IFFCO TOKIO INDIVIDUAL HEALTH PROTECTOR
POLICY FEATURES :
The Policy offers a health protection cover for you and your family for any illness, disease or injury related contingencies like hospitalisation, medical expenses, surgical expenses, organ transplantation etc. The policy covers the members of the family consisting of you, your spouse, dependent children, brother, sister, brother-in-law, sister-in-law, nephew, niece or any other relation who is dependant or relatives living together with you and dependant parents on individual Sum Insured basis. Normal Policy Term is 1 Year. However, there is a provision of issuing policy on short term basis also.
POLICY COVERS :
- Room Rent Expenses as provided in the Hospital/Nursing Home including Hospital Registration/ Service charges.
- Nursing expenses during Hospitalisation periods on advice of Medical Practitioner for duration specified.
- Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist fees.
- Anesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Organs and similar expenses.
- Ayurvedic and/ or Homeopathic and/or Unani and/or Sidha Hospitalisation Expenses upto the limit of the Sum Insured.
- Reasonable and customary charges incurred for Domiciliary Hospitalisation if Medically Necessary upto a maximum aggregate sub-limit of 20% (twenty percent) of the Sum Insured.
POLICY BENEFITS :
We will pay for the additional benefits as mentioned below in accordance with the main-coverage:
- Daily allowance: An additional daily allowance amount equivalent to 0.20% (one fifth of a percent) of the sum insured per day for the duration of hospitalisation.
- Ambulance charges: Ambulance charges 1% (one percent) of the sum insured or Rs. 2500 (two thousand & five hundred), whichever is less for each hospitalisation.
- Pre and post hospitalisation expense: Nursing and Medical Expenses during pre & post hospitalisation period on the advice of Medical Practitioners for duration specified subject to the maximum of 45 days for pre hospitalisation and 60 days for post hospitalisation expenses.
- Cumulative bonus: a) The Cumulative Bonus shall be increased by 5% (five percent) of the basic sum insured at each renewal in respect of each claim free year of insurance, subject to maximum of 50% (fifty percent) of the insured person’s basic sum insured of the expiring policy. For cumulative bonus eligibility, the policy has to be renewed within the expiry date or within a maximum of 30 (thirty) days from the expiry date, beyond which the entire cumulative bonus earned will lapse and be forfeited. b) In case of a claim under the policy in respect of any insured person who has earned cumulative bonus, the existing cumulative bonus will be reduced by 5% (five percent) of basic sum insured at the next renewal, subject to the stipulation that basic sum insured shall be maintained
- Day care surgeries: 121 surgical procedures covered without 24 hours of hospitalisation stipulation.
- Hospitalisation expenses if period of hospitalisation is less than 24 (twenty four) hours: We will pay hospitalisation expenses if the duration of hospitalisation is more than 12 (twelve) hours but less than 24 (twenty four) hours except the day care surgeries, the room rent shall be limited to 50% (fifty percent) of the entitled room rent per day.
- Cost of health check up: Insured person(s) shall be entitled for reimbursement of cost of medical checkup once at the end of a block of every four claim-free policies with us. The reimbursement shall not exceed the amount equal to 1% (one percent) of the average sum insured during the block of four claim free policies.
- Reinstatement of Sum Insured: After occurrence of a claim under the policy, the basic sum insured under the policy will be reinstated by the amount of the claim after charging appropriate premium as per method for reinstatement of the basic sum insured so that full basic sum insured is available for the policy period : Reinstatement premium will be deducted from the claim amount. The reinstatement of sum insured will not be available for Critical illness extension and cumulative bonus. The reinstatement of sum insured will not be available for Domiciliary Hospitalisation and Ayurvedic and/or Homeopathic and/or Unani and /or Sidha hospitalization.
- Vaccination expenses: Insured person(s) shall be entitled for reimbursement of cost of vaccination at the end of every block of two policy period of 365 (three hundred & sixty five) days with us or 366 days in case of leap year, each subject to a maximum of 10% (ten percent) of the total premium paid (excluding taxes, provided no claim are made and the policies were renewed without break).
- Provision for Senior Citizens: Grievance Management for Senior citizen will be as per IRDA regulations.
- Emergency assistance services: This policy provides, at no additional cost, whatsoever, a host of value added emergency medical assistance and emergency personal services. The services are provided when insured person(s) is/are traveling within India 150(one hundred and fifty) kilometers or more away from the residential address as mentioned in the policy schedule for less than 90(ninety) days. No claims for reimbursement of expenses incurred for services arranged by insured/insured person(s) will be entertained unless agreed by us or our authorized representative. Wherever, it is not reasonably possible to ascertain if the reported situation was an emergency or not, the benefit of doubt shall be available to you in respect of the insured person.