health insurance plan of ifco tokyo

Sales Literature Page 1

ITGI/HP/01

SALES LITERATURE Iffco Tokio Health Protector

Scope of Cover

The Policy offers a health protection cover for you and your family for any illness, disease or injury related contingencies like hospitalisation, medical expenses, surgical expenses, organ transplantation etc. The policy covers the members of the family consisting of you, your spouse, dependent children, brother, sister, brother-in-law, sister-in-law, nephew, niece or any other relation who is dependant or relatives living together with you and dependant parents on individual Sum Insured basis.

Normal Policy Term is 1 Year. However, there is a provision of issuing policy on short term basis also.

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

charges.

b) Nursing expenses during Hospitalisation periods on advice of Medical Practitioner 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) Ayurvedic and/ or Homeopathic and/or Unani and/or Sidha Hospitalisation Expenses (upto 10%(ten percent) of Sum Insured).

f) Reasonable and customary charges incurred for Domiciliary Hospitalisation if Medically Necessary upto a maximum aggregate sub-limit of 20% (twenty percent) 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 As per this extension, the Basic Cover Sum Insured will be doubled for the aforesaid Critical Illness claims, for which an additional 30% (thirty percent) of the Basic Cover premium is chargeable.


LIMITS OF LIABILITY:

S No. Nature of Expense Limits

1. Hospitalisation Stay

(a) Room, Boarding & Nursing (Normal room)

1) In respect of class A cities, a limit of 1.75% (one and three fourth of a percent) of the sum insured on per day basis or actual whichever is less.

2) In respect of cities other than class A cities, a limit of 1.50% (one and half of a percent) of the sum insured on per day basis or actual, whichever is less.

Note: Class A cities are Hyderabad, Secundrabad, National Capital Region of Delhi, Ahmadabad, Bangalore, Greater Mumbai, Nagpur, Pune, Jaipur, Chennai, Lucknow, Kanpur and Kolkata.

(b) Room, Boarding & Nursing (ICU/ITU)

1) In respect of class A cities a limit of 3% (three percent) of the sum insured on per day basis or actual whichever is less.

2) In respect of other than class A cities a limit of 2.5% ( two and half percent) of the sum insured on per day basis or actual whichever is less.

Note: Class A cities are Hyderabad, Secundrabad, National Capital Region of Delhi, Ahmadabad, Bangalore, Greater Mumbai, Nagpur, Pune, Jaipur, Chennai, Lucknow, Kanpur and Kolkata.

(c) Registration, Service Charges, Surcharge and similar charges

Actual amount subject to maximum of 0.5% (half percent) of Sum Insured.

2 Fees of Medical Practitioner, Anaesthetist, Consultants and Surgeon

Actual amount up to Sum Insured

3

Anesthesia, Blood, Oxygen, Operation

Theatre, Surgical Appliances, Medicines and

Drugs, Diagnostic Materials and X-ray,

Dialysis, Chemotherapy, Radiotherapy, Cost

of Pacemaker, Artificial Limbs, Cost of

Organs and similar expenses.


4. Vitamins and Tonics forming part of

treatment Actual amount up to Sum Insured

5.

Reasonable and Customary Charges incurred

for Domiciliary Hospitalisation if Medically

Necessary

Upto a maximum aggregate sub-limit of 20% (twenty percent) of the Sum Insured

6. Ayurvedic and/ or Homeopathic and/or Unani and/or Sidha Hospitalisation Expenses


7. Terrorism Covered Actual amount up to Sum Insured


Unique Feature

a) In respect of basic sum insured of Rs. 5 (five) lakhs and above (excluding the sum insured of critical illness), the reimbursement of treatment expenses will be payable according to actual expenses without any capping limits.

b) In respect of basic sum insured below Rs. 5 (five) lakhs (excluding the sum insured of critical illness), the capping on Room rent expenses may be removed on additional payment of 6% on the basic premium.

Additional Benefit

We will pay for the additional benefits as mentioned below in accordance with the main-coverage:

1. Daily allowance: An additional daily allowance amount equivalent to 0.20% (one fifth of a percent) of the sum insured per day for the duration of hospitalisation.

2. Ambulance charges: Ambulance charges 1% (one percent) of the sum insured or Rs. 2500 (two thousand & five hundred), whichever is less for each hospitalisation.

3. Pre and post hospitalisation expense: 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 the insured persons 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 lapse and be forfeited.

b) In case of a claim under the policy in respect of any insured person who has earned cumulative bonus, 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 hospitalisation stipulation.

