For the first time in India, additional optional cover of Critical illness is also provided to the family under a singlesum insured on floater basis. The policy is brought to you by IFFCO-TOKIO General Insurance Company Ltd. at an affordable premium.

What the Policy covers

Basic Cover

a) Room Rent Expenses as provided in the Hospital/Nursing Home including Hospital Registration/ Service charges.

b) Nursing Expenses during hospitalisation period on the advice of Medical Practitioners for duration specified.

c) Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist fees.

d) 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.

e) Ayurveda and/ or Homeopathy and/or Unani and/or Sidha Hospitalisation Expenses {upto the limit of theSum Insured}.

f) Reasonable and customary charges incurred for Domiciliary Hospitalisation, if medically necessary upto a maximum aggregate sub-limit of 20% of the sum insured. 

Higher Sum Insured for Critical Illness

Higher sum insured for critical illness to cover expenses (as listed in Basic Cover) related to following Critical Illnesses:
1. Cancer of Specified Severity
2. First Heart Attack - Of Specified Severity
3. Open Chest CABG
4. Open Heart Replacement or Repair of Heart Valves
5. Coma of Specified Severity
6. Kidney Failure Requiring Regular Dialysis
7. Stroke Resulting In Permanent Symptoms
8. Major Organ /Bone Marrow Transplant
9. Permanent Paralysis Of Limbs
10. Motor Neurone Disease with Permanent Symptoms
11. Multiple Sclerosis with Persisting Symptoms

Addtional Cover

1. Daily allowance: An additional daily allowance amount equivalent to 0.15% (one seventh of a percent) of thesum insured per day, up to a maximum of Rs. 1,000 (one thousand) per day respect of an insured person for the duration of hospitalization. If the hospitalization period is less than 24 (twenty four hours), then this daily allowance will be reduced proportionately for the period of hospitalization.

2. Ambulance charges: Ambulance charges in connection with any admissible claim subject to a limit of 0.75% (three fourth of a percent) of the sum insured or Rs. 2500/-(two thousand & five hundred) whichever is lower, for each hospitalization.

3. Pre and post hospitalization medical expenses: 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.

4. 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 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 lapseand be forfeited.

b) In case of a claim under the policy in respect of any insured person(s), 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.

5. Day care surgeries: 121 surgical procedures covered without 24 hours of hospitalization stipulation.

6. Hospitalisation expenses if period of hospitalization is less than 24 (twenty four) hours: We will pay hospitalization expenses if the duration of hospitalization is more than 12 (twelve) hours but less than 24 (twenty four) hours except for the listed day care surgeries, the room rent shall be limited to 50% (fifty percent) of the entitled room rent per day.

7. Cost of health check up: Insured person(s), on individual or collective basis, shall be entitled forreimbursement 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.

8. Vaccination expenses: Insured person(s), on individual or collective basis, 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 each with

us or 366 days in case of leap year, subject to a maximum of 7.5% (seven and half percent) of the totalpremium paid (excluding taxes) for the last two policies in respect of a single insured person and a maximum of 15% (fifteen percent) for all the insured persons, provided no claim(s) is/are made in respect of the insured person(s) during that period of insurance and the policies were renewed without break.

9. 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.

IFFCO TOKIO General Insurance is the first Insurer to bring to you these services and that too without any sub limits: a) Medical Consultation, Evaluation and Referral b) Emergency Medical Evacuation c) Medical Repatriation d) Transportation to Join Patient e) Care and/or Transportation of Minor Children f) Emergency Message Transmission g) Return of Mortal Remains h) Emergency Cash Coordination.

Cancellation

i. We may cancel the policy on grounds of fraud, moral hazard or misrepresentation or non‐cooperation by theinsured, by sending a 30 (thirty) days notice by registered post to your last known address. You will then be entitled, except in case of fraud or illegality on your part, to a pro-rata refund of premium for unexpired period of this policy in respect of such insured person(s) in respect for whom no claim has arisen. ii. You may cancel the policy by sending written notice to us under registered post. We will then allow a refund on following scale, except for those insured person(s) for whom claim has been preferred on us under the current policy:
Period of cover up to Refund of annual premium rate (%)
1 (one)month 75% (seventy five percent)
3 (three) months 50% (fifty percent)
6 (six) months 25% (twenty five percent)
Exceeding 6 (six) months Nil

Reinstatement of basic 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 the following method for reinstatement of the basic sum insured so that full basic sum insured is available for the policy period :

a) Reinstatement of Basic Sum Insured will be to the extent of claim amount paid.

b) Reinstatement premium will be deducted from the claim amount.

c) Reinstatement will be effected for the period from the first date of hospitalization up to the expiry date of the policy.

d) This reinstated basic sum insured will not be available for the hospitalization treatment expenses of the illness/ disease/ injury for which the insured person(s) was/were hospitalised. It will be available for treatment including that for the same illness or any other disease, illness (other than chronic diseases listed under point g) which are not cases of relapse within 45(forty five) days of first hospitalization for which Insured person(s) was/were hospitalised. Further even in the first hospitalization period, if the insured person(s) sustain(s) any injury or contract(s) any disease other than injury, disease for which he/she was hospitalised, then the Reinstated basic Sum Insured will be available for payment of claim for subsequent disease/injury/illness which insured person(s) has/have sustained whilst being in the hospital for the other disease/injury.

e) Though the basic sum insured will be reinstated as soon as hospitalization of the insured person(s) take place, the premium for the same shall be recovered from the claim settlement amount.

f) This will be applicable on all policies with a basic sum insured of Rs.3 (three) lacs and above.

g) Premium will be computed on pro-rata basis on the proportion of claimed amount to basic sum insured and the annual premium.

h) The reinstated basic sum insured will not be available for the following chronic disease where the initial claim under the same policy period has been lodged for :--
I. Cancer Of Specified Severity;
II. First Heart Attack - Of Specified Severity;
III. Open Chest CABG;
IV. A Open Heart Replacement Or Repair Of Heart Valves;
V. Coma Of Specified Severity;
VI. Kidney Failure Requiring Regular Dialysis :
VII. Stroke Resulting In Permanent Symptoms;
VIII. Major Organ /Bone Marrow Transplant:
IX. Permanent Paralysis Of Limbs
X. Motor Neurone Disease With Permanent Symptoms
XI. Multiple Sclerosis With Persisting Symptoms

i) The reinstatement of basic sum insured will not be available for Critical illness extension and cumulative bonus.

j) The reinstatement of basic sum insured will not be available for Domiciliary Hospitalization and Ayurveda and/or Homeopathic and/or Unani and /or Sidha hospitalization.