IFFCO Tokio Health Insurance

IFFCO-Tokio General Insurance Company Limited was incorporated in 2000, as a joint venture between the Indian Farmers Fertiliser Co-operative Limited (IFFCO), which is the world’s largest fertilizer manufacturer, and Tokio Marine Group, which is one of the largest insurance groups in Japan. IFFCO holds 51 percent in the company and the remaining 49 percent is held by Tokio Marine Group.

The company offers a comprehensive product bouquet of all lines of business such as Car Insurance, Two-wheeler Insurance, Health Insurance, Travel Insurance and Home Insurance, including corporate policies such as property insurance and liability insurance. It is also the first company in India to underwrite mega policies. The comprehensive policy is based on international rates and optimizes the premium outflow for clients even as it offers a one-stop, all-risk cover. Other than the conventional products, it also offers niche products such as Cyber Insurance, Credit Insurance, Fine Arts Insurance, P & I Insurance, Errors & Omission Policy for the IT Sector, etc. At the same time, it has steadfastly carried out its rural centric initiatives by launching products like Sankat Haran Bima Yojana, Mahila Suraksha Bima Yojana and Janata Bima Yojana for the masses.

IFFCO-Tokio has a wide presence in rural areas and Tier 2, 3 and 4 towns, too. It is the first private insurer to establish Bima Kendras, which are single-person operated centers, to increase insurance penetration in rural areas at the customer’s doorstep.

IFFCO Tokio offers their health insurance customers the option of availing quality treatment at more than 5,000+ leading hospitals across the country. With an incurred claims ratio in Health of 102.00%, they also covered 220.15 lac lives during the same year 2018-19, as per the data provided by IRDAI.

Key Highlights

An medical ailment or an injury can arrive at any time when you are totally unprepared. Today’s sedentary life styles, hectic work schedules, long working hours, stressful demands and poor eating habits are causing a health catastrophe and causing a significant rise in the number of Indians suffering from deadly diseases. Thanks to dramatic improvements and high-tech intervention in medical diagnosis and therapeutic procedures, there is a huge increase in medical costs. Health Insurance helps you pay for this high quality healthcare. Health Insurance insures the customer against the risk and protection against medical and surgical expenses.

IFFCO Tokio Health Insurance sum insured
15 lacs − 30 lacs options available

IFFCO Tokio Health Insurance tenure options
1 year

List of network hospitals
5,000+ hospitals

Maximum family floater coverage
Self, Spouse + dependent (children + parents)

Incurred Claims Ratio *
102.00%

Claims Settlement Ratio **
102.43%

Number of policies issued *
155,454

Number of lives covered *
22,015,000

* As per IRDAI report for 2018-19 | ** As per NL25 data published on the Insurance Company website

IFFCO Tokio Health Insurance – Overview

Awards and Recognition

Awards Won in 2020-21

  • Asia’s Top Most Influential Insurance Leaders Award – Mrs. Anamika Roy Rashtrawar by Insurance Alertss, 2020.
  • Business Leader of the Year Award for Mrs. Anamika Roy Rashtrawar by TechCircle Business Transformation Symposium & Awards 2020.
  • IT Leader of the Year Award for Mrs. Seema Gaur by TechCircle Business Transformation Symposium & Awards 2020.

Awards Won in 2019-20

  • IFFCO Tokio won BFSI Digital Innovation Award by Express Computers, Indian Express Group.
  • IFFCO Tokio won Digital Insurer of the Year, 2019 by Insurance Asia News Awards for Excellence.
  • Ms. Seema Gaur inducted to CIO Hall of Fame for winning the CIO 100 main award four times in succession.
  • IFFCO Tokio won the P & C Insurer of the Year, 2019 by Insurance Asia News Awards for Excellence.
  • 2019 Digital Transformer for India and 2019 Omni Experience Innovator for India in the Ecosystem Engagement Category at the 3rd Annual IDC Digital Transformation Awards.
  • “Product Innovator of the Year 2018” for our Bank Locker Protector at the 4th Annual Insurance India Summit and Awards 2019.
  • “2019 CSO 100 Awards” for Mahesh Shrivastav by 3rd Annual CSO 100 Symposium and CSO Online for Information Security Leaders.
  • “Emerging Asia Business Award by ICC, Kolkata. Certificate and Trophy for Good Practices in Crop Insurance”.