6. Hospitalisation expenses if period of hospitalisation is less than 24 (twenty four) hours: We will pay hospitalisation expenses if the duration of hospitalisation is more than 12 (twelve) hours but less than 24 (twenty four) hours except the 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) shall be entitled for reimbursement 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. Reinstatement of 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 :

Remaining number of days of the policy

Reinstatement premium= (Annual premium x claim amount) (calculated from the date of admission in hospital) --------------------------------------------- x -------------------------------------------------------------------

Total basic sum insured 365


Reinstatement premium will be deducted from the claim amount. The reinstatement of sum insured will not be available for Critical illness extension and cumulative bonus. The reinstatement of sum insured will not be available for Domiciliary Hospitalisation and Ayurvedic and/or Homeopathic and/or Unani and /or Sidha hospitalization.

9. Vaccination expenses: Insured person(s) 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 with us or 366 days in case of leap year, each subject to a maximum of 10% (ten percent) of the total premium paid (excluding taxes, provided no claim are made and the policies were renewed without break).

10. Provision for Senior Citizens: Grievance Management for Senior citizen will be as per IRDA regulations.

11. 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.

Specific Exclusions:

a) Trips exceeding 90(ninety) days from declared residence without prior notification to emergency assistance service provider.

b) Students at home/school campus address (as they are not considered to be in travel status).

12. Hospitalization expenses (Items (a), (c) and (d) only of the Basic Cover listed above) of person donating an organ during the course of organ transplant will also be payable subject to the limits applicable to the Insured Person and within the overall Sum Insured of the Insured Person.


Additional Advantages

1. Income Tax benefits under Section 80D only if paid by cheque. 2. Hassle free claims procedure. 3. Cashless claim facility available at over 4000 network hospitals across India.

Extension of policy period

In case the insured person(s) who is/are covered under Health Protector Policy has/have to go abroad for a minimum of 30(thirty) days and accordingly he/she/they buy an Travel protector policy for those 30(thirty) days or more and submit(s) the proof thereof(copy of visa and photocopy of stamped passport on return), in that event the period of insurance under the Health Protector policy in respect of the insured person(s) will be extended by 30 (thirty) days or more i.e. the period of insurance under the policy shall be extended for those number of days for which travel protector policy has/have run or actual period abroad subject to a minimum of 30(thirty) days period abroad.

Payment of premium

The premium payable shall be paid in advance before commencement of risk. No receipt for premium shall be valid except on our official form signed by our duly authorized official. In similar way, no waiver of any terms, provision, conditions and endorsements of this policy shall be valid unless made in writing and signed by our authorized official.

Sum Insured

1. The policy shall be available with the minimum Sum Insured of Rs.50,000 (fifty thousand) with subsequent options available in multiple of Rs.50,000 (fifty thousand) upto Rs.5 (five) lakhs and then in multiples of Rs.1 (one) lakhs upto maximum of Rs.20 (twenty) lakhs.

2. In case of increase in basic Sum Insured more than 10% (ten percent) of last year basic Sum Insured at the time of renewal, subject to certain medical check-up required.

Important Exclusions

1. Co-payment: In case of second and subsequent claims under one policy period for the same insured person, following scales of co-payment shall be applicable:

No. Of claims Percentage of Co-payment

First claim Nil

Second claim 7.5% (seven and half percent )of the admissible claim amount

Third claim 10% (ten percent) of the admissible claim amount

Fourth claim and above 20% (twenty percent) of the admissible claim amount

Note: The above co-payment will not be applicable on hospitalisation claim due to accidental injury


2. a) Any condition(s) defined as pre-existing condition in the policy, until 36 (thirty six) months of continuous coverage has elapsed, since inception of the first health insurance policy, whether group or individual, without any break in the insurance coverage.

b) The following disease(s) arising out of or aggravated by diabetes, if existing at the time of taking the first health insurance policy by insured person(s), will fall under the pre-existing condition as described under 2(a) IMPROTANT EXCLUSION above and shall have a waiting period of 36 (thirty six))months:

i. Diabetic Nephropathy ii. Diabetic Retinopathy

iii. Diabetic Neuropathy iv. Diabetic Angiopathy v. Diabetic Ketoaciodosis or Hyper Hypoglycaemia

vi. Hypoglycaemia vii. Diabetic Foot or Wound

c) The following disease(s) arising out of or aggravated by hypertension, if existing at the time of taking the first health insurance policy by insured person (s), will fall under the pre-existing condition as described under 2(a) above of IMPROTANT EXCLUSION and shall have a waiting period of 36 (thirty six)months:

i. Cerebro Vascular Attack (CVA Hemorrhagic) ii. Hypertensive Encephalopathy;

iii. Hypertensive Heart Disease {e.g. Left Ventricular Hypertrophy(LVH) Congestive Heart Failure(CHF) etc. or Coronary Artery Disease (CAD)

iv. Hypertensive Nephropathy; v. Hypertensive Retinopathy;

vi. Aneurysm.

