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IFFCO Tokio Health Insurance Claim

IFFCO Tokio Health Insurance is a well-recognized and reputed health insurance company in India. This insurance company offers a wide variety of health insurance plans and all these plans shell out several benefits such as in-patient hospitalization coverage, cashless facility, health check-ups, ambulance charges, pre & post-hospitalization expenses, and many more. In addition to these benefits, IFFCO Tokio also adopts a hassle-free and quick claim procedure that aims at providing customers with the utmost help during their tough times. Here, in this article, we are going to take a closer look at IFFCO Tokio’s health insurance claim procedure and help you understand better about this insurance company.

Types of Health Insurance Claims offered by IFFCO Tokio

IFFCO Tokio adopts two methods for settling the health insurance claims, namely- the cashless claim procedure and the Reimbursement claim procedure. The policyholders of IFFCO Tokio health insurance plans can settle their claim using either of these methods, as per their needs. Given below is a brief discussion of both these procedures. Let’s take a look.

Cashless Claim Procedure

In the case of a cashless claim procedure, there is no waiting period for getting the claim amount since the company pays directly to the hospital. The policyholder can get admitted into any of the network hospitals of the insurance company, and the company will settle the treatment bills of the patient directly to the hospital. This way, customers can get admitted without worrying about finances. IFFCO Tokio offers two types of cashless claim facilities:

Cashless Claims procedure for Emergency Admission

This claim procedure is designed for policyholders who go for unplanned medical treatment in emergency situations. In such cases, the customers need to follow the steps given below-

  • Seek admission into any of the network hospitals.
  • Intimate the Third-party administrator (TPA) through their Toll-free number and quote your health card membership number.
  • Fill in the cashless request form and get it certified by the treating doctor.
  • Fax the cashless request form along with supporting medical records to the TPA.
  • The TPA will verify the policyholder’s document and convey the decision to the hospital.

(Please note that the TPA can sanction the cashless request or even call for additional documents, if required.)

  • After getting approved by TPA, the IFFCO Tokio insurance company will settle the hospital bills directly (subject to policy limits). However, some of the inadmissible amounts such as telephone fees, food, attendant charges would have to be settled by the policyholder.
  •  If in case the cashless claim is not approved by TPA, then the customer needs to settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions.

Cashless Claims procedure for Planned Admission

This insurance claim procedure is designed for the customers who have scheduled their medical treatment based on decisions made by them and their physician. To avail this type of claim, the policyholders must follow the steps given below-

  • Select any one hospital from the company’s list of network hospitals
  • Inform the Third-party administrator (TPA) and verify your health card membership number at least 3 days before admission.
  • Fill in the cashless request form and get it certified by the treating physician/doctor.
  • Fax the cashless request form along with supporting medical records to the TPA.
  • The TPA will verify the document and convey the decision to the hospital.
  • If approved, the IFFCO Tokio insurance company will settle all the hospital bills directly to the hospital. However, a few inadmissible amounts like telephone charges, food, attendant charges will be borne by the policyholder.
  • In case the approval is rejected by TPA, the policyholder will have to settle the bill with the hospital and apply for reimbursement. The insurance company will process the claim as per the policy terms and conditions.

Reimbursement of Claim Procedure

The reimbursement claim procedure is opted by customers who were unable to avail the cashless medical treatment in any of IFFCO Tokio’s network hospitals. In such cases, the customer has to submit their original hospital bills and documents to the insurance company and apply for the reimbursement amount. Given below are the steps that must be followed:

  • Intimate the insurance company upon getting admitted into the hospital and not later than 7 days from the date of discharge.
  • You can call at the company’s toll number – 1800 103 5499 and quote your policy certificate number to intimate the claim.
  • The policyholder can avail treatment and settle all the bills with the hospital and then file a claim for reimbursement.
  • Download the relevant claim form from IFFCO Tokio’s website or place a request for the form from the company’s call center.
  • Submit your claim documents to the local IFFCO TOKIO Office address.

The turnaround time for all reimbursement claim requests is 20 days from the date of receipt of all documents.

List of Documents Required While Filling A Claim

There are a variety of documents that need to be submitted along with the application form while applying for a claim at the IFFCO Tokio insurance company. Given below is a general list of all those documents. Let’s take a look at them.

  • Discharge summary report
  • Hospital bills
  • Medical prescriptions
  • Advance and final receipts
  • Diagnostic test reports, X-Ray, scan and ECG and other reports (if any).

(Please note that the required claim processing team can also ask for furthermore documents other than the above-listed ones depending upon the customer’s claim report)

How Can You Check Cashless Hospitals For IFFCO Tokio?

As we’ve already discussed above, it is important to receive the medical treatments from any of the network hospitals of the insurer in order to avail the cashless treatment. It is the customer’s responsibility to find a cashless hospital or healthcare center nearby their area and seek admission into that hospital for their future medical treatment. To help you understand better, we’ve discussed here the detailed process of how you can find the nearest network hospital of IFFCO Tokio insurance company.

  1. Visit the official website of IFFCO Tokio Insurance and click on the Menu tab available at the top left corner of the homepage.
  1. Select the Claim option from the options available in the menu bar.
  1. Click on the Cashless Facilities tab and then select the ‘Hospital List’ option.
  1. Choose the state and city name according to your preference.
  1. All the network hospitals or healthcare centers will appear on the screen within your vicinity.
  1. Enter your preferred hospital name and click on the ‘Submit’ option.
  1. You can also download the entire list of IFFCO Tokio Network hospitals from this link and save for later use.
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