IFFCO Tokio General Insurance is today one of the fastest growing insurance players in India with a lot of focus on both retail and group insurance products. Today the IFFCO Tokio health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 4,000+. Most of the customer’s IFFCO Tokio’s health insurance reviews have been positively influencing the growth of their business year on year. One can also follow the IFFCO Tokio health insurance renewal link on eindiainsurance for renewal of their existing policies and if one needs to file a claim, all they need to do is to fill in the IFFCO Tokio health insurance claim form available on the same website.

Key features of IFFCO Tokio Health Insurance

  • Room Rent : Daily Limit upto 1.5% of Sum Insured / NIL for plans of SI > 7 lacs
  • Co-pay : NIL co-pay for all treatment
  • Restoration Benefit : Restoration benefit available upto Claim Amount paid

Summary of all plans of IFFCO Tokio:

IIFCO Tokio Health InsuranceSum AssuredEntry AgeCritical IllnessCoverage and Benefits
Swasthya Kavach Family Health Insurance2 to 5 LakhsNo LimitNA
  • Ambulance charges
  • Daily Cash allowance
  • Domiciliary hospitalisation expenses
  • Pre-hospitalisation expenses up to 30 days
  • Post-hospitalisation expenses up to 30 days.
  • Organ donor expenses
Individual Medishield Policy1 to 5 Lakhs3 months to 80 yearsNA
  • Organ donors hospitalisation expenses
  • Ambulance charges:
  • Cash benefits.
  • Pre/Post-hospitalisation expenses up to 45 days/60 days
Critical Illness Insurance PolicyNANo LimitIt provides coverage only for critical illness
  • Cancer
  • Renal failure
  • Coronary artery diseases for which bypass surgery is required.
  • Major organ transplant
  • Paralytic Cerebral Stroke
  • Loss of limbs due to accidents
Family Health Protector PolicyUp to 7 LakhsEntry age is 0 and there is no maximum limitNA
  • Doctor consultation fees
  • Organ donor expenses
  • Ambulance charges
  • Cashless hospitalization
  • Domiciliary treatment expenses
  • Pre and post hospitalization expenses
Health Protector PolicyMore than 5 LakhsNo LimitCovers more than 10 critical illnesses
  • Organ donors hospitalisation expenses
  • Ambulance charges
  • Cash benefits
  • Pre/Post-hospitalisation expenses up to 45 days/60 days respectively
IFFCO Tokio Personal Accident Insurance PolicyNA5 years to 70 yearsNA
  • Ambulance charges
  • Organ donor expenses
  • Cashless hospitalization expenses

Critical factors of the Star Health insurance

Why Should a customer opt for IFFCO Tokio General?

    • They provide cashless services for Motor Insurance in more than 4300 garages, which are evenly spread across the country.
    • 5000+ Network Hospitals : They provide cashless services in more than 5000 hospitals, which are spread across the length and breadth of India.
    • 20,000+ Agents & Branches Across India : Their policies can be brought from more than 20,000 agents and branches having a wide presence throughout the country.
    • Quick Claim Settlement : They offer a QCS facility under which motor insurance claims get settled seamlessly within minutes.
    • Trusted Brand : Since 19 years, they have been servicing customers with a wide range of insurance policies.
    • Claim Experience : They have settled a total of 8.61 lakh claims in FY2019 and have a claim settlement ratio of 92.65%.

Features of IFFCO Tokio Health Insurance Plans

  • Coverage for Self, Spouse + dependent children + dependent parents including their Pre Hospitalization (30 days) & Post Hospitalization (60 days) Medical Expenses.
  • Cashless treatment 5000+ network hospitals across India with Sum Insureds ranging from ₹1.50 lacs to ₹30 lacs
  • Coverage is provided for Ambulance charges
  • Coverage for 160+ Day Care Procedures
  • Vaccination and health check-up charges are covered
  • This Policy covers persons in the age group 91 days to 70 years, with the proposer necessarily being an adult.
  • In-patient treatment includes Hospital room rent or boarding expenses, nursing, Intensive Care Unit charges Operation Theatre charges, Medical Practitioner’s charges, fees of Surgeon, Anaesthetist, Qualified Nurse, Specialists, the cost of diagnostic tests, medicines, drugs, blood, oxygen, the cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure. A minimum period of 24 consecutive hours hospitalization as in-patient is must.
  • AYUSH Treatment Expenses
  • Automatic Restoration of Sum Insured upto 50% of Base Sum insured
  • Health Check-up – Medical checkup expenses can be reimbursed once at the end of a block of every four claim free years. The reimbursement shall not exceed the amount equal to 1% of the average Basic Sum Insured.
  • Lifelong Renewability of all policies offering peace of mind given that in present times the health care costs are rising every day.
  • In-House Claim Team: All claims filed under this plan directly attended to by IFFCO’s in-house team. This helps in saving vital time and money while filing claims for hospitalization expenses and quicker support.
  • Portability : An insured can switch their existing Health Policy to IFFCO’s Individual Health Protector with ensured continuity of coverage.