3. Any expense on hospitalisation for any disease which incepts during first 30 (thirty) days of commencement of the insurance cover. This exclusion shall not apply in case of the insured person(s) having been covered under this policy or group or individual medical insurance policy with any of Indian insurance companies for a continuous period of preceding 12(twelve) months without a break exceeding 30(thirty) days. For hospitalisation owing to accidental injury, this 30(thirty) days waiting period shall not apply.

4. a)Any expense incurred in the first year of operation of the insurance cover on treatment of the following diseases:

i. Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma

ii. Hernia, Hydrocele, Congenital Internal Disease. iii. Fistula in Anus, Piles, Sinusitis iv. Choletithiasisand Cholecystectomy

However if these disease(s) is/are under pre-existing condition at the time of the first proposal, then these will be falling under exclusion (2) and will be covered after 36 (thirty six)months of continuous insurance with IFFCO TOKIO General Insurance.

This exclusion shall not apply in case of the insured person(s) having been covered under this policy or group or individual medical insurance policy with any of Indian insurance companies for a continuous period of preceding 12 (twelve) months without a break exceeding 30(thirty) days.


b) Any expense on disease aggravated by Diabetes and/or Hypertension, incurred in the first two years of operation of the insurance cover.

However if these diabetes and/or Hypertension is/are under pre-existing condition at the time of first proposal, then these will be falling under exclusion 2 (b) and 2 (c) above and will be covered

after 36 (thirty six)months of continuous coverage with IFFCO TOKIO General Insurance.

This exclusion shall not apply in case of the insured person(s) having been covered under this policy or group or individual medical insurance policy with any of Indian insurance companies for a continuous period of preceding 24 (twenty four) months without a break exceeding 30 (thirty) days.

5. Cost of spectacles and contact lens or hearing aids.

6. Expenses on diagnostic, x-ray, or laboratory examinations, investigations unless related to the active treatment of disease or injury falling within ambit of hospitalisation claim under LIMIT OF LIABILITY.

7. Procedures/treatments mainly done in outpatient department (OPD) even if these are converted to day care surgery or as in patient in hospital to make it hospitalisation claim

8. Dental treatment or surgery of any kind, unless requiring hospitalisation.

9. Allopathic or Ayurvedic or Homeopathic or Unani or Sidha medicines shall not be allowed unless prescribed by respective practitioner.

10. Maternity expenses (other than ectopic pregnancy requiring surgical intervention), childbirth, miscarriage, abortion or complications of any of these, including caesarean section and any infertility, sub fertility or assisted conception treatment.

11. Any expenses or treatment related to the disease if it is due to chronic alcohol consumption or any self inflicted toxic or drug consumption.

12. Any expense on naturopathy, experimental or unproven treatments.

13. Any expense on procedure and treatment including acupressure, acupuncture, magnetic and such other therapies etc.

14. Travel or transportation expenses, other than ambulance service charges.

15. Any expense related to disease/injury suffered whilst engaged in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, skydiving, paragliding, hang gliding, deep sea diving using hard helmet and breathing apparatus, snow and ice sports and activities of similar hazard.

16. External medical equipment of any kind used at home as post hospitalisation care, like wheelchairs, crutches, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous peritoneal ambulatory dialysis (C.P.A.D) and oxygen concentrator for bronchial asthmatic condition, etc.

17. Genetic disorders and stem cell implantation/ surgery.

18. All non medical expenses including personal comfort and convenience items or services, such as telephone, maid/ barber or beauty services, diet charges, baby food, cosmetics, napkins, toiletry items etc, guest services and similar incidental expenses or services etc.

19. Treatment of obesity or condition arising there from (including morbid obesity) and any other weight control programme, services or supplies etc, hormone replacement therapy, sex change or treatment which results from or is in any way related to sex change.


