3/8/2016

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IndividualMedishieldPolicy

Your Health. Our Support.

EnjoyextensivemedicalcoveragewithIFFCOTokiosFamily
Healthpolicy

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Intheunfortunateeventofyouoryourfamilymembersmeetingwithanillnessoraccidentresultingin
hospitalisation,IffcoTokiosIndividualMedishieldInsurancePolicygivesyoucashfreehospitalisationbenefitin
morethan3000hospitalsacrossIndia.ThePolicyalsoreimbursesexpensesincurredduringprehospitalisation
andposthospitalisationstagesofthetreatment.

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WhatthePolicycovers

Callusat18001035499(Tollfree)

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Hospitalisationexpensesincurredfortreatmentofphysicaldiseaseorinjurysustained/inceptedduring
thePolicyPeriod,althoughtreatmentcancontinuebeyondPolicyexpirydatealso.Followingexpenses
wouldbeincluded:

BranchLocator
HospitalLocator

RoomRent@1.0%ofBasicSumInsureddailyandICU/ITURent@2.5%ofBasicSumInsured
daily.
Registration,ServiceCharges,Surchargesetc.ofhospitalatactual,subjecttoamaximumof0.5%
ofBasicSumInsured.
Nursingexpenses,includingthatincurredduringpreandposthospitalisationperiods(onlyif
qualifiednurseisemployedonadviceofMedicalpractitioner).

GarageLocator
RegisterforHealthandCarCareTips
SetRenewalReminders

AlltypesofMedicalPractitioners(Surgeon,Anesthetist,Consultantetc.)fees.
Costofmedicines,blood,oxygen,anesthesia,diagnosticandpathologicaltests,operationtheatre
charges,costofchemotherapy,dialysis,pacemaker,artificiallimbsetc.
Ambulancecharges@1.0%ofBasicSumInsured,subjecttomaximumRs1,500.
DailyAllowance@0.1%ofBasicSumInsured,subjecttomaximumRs.250perday,forthe
durationofhospitalisation.

DomiciliaryHospitalisationexpenses,uptoamaximumsublimitof20%ofBasicSumInsured.This
relatestoexpensesformedicaltreatmentforaperiodofmorethan3days,whichwouldnormally
requirehospitalisation,butisactuallytakenathomeforspecifiedreasons,asstatedinthePolicy.

FAQs

Isthereanytaxbenefitthatonecanavail
ofwhilepurchasingHealthInsurance?
CanIavailthispolicyifIamnotanIndian
NationalbutlivinginIndia?
Howdoestheinsurancecompanydecide
whetheradiseasewasapreexistingone
ornot?

PreandPostHospitalisationexpensesformaximumperiodof60dayseach,beyondhospitalisation
period.
Hospitalisationexpensesofpersonsdonatingorgansduringorgantransplantationofinsuredperson,
withintheoverallandindividuallimitsofSumInsuredspecifiedunderthePolicy
Costofhealthcheckup,onceattheendof4claimfreeyearsblock@1.0%ofaverageBasicSum
Insured.
Prescribedpackagechargesofhospitalforspecifictreatments,subjecttoamaximumof80%ofSum
Insured.

DownloadForms
IndividualMedishieldPolicyProposal
Form

(513.17KB)

IndividualMedishieldInsurancePolicy
Wording

WhatthePolicydoesnotcover
Anypreexistingdisease,foraperiodof3yearsofcontinuouscoveragefrominceptionofInsuredsfirst
MedicalPolicy.
Aninitial30daywaitingperiodfornewlyincurreddiseases(notaccidents).

(406.65KB)

IndivisualMedishieldProspectus
(1123.65KB)
Guidebook

(2168.36KB)

ListofNetworkHospitals

(4347.19KB)

ListofExcludedHospitals

(172.39KB)

Oneyearexclusionperiodforfewspecifieddiseasesonly,aslistedinthePolicy.
Costofspectacles,contactlensorhearingaids.
Dentaltreatment,unlessrequiringhospitalisation.

https://www.iffcotokio.co.in/healthinsurance/individualmedishieldpolicy

HealthClaimForm

(271.34KB)

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3/8/2016

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Convalescence,generaldebility,congenitaldiseases/defects,sterility.
Allclaimsarisingfromorrelatedtopregnancy,otherthanectopicpregnancy.

