• IFFCO Tokio Health Insurance Claims Procedure

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    IFFCO Tokio Health insurance claims can be applied in 2 ways. You can either opt for cashless claim or get a reimbursement for your claim. Cashless claims facility is made available with network hospitals of the Third Party Administrator that IFFCO Tokio is tied with. You must understand the current status of networking through the TPA before you are getting admitted. The network hospital will assist you in completing the formality regarding the cashless request. The Third Party Administrator can be contacted through the helpline number and you will have to quote your membership number provided to you and the TPA will guide you through the process. There are over 3,000 network hospitals that provide cashless hospitalisation benefits.

    Incurred Claim Ratio of IFFCO Tokio Health Insurance:

    IRDA publishes ICR or Incurred Claims Ratio for Health Insurance companies in India. ICR is the overall value of the claims that the company has paid divided by the total sum of premiums collected during that period. The following is the incurred claim ratio for IFFCO Tokio for the year 2014-15 and 2015-16:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    41531 43296 104.25

    For 2014-15:

    Net earned premium (in lakhs) Net claims paid (in lakhs) Incurred claims ratio
    29,989 27,714 92.41%

    IFFCO Tokio has a good incurred claims ratio and thus proving that the company is making profit and is in a position to settle claims.

    Claim Procedure:

    You can make either cashless claims or you can get a reimbursement for the claims. The following is the claim procedure for the both:

    1. Cashless Claim:

      In cashless claim, you do not have to settle the bill if you are hospitalised in a network hospital. IFFCO Tokio will be represented by the TPA and the TPA will coordinate with the hospital and settle the bill. The process for cashless claim for emergency and planned admissions are different.

      • Cashless Claims Procedure for Emergency Admission:

        You may be admitted in a hospital due to emergency and you worry about paying the hospital bill. If you have been admitted in a network hospital then you can contact the TPA of IFFCO Tokio and check if cashless claim can be made. If you are allowed to make the cashless claim, then you will have to follow the following procedure to claim for emergency admission:

            • Intimate the Third Party Administrator and quote your health card membership number if you are getting admitted in a network hospital.
            • You must then fill in the cashless request form which will be available at the Hospital Insurance Help Desk. Get the form certified by your attending doctor.
            • Fax the request form along with supporting medical documents to the TPA. You can avail the Fax number by calling the toll free number - 1800-103-5499.

        Claims Process:

          • The TPA will check the document that you have faxed and convey their decision to the hospital. If needed, TPA may call for additional documents.
          • On approval of the claim from TPA, the hospital bills will be settled. The other bills like telephone charges, food, attendant charges will have to be covered by you.
          • If the cashless claim is not approved, then you must settle the bill and then apply for reimbursement.
          • The TPA will take 24 hours after receiving the documents to decide if the claim is approved or not.
      • Cashless Claims Procedure for Planned Admission:

        If you are getting any treatment or operation then you can decide on which network hospital you wish to be admitted in and then you must follow the following procedure to claim for planned admission:

            • Select the hospital from the network hospital list.
            • Then you must intimate the Third Party Administrator before 3 days of admission and quote your health card membership number. You can intimate the TPA through the toll free number – 1800-103-5499.
            • You must then fill in the cashless request form that you can find at the Hospital Insurance Help Desk. You must get it certified from the attending doctor.
            • You must then fax the request form to the TPA along with the supporting medical records.

        Claims process:

          • The Third Party Administrator will then check the documents and convey the decision to the hospital. TPA can also ask for additional documents if needed or can sanction the request.
          • After the claim has been approved, the hospital bill will be settled directly. Telephone charges, food, attendant charges, etc. will have to be settled by you.
          • If the claim is not approved, then you must settle the bill and then apply for reimbursement.
          • TPA takes 24 hours after receiving the documents to take a call on the claim.
    2. Reimbursement of Treatment Expenses:

      You can reimburse your treatment expenses if your cashless claim does not get approved or if you got the treatment at a non-network hospital. You will however have to clear the hospital bill first. The following is the procedure to file a claim:

      • You will have to intimate IFFCO Tokio on admission or not later than 7 days from the date of discharge. The number to intimate the TPA is 1800-103-5499.
      • You must quote the policy number while intimating.
      • You must then avail the treatment and settle the bill and then claim for reimbursement.
      • The claim form can be downloaded from the website and it can be requested through the call centre. The claim document must be submitted to the IFFCO Tokio office address.