20. Any expenses for any mental disease (a mental or bodily condition marked by disorganization of personality, mind, and emotions to impair the normal psychological, social or work performance of the individual) regardless of its cause or origin.

21. Expenses related to physiotherapy in a hospital/ nursing home unless arising out of hospitalisation for which the claim is admitted and it is advised by treating Medical Practitioner.

22. Rehabilitation expenses.

23. Ambulance charges, pre and post hospitalisation expenses and daily allowance for the donor in case of major organ transplant.

24. Convalescence, general debility, run down condition or rest cure, congenital disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohols

25. Any expense on treatment related to HIV, AIDS and all related medical conditions.

26. Any expense due to War and Nuclear Risk

27. Injury or diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operation (whether war be declared or not).

28. Any expense under Domiciliary Hospitalisation for

a) Pre and Post Hospitalisation treatment

b) Treatment of following diseases:

i. Asthma ii. Bronchitis

iii. Chronic Nephritis and Nephritic Syndrome iv. Diarrhoea and all type of Dysenteries including Gastro-enteritis v. Diabetes

vi. Epilepsy vii. Hypertension

viii. Influenza, Cough and Cold ix. All types of Psychiatric or Psychosomatic Disorders x. Pyrexia of unknown origin for less than15(fifteen)days

xi. Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharingitis

xii. Arthritis, Gout and Rheumatism xiii. Dental Treatment or Surgery

xiv. Critical Illness

29. Circumcision, unless necessary for the treatment of a Disease not otherwise excluded or required as a result of accidental bodily Injury, vaccination unless forming part of post-bite treatment and as covered in the Additional Benefit, inoculation, cosmetic or aesthetic treatment of any description(including any complications arising thereof), plastic surgery except those relating to treatment of Injury or Disease.

30. Expenses that are not covered as per Annexure 2 (Attached in Policy Document)


Age Limits

The Insurance is available to persons from the age of 91st

(ninety first) day onward. The maximum entry age is 65 (sixty five) years. There is no age limit for renewal of the policy. The minimum age for the proposer is 18 (eighteen) years. Dependents including children can be covered provided one or more adults are covered concurrently. There is no upper age limit for coverage of dependents.

a) For an individual in age group of completed 45 (forty five) years to 55 (fifty five) years following Medical checkup is required:

1. Blood Sugar (PP & Fasting) 2. ECG with Doctors report 3. Urine Test and Physical fitness certificate

b) For an individual in age group of 55 (fifty five) years to 65 (sixty five) years following Medical checkup is required:

1. Lipid profile 2. Kidney Function Test 3. Reports as per tests defined under (a)

The above tests will also be mandatory in following cases: a) Fresh proposals, as per a) and b) mentioned above in respect of persons between 45 to 55 years

and above 55 years, respectively. b) If the basic sum insured is being sought to be enhanced by more than 10% (ten percent) at the

time of renewal. c) When there is break in insurance for more than 30(thirty) days. d) If there is a claim in the expiring policy because of any Critical Illness

In event of acceptance of proposal, 50% (fifty percent) cost of medical check-up will be reimbursed to you. The validity of aforesaid tests would be 15 days.

Procedure for enhancement of Sum Insured

Sum Insured can be enhanced in case of renewal only. Mid-term enhancement of Sum Insured is not allowed.

a) Intimation for enhancement of sum insured should be before the renewal of the policy.

b) If there is a break in insurance for more than 30 days, request for enhancement of sum insured

will be treated as a fresh proposal.

c) If insured is more than 45 years of age, fresh medical check-up would be required in case of

enhancement of Sum Insured beyond 10% on renewal. If the age is less than 45 years, an

increase in Sum Insured up to next two levels as per rate chart shall be permitted without

medical test, after which a medical test would be mandatory.

Renewal

Renewal shall not be refused unless justified on grounds of fraud, moral hazard or misrepresentation or noncooperation by the insured, provided, however, that you apply for renewal and remit the requisite premium before the expiry of this policy. 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 continuity benefits (relating to Pre-existing Disease Exclusion, 30 (thirty) days Waiting Period, First Year Disease Exclusions and Cumulative Bonus earning) will not be available and any insurance cover thereafter will be treated as fresh cover.

In any case, we shall not be liable to pay claim occurring during the period of break in insurance i.e. up to 30 (thirty) days from the due date of renewal.


