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IFFCO Tokio Claim Settlement Ratio

89.38%

IFFCO Tokio

94.21%

Industry Average

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. IFFCO Tokio has a claim settlement ratio of 89.38%, as compared to the industry average of 94.21%.

IFFCO Tokio Claim Process

IFFCO Tokio supports both cashless claims and reimbursement claims. This section covers the information on how to check IFFCO Tokio health insurance claim status, fill IFFCO Tokio health insurance claim form, and the claim settlement process.

Cashless claims are of two types:

  1. Cashless Claims procedure for Emergency Admission
  2. Cashless Claims procedure for Planned Admission
    • Step 1: Select a hospital from our list of network hospitals for treatment
    • Step 2: Intimate our Third-party administrator (TPA) through the Helpline Number before 3 days of admission, quoting your Health card Membership number
    • Step 3: Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor
    • Step 4: Fax the cashless request form along with supporting medical records to the TPA
    • Step 5: The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required
    • Step 6: On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you
    • Step 7: If the cashless claim is not approved by TPA, please 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 Emergency Admission:

  1. Step 1: In the case of network hospital, on admission, intimate the Third-party administrator (TPA) through their Toll-free no. Please quote your health card Membership number
  2. Step 2: Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor
  3. Step 3: Fax the cashless request form along with supporting medical records to the TPA
  4. Step 4: The TPA will scrutinize the document and convey the decision to the hospital. The TPA could sanction the cashless request or call for additional documents if required
  5. Step 5: On approval of a cashless claim by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges, etc would have to be settled by you
  6. Step 6: If the cashless claim is not approved by TPA, please settle the bill with the hospital and apply for reimbursement. The claim will be processed as per policy terms and conditions

If you have not availed cashless facility in-network hospital or you have taken treatment in a hospital that is not a part of the network then you may submit your original documents for reimbursement

  1. Step 1: Intimate IFFCO-Tokio through the toll number - 1800 103 5499 immediately on admission not later than 7 days from the date of discharge. Please quote your Policy Certificate Number while intimating the claim
  2. Step 2: Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement
  3. Step 3: Download the relevant claim form from our website (or) request for one through our call center. Claim documents may also be submitted to the local IFFCO TOKIO Office address which can be obtained by calling our Toll Number 1800 543 5499

If you need guidance on the claims process, you could also contact us through our Toll Numbers - 1800 543 5499

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FAQs

Cumulative bonus is the same as no claim bonus. It is a bonus which is allowed by a health insurance policy if you do not make a claim in a policy year. IFFCO Tokio Health Insurance plans offer you an increase in the sum insured as a cumulative bonus while the premiums do not increase

Most health plans offered by IFFCO Tokio come with coverage duration of one year after which you are required to renew the policy

The requirement of pre-entrance medical check-ups depends on the plan that you are buying, your entry age and sum insured that you choose. At higher ages and if you choose higher levels of the sum insured, pre-entrance medical check-ups would be required.
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