There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form.
In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.
Religare Health Insurance has a well-defined claim processing system.
Cashless Service: seeking Pre-Authorization
- Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
- Send the completed form via email or fax.
- Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
- In case the authorization is rejected, initiate the treatment and file for reimbursement claim.
Reimbursement Claim: Claim Submission
- Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
- Necessary documents include discharge summary, prescriptions, bills etc.
- Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
- In case the claim is rejected, the reasons will be communicated by the team.
In case of any emergencies, you need to inform Iffco Tokio within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Iffco Tokio's toll free number 1-800-103-5499. The same could also be emailed to firstname.lastname@example.org
Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.
Frequently Asked Questions
Can I port my current insurance plan to Iffco Tokio?
Yes. You can port your current policy to Iffco Tokio at the time of renewal. However, you need to initiate the process atleast 45 days in advance for the timely porting.
What happens to my Critical illness Policy after a claim is filed?
The cover under this Policy in respect of a critical illness or injuries for any Insured Person shall cease upon the reimbursement of medical expenses incurred as inpatient /provision of Cashless hospitalization on the treatment of the critical illness or injuries.
When will my policy not pay?
Some of the important Exclusions under the Policy are self-injury, suicide, venereal disease, insanity, influence of intoxicating liquor or drugs, pregnancy or childbirth, HIV or AIDS , war and nuclear risks etc. For more comprehensive list of exclusions, you will need to refer the Policy Wordings of the plan you have opted for.
Does Iffco policies cover Domiciliary Hospitalisation expense?
Yes. Domiciliary Hospitalisation expenses are covered up to a maximum sub-limit of 20% of Basic Sum Insured. This relates to expenses for medical treatment for a period of more than 3 days, which would normally require hospitalisation, but is actually taken at home for specified reasons, as stated in the Policy.
Can I avail this policy if I am not an Indian National but living in India?
Yes, if you are a student studying in India or working with a valid work Visa. But if you are a tourist coming to India for three weeks, it will not be worthwhile to buy this as thirty days cooling-off period itself offsets the benefits which you are looking for. Medical tourism cases are definitely not covered in policy issued in India.
How do I find out which Hospitals are part of a given insurance network?
You can refer to the list of empaneled hospitals on their website or the list provided in the guidebook or welcome kit. Simultaneously, you can also call their Toll Free Line at 1800-103-5499 or email them at email@example.com for any additional assistance you may need. To locate an Iffco Tokio network hospital near you, click here.
Please note that, as an esteemed Coverfox customer, you are welcome to reach out to us as we are obliged to assist you in every possible scenario.
Review of Iffco-ToKio Health Insurance
With a robust base of faithful customers clubbed with sturdy Pan India branch setup, Iffco Tokio's Family Health Insurance Plans are reasonably priced and cost-optimized. Also the premiums are viable, pocket friendly and accounted for. The cover gives you cashless hospitalization benefit in over 3000 hospitals across nation. If a worthy health cover with strict budget is what's on your mind, iffco Tokio is a sure contender.
For details about plans on offer, do call Coverfox at 1800-209-9920 to assist you further.