Portability :

The Portability of health insurance policies shall be governed by the Health Insurance Regulation, 2013 dated 16th February, 2013. For more information please refer to the page no.89 on the following URL of the IRDA website:

http://www.policyholder.gov.in/uploads/CEDocuments/Health%20Insurance%20Regulations%202013.pdf

The salient features mentioning the rights and obligations of the insurer and insured are as follows:

a) A policyholder desirous of porting his policy to another insurance company shall apply to such insurance company, to port the entire policy along with all the members of the family, if any, at least 45 days before the premium renewal date of his/her existing policy.

b) Insurer may not be liable to offer portability if policyholder fails to approach the new insurer at least 45 days before the premium renewal date.

c) Portability shall be opted by the policyholder only as stated in (a) above and not during the currency of the policy.

d) In case insurer is willing to consider the proposal for portability even if the policyholder fails to approach insurer at least 45 days before the renewal date, it may be free to do so.

e) Where the outcome of acceptance of portability is still waiting from the new insurer on the date of renewal : a. The existing policy shall be allowed to extend, if requested by the policyholder, for the short

period by accepting a pro- rate premium for such short period, which shall be o f at least one month and

b. Shall not cancel existing policy until such time a confirmed policy from new insurer is received or at the specific written request o f the insured.

c. The new insurer, in all such cases, shall reckon the date o f the commencement o f risk to match with date o f expiry o f the short period, wherever relevant.

d. If for any reason the insured intends to continue the policy further with the existing insurer, it shall be allowed to continue by charging a regular premium and without imposing any new condition.

Free Lookup Period

a) You will be allowed a period of at least 15 (fifteen) days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable stating the reasons therein for doing so.

b) If you have not made any claim during the free look period, then you shall be entitled to :

i. A refund of the premium paid less any expenses incurred by us on medical examination of the insured persons and the stamp duty charges or;

ii. Where the risk has already commenced and the option of return of the policy is exercised by you, a deduction towards the proportionate risk premium for period on cover less any expenses incurred by us on medical examination of the insured persons and the stamp duty charges or;

iii. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period less any expenses incurred by us on medical examination of the insured persons and the stamp duty charges

c) Free Lookup Period is not applicable for renewal policies.


Cancellation

i. We may cancel the policy on grounds of fraud, moral hazard or misrepresentation or noncooperation by the insured, 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

Limit of Indemnity

The liability under the subject policy by way of indemnity for all the covers shall in no way exceed the overall Sum Insured opted by the Insured. However this condition is not applicable in case of Indemnity of Critical Illness treatments.

Withdrawal & Alteration of Policy Conditions

The policy terms and conditions may undergo alteration as per the IRDA Health Regulation. However the same shall be duly notified to you at least three months prior to the date when such alteration or revision comes into effect by registered post at your last declared correspondence address. The timeliness for revision in terms and rates shall be as per the IRDA Health Regulation.

A product may be withdrawn with the prior approval of the Authority and information of withdrawal shall be given to you in advance as per the IRDA guidelines with details of options provided by us. If we do not receive your response on the intimation of withdrawal, the existing product shall be withdrawn on the renewal date and you shall have to take a new policy available with us, subject to portability conditions

Fraud

If a claim is fraudulent in any respect or supported by any fraudulent statement with or without your knowledge or that of the insured person(s), all benefit(s) under this policy shall be forfeited

Premium

Basic cover

Depending upon the age of the insured person(s) and sum insured for that person.


Loadings & Discounts

1) Family Discount: A Family Discount on total premium is permissible as per the following scale depending upon the total number of insured persons covered under the policy at inception of the cover. Increase/decrease in size of the family during the currency of the policy is permissible; however there will not be any adjustment of discounts during the currency of policy.

2(two) Family Members --5%(five percent)discount on total premium (Main Cover plus Higher Sum Insured for Critical Illness)

3(three)and more Family Members --10%(ten percent) discount on total premium (Main Cover plus Higher Sum Insured for Critical Illness)

The above slabs for Family Discount on number of persons covered will be followed. However, depending on specific requirement and merit of the case, it can be altered by CEO of IFFCO-TOKIO.

2) Discount for employees covered under the Group Mediclaim Policy: All the employees covered under the Group Mediclaim Policy insured with IFFCO TOKIO will be eligible for a discount as per below mentioned slabs.

Product Type Sum Insured opted under Health Protector Discount

Health Protector Upto Rs 2(two)lacs 10%(ten percent)

Health Protector Above Rs 2(two)lacs 20%(twenty

percent)

3) 10% (ten percent) discount in policy premium for all customers holding any other insurance policy of IFFCO TOKIO.