IFFCO Tokio health insurance Claims Process

For any Claims Assistance:
Call : Toll Free No 1800-103-5499
Call : Center Chargeable No 0124-4285499
Fax No : 0124-4722010
Email ID : healthclaims@iffcotokio.co.in
Grievance Redressal details : grievance@iffcotokio.co.in
You can apply for a Health Insurance claim in 2 ways. You can either go for Cashless Claim or get Reimbursement for your claim. Given below are the procedures to be followed:
Cashless Claims Settlement:
Cashless claims facility is available only with the network hospitals of the TPA we are tied with. You are advised to understand from our TPA before you get admitted, about the current status of networking of any particular hospital.Under this facility, the network hospital shall assist you in completing the formality related to the cashless request. You can also contact our Third Party Administrator through their helpline numbers, by quoting your Membership Number given on your health card.
Cashless claims are of two types:

  • Cashless Claims procedure for Emergency Admission
  • Cashless Claims procedure for Planned Admission

Cashless Claims procedure for Emergency Admission:

 Emergency HospitalisationPlanned Hospitalisation
Step 1In the case of network hospital, on admission, intimate the Third-party administrator (TPA) through their Toll-free no. Please quote your health card Membership number.Select a hospital from our list of network hospitals for treatment.
Step 2Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor.Intimate our Third-party administrator (TPA) through the Helpline Number before 3 days of admission, quoting your Health card Membership number.
Step 3Fax the cashless request form along with supporting medical records to the TPA.Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor.
Step 4The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required.Fax the cashless request form along with supporting medical records to the TPA.
Step 5On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges, etc would have to be settled by you.The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required.
Step 6If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions.On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you.
Step 7 If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions.

The Turnaround time for approving Cashless decision by our TPA is 24 HOURS AFTER RECEIPT OF ALL DOCUMENTS.

Reimbursement of Claim Settlement
If you have not availed cashless facility in-network hospital or you have taken treatment in a hospital that is not a part of the network then you may submit your original documents for reimbursement.

Step 1Intimate IFFCO-Tokio through the toll number – 1800 103 5499 immediately on admission not later than 7 days from the date of discharge. Please quote your Policy Certificate Number while intimating the claim.
Step 2Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement.
Step 3Download the relevant claim form from our website (or) request for one through our call center.
Step 4Claim documents may also be submitted to the local IFFCO TOKIO Office address which can be obtained by calling our Toll Number 1800 543 5499.

Document checklist : Documents to be submitted in case of Reimbursement of Claim

  • Duly filled claim form along with Doctor’s certificate.
  • Discharge summary.
  • Bills.
  • Prescriptions.
  • Advance and final receipts.
  • Diagnostic Test Reports, X-Ray, Scan and ECG and other films.

If the required claim processing team shall seek furthermore documents other than the above-listed ones.
Please Note:

    • Claims would be processed on receipt of all required documents and additional documents / information if any required will be called for after scrutiny of the claim.
    • The cheque will be dispatched to you if the claim is admissible. If not, a repudiation letter would be sent to you.
    • The turnaround time for Reimbursement claims is 20 days from the date of receipt of all documents.
    • Payment of Claim
      • All claims under this Policy shall be payable in Indian currency. All medical treatments for the purpose of this insurance will have to be taken in India only.
      • IFFCO-Tokio shall not be liable to pay any interest/penalty for sums paid or payable under the policy other than as provided by IRDA regulations.
      • The claim if admissible shall be paid to the legal heir of the proposer in case the proposer is not surviving at the time of payment of a claim.

