IFFCO-Tokio Swasthya Kavach Policy: Coverage, Claim & Renewal

Updated: 18-01-2024 07:06:11 AM

When they say precaution is better than cure, it’s not just the vaccines and good diet that ensures this safety. Why you ask? Because there are times when despite taking utter care at your end, you might find yourself surrounded by doctors and nurses, i.e. in a hospital. At such times, an insurance policy like IFFCO-Tokio Swasthya Kavach Policy comes quite handy.

Eligibility Criteria

 

Particulars	Details
Proposer entry age	18 – 60 years
Dependent children entry age	91 days – 23 years
Dependents allowed	Policyholder, spuse and children
Renewal Limit	80 years

 

Note:  For insurance proposers above the age of 55, they are required to take up pre-acceptance tests that include urine, sugar, ECG, and some more if required

Types of IFFCO-Tokio Swasthya Kavach Policy

Basic Coverage Plan Options (in terms of Sum Insured)

• 2,00,000
• 3,00,000
• 4,00,000
• 5,00,000

Basic Plan

• Hospital expenses are covered till 20% of basic sum insured are covered
• Procedure related to organ transplant from the behalf of owner are covered by the policy
• Expenses related to nursing charges before and after hospitalization are covered under the policy
• Any fees related consultation from specialists, anesthetists, and physicians is covered
• Charges related to blood transfusions, anesthesia, oxygen, as well as medical tests are included in the basic cover
• Registration and surcharges are covered at the rate of 0.5% of total sum insured

Wider Plan

• Larger amount of hospital room rent allowed
• Larger amount incurred in ICU/ambulance is covered
• You can avail cumulative bonus feature
• Health check-up expenses are covered
• Critical illnesses (out of a list of 10 illnesses) are covered.
• More number of days covered in post-hospitalization expenses
• Higher daily allowance is provided under the wider policy coverage

How to Purchase IFFCO-Tokio Swasthya Kavach Policy?

Online:

• You can easily access the online portal of IFFCO-Tokio at iffcotokio.co.in and avail the desired policy by checking the eligibility and the quote

Offline:

• You can call the 24/7 helpline of IFFCO-Tokio on 1-800-103-5499, which is a toll-free number. You can also reach the, @ (0124) 428 5499 if former number is not reachable. By calling them, you will receive assistance about all the policy procedures
• You can also use the branch locator tool to search for the nearest branch and receive personal help to understand and apply for all policies

Claim Process of IFFCO-Tokio Swasthya Kavach Policy

• An event which might become a claim under the Policy must be reported to the insurer not later than 7 days from the date of hospitalization. A written statement of the claim will be required along with the claim form
• Claim must be filed within 30 days from the date of discharge from the hospital or completion of treatment
• Company shall go through all the submitted documents along with the claim form to check for discrepancies, if any
• Once all is cleared, payment shall be transferred to the person’s registered bank account.

Documents needed to support the claim

• Duly filled and signed Claim Form (Form B required)
• Photo ID Proof (photocopy)
• Discharge Papers
• All hospital bills (original)
• Hospital Receipt (original)
• Test Reports and bills (original)
• Registration Certificate of Hospital (for establishing authentication of the institution)
• KYC form (Know Your Customer) if the claim amount exceeds Rs.1 lakh

This is non-exhaustive list, thus open to omission and addition.

Cases where you can’t claim IFFCO-Tokio Swasthya Kavach Policy

• Medical accessories such as vision glasses, contact lens, and hearing aids
• Expenses related to dental treatments, unless required due to hospitalization
• Any condition related to or evolving from HIV AIDS Any illness or injury that is a result of participation in adventurous activities such as rafting, mountain climbing, bungee jumping, etc.
• Any expenses related to conception or abortion of pregnancy
• Any illness or injury occurring due to foreign invasion, war, or war-like activities.
• Any procedure related to treatment of obesity, or opting for sex-change
• Any treatment that belongs to alternative medicine such as Ayurvedic, Yunani, Siddha, and Homeopathy
• Any condition evolving from malnutrition or debility
• Any pre-existing condition or illness emerged as a result of pre-existing conditions up till 48 months from policy initiation.
• If a patient is suffering from diabetes alone or along with hypertension, then respectively 10% and 25% of claim will not be covered                                                                     

Renewal Process of IFFCO-Tokio Swasthya Kavach Policy

The Swasthya Kavach Policy can be renewed every year by mutual consent. To initiate the process, the renewal premium must be paid to the insurer on or before expiration of the policy. To avail the continuance benefits of the policy, it is required to to renew the policy within 30 days of expiry date otherwise insurance cover shall be treated as new.

Advantages of IFFCO-Tokio Swasthya Kavach Policy

• You can add critical illness cover under the wider plan, while only paying 30% compared to basic premium
• The total sum insured is reinstated once a claim is made for treatment
• You can avail cashless claim facility at over 4000 hospitals across India, which are a part of the IFFCO-Tokio Network. The network hospitals also assist you in any issue regarding claims
• You can port to this cover from a similar cover ongoing at a different company
• You can add critical illness cover under the ‘wider policy’ option
• If no claims are made during a given year, 5% amount (maximum 50%) is added on a cumulative basis to the insured amount next year
• If the insurer is already under coverage of other IFFCO-Tokio group health policies, he/she can avail a special premium discount on Swasthya Kavach Policy
• There is a waiting period of 30 days past commencement for making any claims with the company

 

FAQs

Q1. Should I still consider getting a health cover if I feel healthy?

If you are young, it is the best time to get a health cover as you can avail cumulative benefits through the policy and protect your family from any health benefits.

Q2. Is health insurance and life insurance the same?

While the benefits of life insurance can be availed only after the insured member has died, health insurance benefits the insured member and their family to live a healthy life.

Q3. Is there are tax benefit in getting a health cover for my family?

Yes, you are liable to receive income tax benefit on the premium paid according to section 80D of the Income Tax Act, 1961.

Q4. If I stay in Ahmedabad and my family stays in Bengaluru, can we still get the benefits of Swathya Kawach Family Floater policy?

Yes, IFFCO-Tokio extends its services all across India, where more than 4000 hospitals are a part of its network.

Q5. Is there are waiting period for the policy to start?

Yes, there is a 30-day waiting period after the starting of policy for making any claims.

Q6. How many family members are covered under this plan?

You can cover yourself, your spouse, as well as 3 dependent children (can include own children, nephews, cousins, as well as siblings are covered.

 

Features
Claim Type (In-House or TPA)	TPA
Pre-Hospitalization	Yes, 30 days
Network Hospital Count	4000+
Post-Hospitalization	Yes, 30 days
Room Eligibility	Differs as per the Sum Insured
Share Claim Payments	No
Restoration of Cover	–
No Claim Bonus	Yes, 5% of the Base Sum Insured
Ambulance Charges	Rs. 720 (base plan Rs. 1500(wider plan)
Worldwide Coverage	No
Maternity Cover	–
Hospitalization at Home	Yes (conditions applied)
Day Care Treatment	Yes
Non-Allopathic Treatment Coverage	No
Emergency Ambulance	Yes
Health Check-up	Yes (in wider plan)