4) 20% (twenty percent) discount for all employees of IFFCO TOKIO.

Note: All the above mentioned discounts are on cumulative basis and cannot exceed a total of 25% (twenty five) percent.

Documents required for settlement of claims: Claim Form

Discharge Summary

Bills and Receipt of Hospital/Nursing Home

Attending Doctors Report and Bills as well as cash memos of medicines and pathological tests duly supported by proper prescription.

This brochure provides only the salient features and for details kindly refers to the complete Policy wordings. For enquires kindly contact our nearest Bima Kendra LSC, SBU or Dial Toll Free No. 1800-103-5499 / 1800-345-3303 or visit our website www.iffcotokio.co.in


Premium Sheets

Rate Sheet of Health Protector portfolio other than Gujarat

Age (in Years) / Sum Insured

(in Rs) 500

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1000

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1500

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2000

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2500

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3000

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3500

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4000

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4500

00

5000

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6000

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7000

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8000

00

9000

00

1000

000

1100

000

1200

000

1300

000

1400

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1500

000

1600

000

1700

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1800

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1900

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2000

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up to 25 yr 1191 1634 2124 2451 3040 3432 3947 4290 4804 5148 5582 6054 6565 7120 7721 7944 8372 8823 9298 9799 9987 10180 10376 10575 10779

26 to 35 1360 2043 2656 3064 3799 4290 4933 5362 6006 6435 6978 7568 8207 8900 9652 9930 10465 11028 11622 12249 12484 12725 12969 13219 13473

36 to 45 1641 2553 3319 3830 4749 5362 6166 6703 7507 8043 8723 9459 10258 11125 12065 12412 13081 13785 14528 15311 15605 15906 16212 16524 16842

46 to 55 3087 3702 4813 5554 6886 7775 8941 9719 10885 11663 12648 13716 14875 16131 17494 17997 18967 19989 21066 22201 22628 23063 23507 23960 24421

56 to 65 4337 5739 7460 8608 10674 12051 13859 15064 16872 18077 19604 21260 23056 25003 27116 27896 29399 30983 32652 34411 35073 35748 36436 37137 37852

66 to 70 7195 8895 11564 13343 16545 18680 21482 23349 26151 28019 30386 32953 35737 38755 42029 43239 45568 48023 50610 53337 54363 55410 56476 57563 58671

71 to 75 9211 10674 13876 16011 19854 22416 25778 28019 31382 33623 36463 39544 42884 46506 50435 51886 54682 57628 60732 64004 65236 66491 67771 69075 70405

76 to 80 12244 13343 17345 20014 24817 28019 32222 35024 39227 42029 45579 49430 53605 58133 63044 64858 68352 72035 75915 80005 81545 83114 84714 86344 88006

81 to 85 14693 16011 20814 24017 29781 33623 38667 42029 47073 50435 54695 59315 64326 69760 75652 77830 82023 86442 91099 96006 97854 99737 101657 103613 105607

86 to 90 16162 17612 22896 26418 32759 36986 42533 46232 51780 55478 60165 65247 70758 76736 83218 85613 90225 95086 100208 105607 107639 109711 111822 113974 116168

91 to 95 17778 19373 25185 29060 36035 40684 46787 50855 56958 61026 66181 71772 77834 84409 91539 94174 99248 104594 110229 116168 118403 120682 123005 125372 127785

96 to 100 19556 21311 27704 31966 39638 44753 51465 55941 62654 67129 72799 78949 85618 92850 100693 103591 109172 115054 121252 127785 130244 132750 135305 137909 140563

101 & Above 20534 22377 29089 33564 41620 46991 54038 58738 65787 70485 76439 82896 89899 97493 105728 108771 114631 120807 127315 134174 136756 139388 142070 144804 147591

Above rates (in Rs) are exclusive of Service Tax


Rate sheet of Health Protector with Critical Illness other than Gujarat

Age (in Years) / Sum Insured (in Rs)

5000

0

1000

00

1500

00

2000

00

2500

00

3000

00

3500

00

4000

00

4500

00

5000

00

6000

00

7000

00

8000

00

9000

00

1000

000

1100

000

1200

000

1300

000

1400

000

1500

000

1600

000

1700

000

1800

000

1900

000

2000

000

upto 25 yr

1548 2124 2762 3187 3951 4461 5130 5577 6246 6692 7257 7870 8535 9256 10038 10327 10883 11469 12087 12739 12984 13234 13488 13748 14012