Exclusions under IFFCO Tokio Health Plan

Most of the major exclusions under health insurance policy are listed below, it is recommended to review the entire list of exclusions which is available in the policy kit, sent to you by the insurer:
  • Any expense incurred in the first two continuous years of operation of the insurance cover on treatment of the following diseases (to be considered on each insured person separately):
    • Cataract, Benign Prostatic Hypertrophy, DUB
    • Uterine Fibroids, PV Bleeding, Hysterectomy, Myomectamy
    • Hernia, Hydrocele
    • Sinusitis
    • Gall Bladder, Billiary, Renal and Urinary Stones
    • Inter-vertebral Disc disorder like Spondylitis
    • Spondylosis, prolapse etc. (other than caused by an accident)
    • Knee replacement/Joint Replacement/Hip replacement (other than caused by an accident)
    • Chronic Renal failure
    • Any type of benign growth/Cyst/Nodules/Polyps/Tumor/Lump
  • Correction of vision (Lasik or other similar surgery) /and all types Laser treatments / surgeries for EYE which can be performed on OPD basis.
  • Cytotron Therapy, Rotational Field Quantum Magnetic Resonance (RFQMR), EECP (Enhanced External Counter Pulsation) Therapy, Chelation Therapy, Hyperbaric Oxygen Therapy
  • External durables like (but not limited to): CPAP, Nebulizingmachine, Oxygen cylinder, Oxygen concentrator, ventilator.
  • Oral Chemotherapy where no monitoring under Doctor Supervision is required in Hospital Setting.
  • Cost of spectacles and contact lens or hearing aids.
  • Expenses on diagnostic, x-ray, or laboratory examinations, investigations unless related to the active treatment of disease or injury falling within ambit of hospitalization claim under “What is Covered”.
  • Procedures/treatments mainly done in outpatient department (OPD) even if these are converted to day care surgery or as in patient in hospital to make it hospitalization claim.
  • Dental treatment or surgery of any kind, unless requiring hospitalization.
  • Maternity expenses (other than ectopic pregnancy requiring surgical intervention), miscarriage, medical termination, abortion or complications of any of these, including caesarean section and any infertility, sub fertility or assisted conception treatment.
  • Treatment of mental illness, psychiatric or psychological disorders, Convalescence, general debility, run down condition or rest cure, external congenital Disease or defects or anomalies, sterility, venereal Disease, intentional self-Injury, or cause of accident/illness is use of intoxicating drugs/alcohols by the insured person(s)and treatment resulting from any criminal act.
  • Any expense on experimental or unproven treatments.
  • Stem cell implantation/ surgery and Genetic disorders.
  • Treatment of obesity or condition arising there from (including morbid obesity) and any other weight control program, services or supplies etc., hormone replacement therapy, sex change or treatment which results from or is in any way related to sex change.
  • Rehabilitation Expenses.
  • Any expense on treatment related to HIV, AIDS.
  • Any expense on injury or diseases directly or indirectly caused by or contributed to by nuclear weapons/material.
  • Injury or diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operation (whether war be declared or not).

IFFCO Tokio Health Insurance Products

Family Health Protector Policy

Key Features:
This Iffco Tokio family floater policy insures your full family against health risks and financial distress by providing cashless settlements at an affordable cost. An additional optional cover of Critical illness is also provided to the family under a single sum insured on a floater basis.

Individual Health Protector Policy

Key Features:
The insured can receive hospitalization expenses for any injury or medical ailment related situations including organ transplantation etc. It is possible to issue this policy on ashort term basis also.

Swasthya Kavach Policy

Key Features:
IFFCO Tokio offers the best family health and medical insurance policy. This policy gives you cashless hospitalization benefits in more than 3000 hospitals across the nation.

Individual Medishield Policy

Key Features:
Insurance Policy gives you cash free hospitalisation benefit in more than 3000 hospitals across India.

Critical Illness Insurance Policy

Key Features:
This policy provides comprehensive coverage for hospitalisation, protecting the insured and his/her family during critical Illness

Health Protector Plus Policy

Key Features:
The policy covers hospitalization expenses which provides coverage to the insured and family in the event of high treatment costs for any injury or disease related hospitalization, organ transplantation etc.

Swasthya Raksha Bima

Key Features:

  • Affordable health insurance plan for people living in smaller towns and cities.
  • Covers Pre-Hospitalization and Post Hospitalization expenses for 30 days.
  • Ambulance services charges limited to ₹750 or actual whichever is less.
MOS-BITE Protector

Key Features:

  • The policy covers seven vector-borne diseases.
  • It pays you the sum insured in case the policyholder gets hospitalised for 48 hours.
  • The insurance policy is available to an adult between 18 and 65 years of age.
Arogya Sanjeevani

Key Features:

  • The Policy covers Hospitalisation Expenses for In-Patient Care or Day Care Treatment incurred for treatment of an Illness contracted/ Injury sustained during the Policy Period.
Corona Kavach health insurance

Key Features:

  • Policy can be availed by persons between the age of 18 years up to 65 years, as Proposer. Proposer with higher age can obtain policy for family, without covering self.
Corona Rakshak health insurance

Key Features:

  • Age means age of the Insured person on last birthday as on date of commencement of the Policy