• IFFCO Tokio Swasthya Kavach Family Health Insurance Policy

    Health Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    IFFCO Tokio is one of the private general insurance service providers operating in India. The company offers insurance service in multiple domains including motor, health, travel, home, etc. In the health insurance domain, the company offers a lot of products suitable for people with different requirements. Swasthya Kavach Policy by IFFCO Tokio is a comprehensive family health insurance plan that offers complete protection against various health ailments. This policy offers a range of benefits and ensures that a family does not face financial distress during a medical emergency.

    Eligibility for IFFCO Tokio Swasthya Kavach Policy

    People who wish to subscribe to IFFCO Tokio Swasthya Kavach Policy must belong to the following criteria.

    • The entry age of the proposer must be between 18 years and 60 years.
    • Dependent children between the age of 91 days and 23 years can be enrolled in the policy provided their parents are also covered.
    • Coverage is available for the proposer, spouse, and 3 dependents (children, siblings, nephew or niece)
    • This policy can be renewed till the age of 80.

    Features of IFFCO Tokio Swasthya Kavach Policy

    Some of the key features of IFFCO Tokio Swasthya Kavach Policy can be listed as follows.

    • This is a family floater policy that covers the whole family under a single insurance policy.
    • This policy is available in two different plans, and the coverage varies based on the chosen plan.
    • This policy comes in four different sum insured options - Rs.2 lakh, Rs.3 lakh, Rs.4 lakh, and Rs.5 lakh.
    • Pre-acceptance medical examination is required for people over the age of 45.
    • Additional medical examination is required for people over the age of 55 in order to provide fresh coverage.
    • All pre-existing diseases have a waiting period of 4 years before coverage is available.
    • Certain conditions such as heart diseases, renal failure, blood cancer, etc. have a waiting period of 2 years.
    • There is a general waiting period of 30 days for all illnesses. However, this waiting period does not apply for accidental hospitalisation.
    • There is no copayment or deductible option available with this policy. Policyholders can enjoy the full benefits without any deductibles.
    • Cashless treatment facility is available in the company‚Äôs network hospitals which exceed 3,000 all over the country.
    • There are no third-party administrators (TPAs) involved in this policy. Policyholders can contact the company directly in case of a claim.
    • Portability option is available under this policy to ensure that customers transfer the policy without losing out their cumulative benefits and waiting period benefits.
    • There is a free look period of 15 days for policyholders to review the terms and conditions of this policy.
    • The premium amount paid towards this policy is eligible for tax relief according to Section 80D of the Income Tax Act.

    Benefits of IFFCO Tokio Swasthya Kavach Policy

    This policy offers a range of benefits for its policyholders. The benefits offered by IFFCO Tokio Swasthya Kavach Policy along with their sub limits can be given in the following table.

    Benefits Base Plan Wider Plan
    Room rent 1% of the sum insured 1.5% of the sum insured
    Intensive care unit charges 2% of the sum insured 2.5% of the sum insured
    Ambulance charges Up to Rs.750 per hospitalisation Up to Rs.1,500 per hospitalisation
    Cumulative bonus nil 5% per claim-free year subject to a maximum of 50% of the sum insured
    Daily allowance Rs.150 per day Rs.250 per day
    Health checkup expenses nil Up to 1% of the sum insured after 4 years of continuous policy coverage
    Critical illness cover (optional) Not available Available for up to 10 major illnesses named in the policy policy document upon payment of 30% additional premium
    Pre hospitalisation expenses Covered for up to 30 days before admission in a hospital Covered for up to 30 days before admission in a hospital
    Post hospitalisation expenses Covered for up to 30 days after discharge from a hospital (capped at 7% of the hospitalisation expenses) Covered for up to 60 days after discharge from a hospital (no monetary capping)
    Domiciliary hospitalisation Up to 20% of the sum insured limit (treatment period must be at least 3 days) Up to 20% of the sum insured limit (treatment period must be at least 3 days)

    Exclusions of IFFCO Tokio Swasthya Kavach Policy

    Though the coverage offered is extensive, the company is not liable to compensate the insured for all injuries or illnesses. Some of the exclusions under IFFCO Tokio Swasthya Kavach Policy can be given as follows.

    • All non medical expenses including personal comfort and convenience items
    • Cost of accessories such as spectacles, contact lens, and hearing aids
    • Any injuries or illnesses arising out of war, terrorism, and nuclear attacks
    • Any expenses related to outpatient treatments
    • Any injuries caused by participation in extreme sports
    • Stem cell treatments and weight management treatments
    • Cost of external medical equipment
    • Convalescence, general debility, congenital diseases, etc.
    • Any expenses related to pregnancy
    • Dental treatment, unless requiring hospitalisation
    • Expenses related to alternative treatments such as naturopathy, acupressure, acupuncture, magnetic therapy, etc.

    Claim Procedure

    The claim procedure under IFFCO Tokio Swasthya Kavach Policy begins soon after the company is intimated about the hospitalisation. For planned hospitalisation, the policyholder must intimate the company or TPA at least 3 days before the date of admission. Emergency admissions must be intimated within 24 hours of hospitalisation.

    Cashless treatment: For cashless treatment, the pre-authorisation form must be filled and submitted to the company during the time of admission. Upon receival of the request through fax, the company will provide authorisation for treatment. All bills, except for non-medical expenses, will be sent directly to the insurer. The insured must bear the cost of convenience and other non-medical expenses.

    Reimbursement claims: For reimbursement claims, all bills related to the medical treatment must be submitted to the insurer within 7 days after discharge from the hospital. Some of the documents required for the claim include discharge summary, medical bills, cash memo, prescriptions, diagnostic reports, physician certificates, etc. Once the documents are received, the company will process the claim and provide the settlement amount within a maximum of 20 days.

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