26 to 35

1768 2656 3452 3983 4939 5577 6413 6971 7807 8365 9071 9838 10669 11570 12547 12908 13604 14337 15109 15923 16230 16542 16860 17185 17515

36 to 45

2133 3319 4315 4979 6174 6971 8016 8713 9759 10456 11339 12297 13336 14463 15684 16136 17005 17921 18886 19904 20287 20677 21075 21481 21894

46 to 55

4013 4813 6257 7220 8952 10108 11624 12634 14151 15161 16442 17831 19337 20971 22742 23397 24657 25985 27385 28861 29416 29982 30559 31147 31747

56 to 65

5637 7460 9698 11191 13876 15667 18017 19583 21933 23500 25485 27638 29973 32504 35250 36265 38218 40277 42447 44734 45595 46473 47367 48278 49208

66 to 70

9353 11564 15033 17345 21508 24283 27926 30354 33997 36425 39502 42839 46458 50382 54638 56210 59239 62430 65793 69338 70672 72032 73419 74832 76272

71 to 75

11974 13876 18039 20814 25810 29140 33511 36425 40796 43710 47403 51407 55749 60458 65565 67452 71086 74916 78952 83206 84807 86439 88102 89798 91526

76 to 80

15917 17345 22549 26018 32262 36425 41889 45531 50995 54638 59253 64258 69686 75573 81957 84316 88858 93645 98690 104007 106009 108049 110128 112247 114408

81 to 85

19101 20814 27059 31222 38715 43710 50267 54638 61194 65565 71104 77110 83624 90687 98348 101179 106630 112374 118428 124808 127210 129658 132154 134697 137289

86 to 90

21011 22896 29765 34344 42586 48081 55293 60102 67314 72122 78214 84821 91986 99756 108183 111297 117293 123612 130271 137289 139931 142624 145369 148167 151018

91 to 95

23112 25185 32741 37778 46845 52889 60823 66112 74045 79334 86036 93303 101185 109732 119001 122426 129022 135973 143298 151018 153924 156887 159906 162983 166120

96 to 100

25423 27704 36015 41556 51529 58178 66905 72723 81450 87267 94639 102633 111303 120705 130901 134669 141924 149570 157628 166120 169317 172575 175897 179282 182732

101 & above 26694 29089 37816 43634 54105 61087 70250 76359 85523 91630 99371 107765 116868 126740 137446 141402 149020 157049 165509 174426 177783 181204 184692 188246 191869



Rate Sheet of Health Protector for Gujarat

Age (in Years) / Sum Insured (in Rs)

5000

0

1000

00

1500

00

2000

00

2500

00

3000

00

3500

00

4000

00

4500

00

5000

00

6000

00

7000

00

8000

00

9000

00

1000

000

1100

000

1200

000

1300

000

1400

000

1500

000

1600

000

1700

000

1800

000

1900

000

2000

000

upto 25 yr

1369 1879 2443 2819 3495 3947 4538 4933 5525 5920 6420 6962 7550 8188 8880 9135 9627 10146 10693 11269 11486 11707 11932 12162 12396

26 to 35 1564 2349 3054 3524 4369 4933 5673 6166 6906 7400 8025 8703 9438 10235 11100 11419 12034 12683 13366 14086 14357 14633 14915 15202 15494

36 to 45 1887 2936 3817 4405 5462 6166 7091 7708 8633 9250 10031 10878 11797 12794 13874 14274 15043 15853 16707 17607 17946 18292 18644 19002 19368

46 to 55 3550 4258 5535 6387 7919 8941 10283 11177 12518 13412 14545 15774 17106 18551 20118 20697 21812 22987 24226 25531 26022 26523 27033 27553 28084

56 to 65 4987 6600 8579 9899 12275 13859 15938 17324 19403 20789 22545 24449 26514 28754 31183 32080 33809 35630 37550 39573 40334 41110 41901 42708 43530

66 to 70 8274 10229 13298 15344 19026 21482 24704 26852 30074 32222 34944 37896 41097 44569 48333 49725 52403 55227 58202 61337 62518 63721 64947 66197 67471

71 to 75 10592 12275 15958 18413 22832 25778 29645 32222 36089 38667 41933 45475 49317 53482 58000 59669 62884 66272 69842 73605 75021 76465 77937 79437 80965