      Documents Required:

      While reimbursing your healthcare insurance claim, you must submit the following documents:

      • The claim form must be filled and a doctor’s certificate must be attached.
      • Discharge summary
      • Treatment bills
      • Prescription notes
      • Advance and final receipts
      • Diagnostic test reports, scan, X-ray, ECG or other relevant films.
      • The documents must be mailed to the IFFCO Tokio office address which you can avail by calling the toll free number - 1800-103-5499.

      Claims Process:

      • The claim processing team will check the above documents and ask for additional documents if required.
      • If the claim is admissible, the cheque will be dispatched.
      • If the claim is not admissible you will get a repudiation letter.
      • The reimbursement claim process will take 20 days turnaround time from the day the documents are received.

    Claim Payment:

    The claims under the IFFCO Tokio Health insurance are payable in Indian currency. The treatment will have to be taken in India only. The company is not liable to pay any interest or penalty for sum paid under the policy other than as provided under the IRDA regulations. If the insured is not surviving at the time of paying the claim, then it will be paid to the legal heir.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    IFFCO Tokio Health Insurance Claims Procedure Reviews

  • Page 1 of 4 1 2 3 4
    • review Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have my health insured with IFFCO TOKYO from last 1 year, i am happy with the coverage value of this insurance policy. I do not have claim experience so far with this insurance company. My premium amount gets auto deducted from the salary account. I have a coverage of Rs 5 lakhs for this insurance.
      Was this review helpful? 0
      , kolkata
      Reviewed on Apr 25, 2018
    • review Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with Iffco tokio,the premkum amount is 8000 paid by cash,i have no claim experience with the,they cover 100% cashless treatment.I am happy with the insurance.This policy is including family member is five lakhs.
      Was this review helpful? 0
      , kolkata
      Reviewed on Mar 02, 2018
    • review Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I never got any claim experience with the IFFCO TOKIO GENERAL INSURANCE health insurance policy. The customer support service is average with the IFFCO TOKIO GENERAL INSURANCE company. This policy covers 3 members in my family,. The medical coverage of Rs,2lakh is available with this policy.
      Was this review helpful? 0
      , goa
      Reviewed on Feb 05, 2018
    • review Health Insurance
      "Great Insurance"
      0.5 3.5/5 "Pretty good"
      Iffco Tokio have given me a Health coverage of Rs.25 Lakhs for my complete family.. The Insurance lasts for 5 Generations. I have been in this Health Insurance for the past 4 years. I took it because it had a collaberation with Apollo. Claims experience is sometimes difficult though over here.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jan 07, 2018
    • review Health Insurance
      "Claim Experience has been good"
      0.5 4.0/5 "Great!"
      This is a company provided Health Insurance and they have given me a coverage of Rs.4 Lakhs. The number of network hospital are more. The claim experience with them has been very good. The Cashless options with them is quite good too. They have been very good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jan 06, 2018
    • review Health Insurance
      "Claim Experience has been good"
      0.5 5.0/5 "Blown Away!"
      This was the previous Insurance I had. And I felt it was a very good one that I had. They offered me a coverage of Rs.2.5 Lakhs and the number of hospitals in this Insurares are very high. The claim experience over here is pretty good and easy too.
      Was this review helpful? 0
      , gurgaon
      Reviewed on Dec 20, 2017
    • review Health Insurance
      "Good Doctor for Family"
      0.5 5.0/5 "Blown Away!"
      Its a low premium health insurance with high benefits, I make the premium around Rs.6000 for 4 person. It gives me the medical coverage of 1 lakh for each, totally coverage has Rs. 4 lakhs. Customer service is also good, Iffco Tokiyo is providing coverage for multiple diseases with reputed hospitals.
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 13, 2017
    • review Health Insurance
      "Overall good"
      0.5 5.0/5 "Blown Away!"
      I have taken a health insurance com Accidental coverage from Iffco tokio general insurance. The customer services are good. It was a online process as well. The premium is of 1800 and it is paid on a yearly basis. The medical coverage is of five lakhs.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 20, 2017
    • review Health Insurance
      "Excellent"
      0.5 4.5/5 "Excellent!"
      I am having health insurance policy with the Iffco tokio general insurance company . I had been with them from the last three years of time. Customer service is an excellent one and I have not faced any issues with them till now. Response and other features were really a good one.
      Was this review helpful? 0
      , vadodara
      Reviewed on Aug 21, 2017
    • review Health Insurance
      "Its Average"
