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Health Insurance 458 views July 8, 2021
IFFCO TOKIO Swasthya Kavach (Family Health) Policy covers you and your family against medical expenses. The policy shall cover the members of the family comprising you, your spouse and dependent children up to the age of 23 years. The coverage under this policy is applicable under a single sum insured and no separate sum insured shall be provided to each family member. Read this page further to know more about the IFFCO TOKIO Swasthya Kavach (Family Health) Policy coverage and benefits.
Table of Contents
IFFCO TOKIO Swasthya Kavach (Family Health) Policy Coverage
IFFCO TOKIO Swasthya Kavach (Family Health) Policy comes in two different variants – Base & Wider. Check out the table below to know their coverage.
| Base Plan | Wider Plan |
|---|---|
| Room, Boarding & Nursing (Normal room) - 1.0% of the Basic Sum Insured per day for Sum Insured up to INR 2 Lakh | Room, Boarding & Nursing (Normal room) - 1.5% of the Basic Sum Insured per day for Sum Insured up to INR 2 Lakh |
| ICU/ITU charge 2.0% of the Basic Sum Insured per day for Sum Insured up to INR 2 Lakh | ICU/ITU charge 2.5% of the Basic Sum Insured per day for Sum Insured up to INR 2 Lakh |
| Service Charges of Hospital/Nursing Home up to the sum insured | Service Charges of Hospital/Nursing Home up to the sum insured |
| Fees of Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees | Fees of Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees |
| Cost of Anaesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials, Diagnostic Imaging Modalities, Dialysis, Chemotherapy, Radiotherapy, Pacemaker, Artificial Limbs, Organs and similar expenses. | Cost of Anaesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials, Diagnostic Imaging Modalities, Dialysis, Chemotherapy, Radiotherapy, Pacemaker, Artificial Limbs, Organs and similar expenses. |
| Domiciliary Hospitalization Treatment up to 20% of the Basic Sum Insured | Domiciliary Hospitalization Treatment up to 20% of the Basic Sum Insured |
| Daily Allowance for Hospitalization period at INR 150 per day | Daily Allowance for Hospitalization period at INR 250 per day |
| Ambulance Charges up to INR 750 | Ambulance Charges up to INR 1,500 |
| Package Charges for Treatment - 80% of the Sum Insured (Basic plus Optional Extension, if applicable) or Actual, whichever is less | Package Charges for Treatment - 80% of the Sum Insured (Basic plus Optional Extension, if applicable) or Actual, whichever is less |
| Organ donor expenses | Organ donor expenses |
| Pre-hospitalization expenses cover up to 30 days (including approved home nursing if prescribed by the Medical Practitioner) | Pre-hospitalization expenses cover up to 30 days (including approved home nursing if prescribed by the Medical Practitioner) |
| Post-hospitalization expenses covered up to 7% of the hospitalization expenses for 30 days | Post-hospitalization expenses covered up to 60 days |
| AYUSH Treatment | Cost of Health Check-up at the end of every block of 4 consecutive claim-free years |
| Daycare procedures | Cumulative Bonus of 5% on every claim-free year, subject to a maximum of 50%. |
| AYUSH Treatment | |
| Daycare procedures |
Additional Optional Cover of Critical illness (Available Under Wider Plan Only)
You can enhance your policy coverage under IFFCO TOKIO Swasthya Kavach (Family Health) Policy by adding Higher Sum Insured for Critical Illness Rider. Under this rider plan, the insurer cover expenses related to the following Critical Illnesses:
- Cancer of specified severity
- Coma of Specified Severity
- End-Stage Liver Disease
- Kidney Failure Requiring Regular Dialysis
- Major Injuries
- Major Organ /Bone Marrow Transplant
- Multiple Sclerosis with Persisting Symptoms
- Open Chest CABG
- Third Degree Burns
- Stroke Resulting in Permanent Symptoms
If you add this extension, the Base Policy Sum Insured will double for the aforesaid Critical Illness claims, for which the insurer will charge an additional 30% premium.
Sub-Limits Applicable to IFFCO TOKIO Swasthya Kavach (Family Health) Policy
The insurer has set a sub-limit for the following list of treatments:
- Cataract – 7.5% of the Sum Insured, subject to a maximum of INR 15,000
- Piles, Fistula, Fissure, Tonsillitis, Sinusitis – 10% of the Sum Insured, subject to a maximum of INR 30,000
- Benign Prostatic Hypertrophy, Hernia – 20% of the Sum Insured, subject to a maximum of INR 50,000
- Knee/Hip Joint replacement, Cancer, renal failure – 50% of the Sum Insured, subject to a maximum of INR 2,00,000
- Appendicitis, Gallbladder stones and Hysterectomy – 15% of the Sum Insured subject to a maximum of INR 40,000/-
Eligibility for IFFCO TOKIO Swasthya Kavach (Family Health) Policy
IFFCO TOKIO Swasthya Kavach (Family Health) Policy is available to persons aged between 18 to 65 years. Under this policy, you can also cover children between the age of 91 days to 23 years, provided one or both parents are covered under this policy.
Free Look Period
A free look period of fifteen days shall apply to this policy from the date of receipt to review the terms and conditions. During this period, you can return the policy if the terms and conditions are not acceptable. If you have not made any claim during the free look period, you shall be entitled to a refund of the paid premium after the deduction of medical examination expenses and the stamp duty charges. Where the risk has already commenced and the option of return of the policy is exercised, a deduction towards the proportionate risk premium for the period of cover shall be provided. If only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period.
Important Notes About IFFCO TOKIO Swasthya Kavach (Family Health) Policy
- Sum insured under this policy ranges from INR 1-5 Lakh
- An individual who falls under the age group of 45-55 years needs to go through the following medical check-ups – Blood Sugar (PP & Fasting), ECG with Doctor report, Urine Test and Physical Fitness Certificate
- An individual who falls under the age group of 55-65 years needs to go through the following medical check-ups – Lipid profile, Kidney Function Test, Blood Sugar (PP & Fasting), ECG with Doctor Report, Urine Test and Physical Fitness Certificate
- The above tests will also be mandatory if the basic sum insured is enhanced or when there is a break in insurance for more than 30 days.
- 50% of the cost of pre-acceptance medical check-up will be reimbursed to you
- The hospitalization expenses incurred for treatment of any illness under package charges of the Hospital/Nursing Home will be restricted to 80% of the package if you seek treatment in hospitals outside the network hospital.