HealthCashlessRequestForm

(397.3

KB)

Anydomiciliaryoroutpatienttreatment.
Costofexternalmedicalequipments.
Claimsarisingoutofparticipationindangeroussports/activities.

KYCForm

(288.02KB)

ListofNonPayableItems

(204.35KB)

ClaimsarisingfromorrelatedtoHIV/AIDS.
DayCareProcedures

(287.35KB)

War,terrorismandnuclearrisks.
Allnonmedicalexpenses,includingpersonalcomfortandconvenienceitemservices.
Treatmentofobesity,hormonereplacementtherapy,sexchange.
Geneticdisorders,stemcellimplantationandsurgery.
Expensesonnaturopathy,experimentaloralternativemedicine,acupressure,acupuncture,magnetic
andsimilartherapies.

OtherfeaturesofthePolicy
Personofanynationalitycanbecovered,butshouldbeprimarilyaresidentofIndia,sincecoverageis
availablefortreatmentinIndiaonly.
Coverageisavailableforpersonsbetween3monthsand80yearsofage.Childrenbetween3months
and5yearscanbecoveredonlyifbothparentsarecoveredconcurrently.
Nomedicalcheckupisrequiredupto45years.Beyondthatage,preacceptancemedicaltests(Blood
Sugar,Urine&ECG)arerequiredtobedoneforfreshandbreakcoverageonly(notforcontinuous
renewals).Forpersonsbeyond55years,additionaltests(LP&KFT)havealsotobedonefor
fresh/breakcoverage.
ThereisprovisionofFamilyPackagecover,includingspouse,dependentchildrenanddependent
parents,withpremiumdiscountfacility.Dependentchildrenhavetobeunmarriedandunder23yearsof
age.Otherwise,separatePolicieswithoutpremiumdiscountcanbeissuedtothem.
Hospitalisationhastotakeplaceindefinedinstitutionsforaminimum24hoursperiod,exceptfor
treatmentspertainingto121listeddaycaresurgeries,whenclaimswouldbeconsideredforshorter
durationstayalso.

SumInsuredandPremium
TherearetenSumInsuredoptionsavailableunderthePolicyfromRs.50,000toRs.500,000.However,
ifInsureddesirescoverbeyondRs.500,000(uptoRs.2,000,000),multiplePoliciescanbeissuedto
meethisrequirement.
CumulativeBonus(i.e.freeenhancementofSumInsured)of5%isgrantedperclaimfreeyearon
renewal,subjecttomaximum50%ofBasicSumInsured.Intheeventofaclaim,existingCumulative
Bonusisnotentirelywithdrawn,butgetsreducedby10%atnextrenewal,subjecttothestipulationthat
expiringBasicSumInsuredshallbemaintained.UnderaFamilyPackagePolicy,theCumulativeBonus
iscomputedseparatelyforeachinsuredpersoni.e.allotherpersons(whodidnothaveaclaim)will
continuetogetSumInsuredincreaseby5%onrenewal.
ForAyurvedicandHomeopathichospitalisationtreatments,coverageisavailableunderthePolicy,but
SumInsurediscappedat10%ofBasicSumInsuredlimits,includingpreandposthospitalisation
expenses.
PremiumdependsontheBasicSumInsuredoptedforandageoftheinsuredperson.Thepremium
ratesareonallIndiabasis,exceptforGujarat,whereitisdifferent.
TheoptionalCriticalIllnessExtension(fordoublingofSumInsuredinrespectof10listedmajor
diseases)canbetakenunderthePolicy,onpaymentofextra30%onthebasicpremium.
ForFamilyPackagecovers,thereisprovisionofpremiumdiscount@5%iftwopersonsarecovered
and10%ifmorethantwopersonsarecoveredunderthePolicy.
AspecialpremiumdiscountschemeisavailableunderthisPolicy,iftheInsuredhaseffectedhisMotor
TwoWheelerInsurancePolicywithIffcoTokio,orifheiscoveredsimultaneouslyasan
employee/memberunderanyGroupMedicalPolicyissuedbyIffcoTokio.