      0.5 3.0/5 "Satisfactory"
      I am holding IFFCO TOKIO health insurance around four years, but I don't have any claim experience as of now. My company is paying for the health insurance, they gave the medical coverage of Rs. 5 lakhs its has covers for me. It got good network hospital with cash less treatment facility.
      Was this review helpful? 1
      , chennai
      Reviewed on May 24, 2017
    • review Health Insurance
      "Very good insurance policy"
      0.5 4.0/5 "Great!"
      Having a medical insurance policy with IFFCO TOKIO GENERAL INSURANCE company, which was provided by my company. I am not aware of the claim experience. Because I haven't got any claim experience so far. I am not sure how much my company pays to this insurance policy. This medical insurance covers whole family .
      Was this review helpful? 0
      , pune
      Reviewed on May 13, 2017
    • review Health Insurance
      "Bad after sale service"
      0.5 2.0/5 "Expected more"
      IFFCO TOKIA not got the tie up with good hospitals it not like a HDFC ERGO, I making the premium around Rs.3500, they giving coverage for my nuclear family. It has double coverage for cirital illness, 2 lakhs become 4 lakhs in that situation. I used to make online payment for this policy.
      Was this review helpful? 1
      , kolkata
      Reviewed on May 11, 2017
    • review Health Insurance
      "Good benefits coverage for family"
      0.5 4.0/5 "Great!"
      My company got a tie up Iffco Tokio, they offered me health insurance. Its covers for me and entire family. As a premium they were taking Rs.1400 yearly basis. Medical coverage around Rs.3 lakhs for my family. My mother is not well, she getting treatment in hospital, hence I am getting the reimbursement from them.
      Was this review helpful? 0
      , new delhi
      Reviewed on May 10, 2017
    • review Health Insurance
      "Its Good"
      0.5 5.0/5 "Blown Away!"
      I had taken good policy for my entire family with IFFCO, Medical coverage upto 15 Lakhs it was good for hospitalization , cash less treatment and other benefits. My wife was hospitalized so we had claimed upto 48,000 it was really helped at the time. I used make 7800 per annum through Online.
      Was this review helpful? 1
      , vadodara
      Reviewed on Nov 12, 2016
    • review Health Insurance
      "Worst please dont buy"
      0.5 1.0/5 "Really Bad"
      while buying the policy the executive updated that claim will be done within 15 working days. (its a false promise) I am done a claim and its pending from last one month, every time i call customer care that update its under process, it more then a month and still it is under process.
      Was this review helpful? 1
      , bangalore
      Reviewed on Oct 06, 2016
    • review Health Insurance
      "Medical insurance"
      0.5 4.0/5 "Great!"
      IFCO TOKYO is a company based policy . The company is supposed to pay premium for this. I have got the company I- card and every year they will renew this policy. I have submitted all the required documents to my company for availing this policy.
      Was this review helpful? 1
      , noida
      Reviewed on Sep 27, 2016
    • review Health Insurance
      "My medi claim insurance"
      0.5 5.0/5 "Blown Away!"
      IFFCO TOKIO has offered a cashless card where it has got a cover of about 3 lakhs. I had just to call the customer service of that insurance and I was offered a cash less card. They have provided a list of hospitals and their number as well. They had also mentioned the expiry date on it and after one year the policy would be renewed.
      Was this review helpful? 1
      , thane
      Reviewed on Sep 16, 2016
    • review Health Insurance
      "Less premium "
      0.5 4.0/5 "Great!"
      They have got the lesser premium offered to customer in case of medical coverage offered.I have not used the service yet.The terms and conditions are clearly mentioned for the customer.I received the documents on time from IFFCO TOKIO GENERAL insurance
      Was this review helpful? 0
      , faridabad
      Reviewed on Aug 27, 2016
    • review Health Insurance
      "Excellent services"
      0.5 5.0/5 "Blown Away!"
      Iffco Tokio general insurance has very good services. Though I do not have a personal claim experience. I have seen the services as my colleague had a claim and the response from them was fast. The procedure was compelted within three hours. I have taken a health insurance for my family and I. The medical coverage if for three lakhs per person. I pay a premium of 15K on a yearly basis. The best is they have a tie up with all the major hospitals.
      Was this review helpful? 1
      , bangalore
      Reviewed on Jul 19, 2016
    • review Health Insurance
      "Excellent policy"
      0.5 5.0/5 "Blown Away!"
      Iffo tokio has been good in their services. They have online facilities as well as a good customer support. The best feature of the health insurance policy is, a unlimited claim could be done for a two lakh policy. The coverage can be taken as far as two crores. The premiums are also very economical. Overall it is the best I have seen when compared to other policies.
      Was this review helpful? 0
      , bhubaneshwar
      Reviewed on Jun 06, 2016
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