76 to 80 14081 15344 19947 23016 28540 32222 37056 40278 45111 48333 52416 56844 61646 66853 72500 74587 78605 82840 87303 92006 93777 95582 97421 99296 101207

81 to 85 16897 18413 23937 27619 34248 38667 44467 48333 54133 58000 62899 68213 73975 80224 87000 89504 94326 99408 104763 110407 112532 114698 116905 119155 121448

86 to 90 18586 20254 26330 30381 37672 42533 48913 53167 59547 63800 69189 75034 81372 88246 95700 98455 103759 109349 115240 121448 123785 126168 128596 131070 133593

91 to 95 20445 22279 28963 33419 41440 46787 53805 58483 65501 70180 76108 82537 89509 97071 105270 108300 114135 120284 126764 133593 136164 138784 141455 144178 146952

96 to 100

22490 24507 31860 36761 45584 51465 59185 64332 72052 77198 83719 90791 98460 106778 115797 119130 125548 132312 139440 146952 149780 152663 155601 158595 161647

101 & above 23615 25732 33453 38599 47863 54038 62144 67549 75655 81058 87905 95331 103383 112117 121587 125087 131825 138928 146412 154300 157269 160296 163381 166525 169729



Rate Sheet of Health Protector with Critical Illness for Gujarat Age (in Years) / Sum Insured (in Rs)

5000

0

1000

00

1500

00

2000

00

2500

00

3000

00

3500

00

4000

00

4500

00

5000

00

6000

00

7000

00

8000

00

9000

00

1000

000

1100

000

1200

000

1300

000

1400

000

1500

000

1600

000

1700

000

1800

000

1900

000

2000

000

upto 25 yr

1780 2443 3176 3665 4544 5130 5900 6413 7183 7696 8346 9051 9815 10644 11544 11876 12516 13190 13900 14649 14931 15219 15511 15810 16114

26 to 35

2034 3054 3970 4581 5680 6413 7375 8016 8978 9620 10432 11313 12269 13306 14429 14845 15644 16487 17376 18312 18664 19023 19389 19762 20143

36 to 45

2453 3817 4963 5726 7100 8016 9219 10020 11223 12025 13040 14142 15336 16632 18037 18556 19556 20609 21719 22890 23330 23779 24237 24703 25179

46 to 55

4615 5535 7196 8303 10295 11624 13367 14530 16273 17436 18908 20506 22238 24116 26153 26906 28356 29883 31493 33190 33829 34480 35143 35820 36509

56 to 65

6483 8579 11153 12869 15958 18017 20719 22521 25223 27025 29308 31784 34469 37380 40538 41704 43951 46319 48814 51444 52434 53443 54472 55520 56589

66 to 70

10756 13298 17288 19947 24734 27926 32115 34907 39096 41889 45427 49265 53426 57939 62833 64642 68124 71795 75662 79739 81273 82837 84432 86056 87713

71 to 75

13770 15958 20745 23937 29681 33511 38538 41889 46916 50267 54513 59118 64111 69527 75400 77570 81749 86153 90795 95686 97528 99405 101318 103268 105255

76 to 80

18305 19947 25931 29921 37102 41889 48172 52361 58645 62833 68141 73897 80139 86909 94250 96963 102187 107692 113494 119608 121910 124256 126647 129085 131569

81 to 85

21966 23937 31118 35905 44522 50267 57807 62833 70373 75400 81769 88677 96167 104291 113100 116355 122624 129230 136192 143530 146292 149107 151977 154901 157883

86 to 90

24162 26330 34229 39495 48974 55293 63587 69117 77411 82940 89946 97544 105784 114720 124410 127991 134886 142153 149812 157883 160921 164018 167174 170392 173671

91 to 95

26579 28963 37652 43445 53872 60823 69946 76028 85152 91234 98941 107299 116362 126192 136851 140790 148375 156369 164793 173671 177013 180420 183892 187431 191038

96 to 100

29237 31860 41417 47789 59259 66905 76941 83631 93667 100358 108835 118028 127999 138811 150536 154869 163213 172005 181272 191038 194714 198462 202281 206174 210142

101 & above 30699 33453 43488 50178 62222 70250 80788 87813 98350 105376 114277 123929 134399 145752 158063 162612 171374 180605 190336 200590 204450 208385 212395 216483 220649

Above rates (in Rs) are exclusive of Service Tax Note: The above stated premium & policy coverages, terms & conditions as per IRDA (Health Insurance Regulations are subject to revision from time to time but chargeable/implementable only at the time of renewal.