Founded in the year 2000, IFFCO Tokio General Insurance has more than 4,600 network hospitals spread across the country. At any of the network hospitals of IFFCO Tokio General Insurance, policyholders can avail the benefit of the cashless claim settlement facility, meaning that the hospitalisation expenses will be settled between IIFCO Tokio General Insurance and the network hospital.
What are the benefits of choosing an IFFCO Tokio Health Insurance network hospital?
Listed below are some of the benefits of choosing a network hospital of IIFCO Tokio to receive treatment:
- The claim settlement team of IIFCO Tokio General Insurance promises to settles claims within 4 hours.
- Provision of emergency assistance services as well as treatments for critical illnesses.
- Avail the benefit of cashless claim settlement at more than 4,600 network hospitals of IFFCO Tokio General Insurance.
- Cashless settlement for hospitalisation expenses as well as for pre-hospitalisation and post-hospitalisation expenses.
- Coverage for more than 120 surgical procedures.
- Coverage for doctor’s fees, medical screening expenses, ambulance charges, room and nursing expenses under the health insurance policy offered by IIFCO Tokio General Insurance.
What procedures are covered under the IFFCO Tokio health insurance cashless claim facility?
Listed below are some of the treatments and surgical procedures that will be covered by select policies through the cashless claim facility:
- Cancer and coma of a specific severity.
- Organ and bone marrow transplant.
- Stroke resulting in permanent disability or stroke-related symptoms.
- Heart attack of specified severity.
- Open chest surgical procedure.
- Permanent disability or paralysis of limbs.
- Kidney failure surgery.
- Mutiple sclerosis.
- Motor neuron diseases.
IFFCO Tokio health insurance policies also offer cashless coverage for nursing expenses, ayurvedic treatments, daily cash allowance, etc., for select health insurance policies.
What procedures are not covered under the IFFCO Tokio cashless claim facility?
Listed below are basically the treatments and procedures that are not covered by IIFCO Tolkio General Insurance:
- Cost of medical equipment for certain treatments and surgeries.
- Dental treatments unless hospitalisation is required.
- Any treatment for AIDS and HIV-related diseases.
- If the policyholder is injured or disabled following participation in an extreme sports activity.
- Any treatments related to pregnancy.
- Treatments for congenital diseases, general debility, fertility, and sterility treatments.
- If the policyholder or insured person is injured or disabled following war, strike, riots, terrorist activity, etc.
- Treatments or surgeries for sex change, obesity, or hormone replacement therapy.
- Non-medical expenses.
- Genetic disorder treatments and pre-existing diseases during the waiting period.
- Certain diseases that have a waiting period of 1-2 years.
- Naturopathy, acupressure, acupuncture and related treatments.
How do you file a claim at an IFFCO Tokio network hospital?
Depending on whether it is planned hospitalisation or emergency hospitalisation, IFFCO Tokio policyholders have to follow the cashless claim process at a network hospital of the insurer:
- Emergency hospitalisation:
Policyholders have to follow the cashless claim process listed below in the case of an emergency hospitalisation:
- Following emergency hospitalisation, the insured person has to intimate the third-party administrator of IFFCO Tokio. The insured person or policyholder has to mention the health insurance policy card number.
- At the insurance desk of the network hospital, the policyholder or insured person has to fill the cashless request form.
- The cashless request form and has to be submitted with relevant medical documents.
- The third-party administrator will then verify the submitted documents and request for additional documents if required.
- Once the cashless claim has been approved by the third-party administrator, the hospitalisation expenses will be settled between the insurer and the network hospital.
The policyholder will have to make a payment even if it is a cashless claim process if the medical expenses exceed the sum assured of the health insurance policy or if the expenses are non-medical. If the cashless claim Is rejected by the insurer, then the policyholder can opt for a reimbursement claim.
Listed below is the cashless claim process at a network hospital of IFFCO Tokio in the case of planned hospitalisation:
- The policyholder has to choose a network hospital of IFFCO Tokio and intimate the third-party administrator of the insurer 3 days prior to admission in the hospital. The policyholder has to mention his/her policy number to register the claim.
- At the insurance desk of the hospital, the policyholder or insured person has to fill the cashless form which has to be attested by the practicing doctor.
- The cashless form as well as the relevant medical documents will be faxed to the third-party administrator for verification.
- The third-party administrator will then verify the submitted medical documents and might request the policyholder for additional documentation if required.
- If the third-party administrator approves the cashless claim, the hospitalisation expenses will be settled between the insurer and the network hospital. If there are any non-medical expenses or if the hospitalisation expenses exceed the sum assured of the policy, the policyholder will have to pay the balance amount prior to getting the discharge certificate.
Here too, if the cashless claim is rejected by the insurer then he/she can opt for the reimbursement claim process. In this case, the policyholder will have to pay for the hospitalisation expenses and then submit the medical bills and documents to the insurer following discharge for reimbursement.
- What’s the difference between an individual health insurance policy and a family floater health insurance policy? Does it make sense for each member of a family to buy an individual policy?
An individual health insurance policy offers coverage of hospitalisation expenses for a single person - the policyholder. On the other hand, a family floater health insurance policy insures the immediate family members of the policyholders such as the spouse, children, and parents. Insuring one’s family members with individual health insurance policies will prove to be an expensive affair and the family floater insurance policy will be a lot more beneficial and inexpensive in such a case.
- Does it make sense to have a health insurance policy if I have a life insurance policy?
Life insurance policies do not offer coverage for hospitalisation expenses but only a lump-sum payout if the policyholder has opted for a critical illness add-on cover and is diagnosed with a critical illness. To cover medical and hospitalisation expenses, a health insurance policy is absolutely necessary.
- What if my reimbursement claim is rejected after a filing for a cashless claim at a network hospital which got rejected as well?
You should ask the insurer to state the reason for rejecting the claim and appeal against it to the Insurance Ombudsman. You could also approach the consumer court with your defense.
- What can be done if the policyholder is admitted in a non-network hospital following an accident?
You will have to file for a reimbursement claim since you have received treatment at a non-network hospital and the cashless claim facility will not be a possibility.
- What affects the premium of a health insurance policy?
Listed below are some factor that affect the premium of a health insurance policy:
- The age of the policyholder
- Whether he/she is a smoker or non-smoker
- Medical history
- Sum assured chosen by the policyholder
- Medical history of the family of the policyholder