KeyBenefitsofIffcoTokiosPolicy
DigitallysignedPolicydocumentcanbeissuedimmediatelyatIffcoTokiooffices,POScentres,orfor
onlinepurchases.
IncomeTaxbenefitisavailabletothemainProposeru/s80DoftheI.T.Act,forpremiumpaidunderthe
Policy.
PreexistingDiseaseExclusionisapplicableforonly3yearsandnot4years,asundermostPoliciesin
themarket.Also,onlyafewdiseasesareexcludedforthefirstyearofPolicycoverage.Thereareno2
yearor4yeardiseaseexclusions,asundermostPoliciesinthemarket.
SpecialprovisionisavailableforautomaticreinstatementofSumInsuredintheeventofaclaimunder
thePolicy,totheextentoftheclaimamountpaid,exceptforsomespecifiedchronicdiseases.The
reinstatementpremiumiscomputedonshortperiodbasis,fromdateofhospitalisationtillexpiryof
Policyanddeductedfromtheclaimamountitself.ThisensuresthattheInsureddoesnothaveany
worriesaboutgettingthebenefitoffullSumInsuredagainforanysubsequentclaims,unlikethe
standardPoliciesavailableinthemarket,whereSumInsuredgetsreducedbytheclaimamountforthe

https://www.iffcotokio.co.in/healthinsurance/individualmedishieldpolicy

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3/8/2016

BuyIndividualHealthInsurancePolicyOnline|IFFCOTokio
balanceperiodunderthePolicy.ThisfacilityisavailableunderIMIPolicieswithSumInsured
Rs.150,000ormore.
UnlikemostPoliciesinthemarket,thereisnoprovisionforanyExcessorCopayunderthisPolicyand
accordingly,thefulleligibleclaimispaid,withoutanydeductions.
ThereisnodependenceonanyexternalTPAforclaimsandtheentireactivityofservicingand
processingclaimsishandledbyanexpertinhouseteamcomprisingofdoctorsandotherparamedical
personnel.
Therearealargenumberofnetworkhospitalsallacrossthecountry(exceeding3000),wherecashless
claimsettlementfacilityisavailable.Thereisalsoa24x7callcentreserviceinplace,foranysupport
relatingtoclaims.
PortabilityfacilityisavailableforallpersonsdesiringtoswitchinfromcoversunderotherInsurers
Policies,wherebytransferofcreditgainedbytheInsuredforCumulativeBonusandtimebound
ExclusionClausesiseffected,atthetimeofrenewalthroughIffcoTokiosPolicy.
UniqueaddoncoveravailablethroughtheCriticalIllnessExtensionunderthisPolicy,onpaymentofa
smallextrapremium.
Uniqueemergencymedicalandpersonalassistanceavailableforallinsuredpersonsundertaking
domestictravel,throughtheValueAddedServicesavailableunderthisPolicy,atnoextracost.

CancellationofPolicy
Wewillnotordinarilycancelthepolicyunlessitisacaseofmisrepresentation,concealmentofmaterialfactor
fraudulentactofinsured.Incaseofcancellationofthepolicyduetoabovereasons,policyshallbevoidandall
premiumpaidhereonshallbeforfeitedtotheCompanyandthesameshallbecommunicatedtoyoubysending
a15(Fifteen)noticebyregisteredPosttoyourlastknownaddress.
Youmaycancelthepolicybysendingatleast15(Fifteen)dayswrittenNoticetoUsunderRegisteredPost.We
willthenallowarefundonfollowingscaleprovidedthereisnoclaim.Whereclaimispreferred,norefundwillbe
made.
PeriodofCoveruptoRefundofAnnualPremiumrate(%)
1Month75%
3Month50%
6Month25%
ExceedingSixMonthsNIL
Forthecancellationrequest,insuredcanalsocontacttoourTollFreenumberorgeneratetheservicerequest(
ContactUs>ContactUsForm>ServiceRequests)

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