pregnancy, excluding ectopic pregnancy
Convalescence, congenital diseases/defects, sterility, general debility
Cost of external medical equipment
Claims arising from or related to HIV/AIDS
Claims arising out of participation in dangerous sports/activities
War, terrorism and nuclear risks
Treatment of obesity, hormone replacement therapy, sex change
All non-medical expenses, including personal comfort and convenience item services.
Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies
Genetic disorders stem cell implantation and surgery.
First 10% of any admissible claim, if insured person is suffering from either diabetes or hypertension and first 25% of claim, if he is suffering from both diabetes and hypertension. (This provision is applicable for claims arising out of diabetes and/or hypertension only)
Any domiciliary or out-patient treatment
Pre-existing diseases – This health insurance plan does not cover pre-existing diseases suffered by the policyholder, up to 4 years of continuous coverage from the start of the Medical Policy.
Waiting period – Even in case of newly incurred diseases (excluding accidents), coverage will only kick in after a waiting period of 30 day has passed.
For certain specified diseases, as listed in the Policy, there are one and two year exclusions periods too.
Frequently Asked Questions
Q. What is waiting period?
Waiting period refers to the number of days for which a health insurance plan does not provide any coverage to the insured, other than for emergency cases like accident.
Q. Does this health insurance plan cover maternity expenses?
No. Expenses related to or arising out of pregnancy, (except ectopic pregnancy) are not covered under this plan.
Q. How many family members does this plan cover?
The Swasthya Kavach Policy covers the proposer, spouse and 3 dependents (children, sibling, nephew and niece in the age group of 3 months-23 years).
Q. What do you mean by sub-limit?
Sub-limit is an additional limit that is applied on various aspects of a health insurance claim.
Q. Can this insurance policy be cancelled by IFFCO Tokio?
IFFCO Tokio will not cancel your insurance policy, unless it is a case of misrepresentation, concealment of material fact or fraudulent act of insured.
Q. What are add-on covers?
Add-on covers are additional covers that come alongside a standard health insurance policy and can be purchased by the buyer on payment of extra premium.
Q. What is domiciliary hospitalization?
Domiciliary hospitalization refers to the medical treatment that an individual receives at home, which should have otherwise been treated in a hospital but was not due to specific reasons.
**To understand exactly about the policy coverage, exclusions etc, please read the Policy Wording carefully.**
"These documents are applicable for health policies incepting from 01/01/2019".