Claim Settlement of IFFCO Tokio Health Insurance
IFFCO Tokio Health Insurance, a pioneer in the health insurance industry, is dedicated to offering hassle-free health claim procedure. With a huge network of around 4200 network hospitals, the insurer ensures a smooth claim settlement procedure across the nation according to its regulations. IFFCO Tokio is widely appreciated for its easy and fast cashless claim procedure either through external TPAs or directly by IFFCO Tokio. The policyholders can get their claims settled with reimbursement option or cashless facility.
Claim Process for Cashless Treatment
Cashless claims can be availed at the network hospitals of IFFCO Tokio only. Currently, the insurer is empanelled with 4,200+ hospitals. However, here is a guide to filing a cashless claim with IFFCO Tokio:
- Search a hospital tied-up with IFFCO Tokio, where you would like to avail cashless treatment
- Inform the Third Party Administrator (TPA) as soon as you get hospitalised in the case of emergency hospitalisation, while within 3 days before the hospitalisation in the case of planned admission.
- Find a cashless request form from hospital’s help desk, fill it and send it with relevant medical records to the TPA
- The TPA will intimate the hospitals about its decision, which may include the approval of claim or a request for additional documents
- If TPA grants the approval for a cashless claim, medical bills will be settled directly as per the policy offerings
- If the claim gets rejected by the TPA, the policyholder will have to settle the bill with the hospital on its own and later can request for the reimbursement process as per the terms and conditions
In case, someone couldn’t avail the cashless treatment facility at the network hospital due to any reason or had to get treated at a non-network hospital; then reimbursement procedure comes into force. Here is the process for it:
- Convey about the hospitalisation to IFFCO-Tokio just after the hospitalisation but not later than 7 days of discharge
- While informing do quote your Policy Certificate Number
- Opt for medical treatment or procedure and avail it
- Pay the bills at the hospital and file the reimbursement claim.
- Download the claim form from the insurer’s website
- Collect all the supporting documents such as medical reports, invoices, ID proof and so on at the time of discharge and submit along with the claim form to the insurer's office
Following are some essential documents that are required to be submitted to claim a reimbursement.
- Claim form with doctor's certificate
- Discharge details
- Medical bills
- Prescriptions for medicines
- Final receipts
- Test reports of diagnosis, x-ray scan, ECG etc.
However, if required, the team handling the claim process may ask for some more documents as well.
Incurred Claim Ratio (ICR) of IFFCO Tokio Health Insurance
One can gauge the potential of an insurance company through Incurred Claim Ratio (ICR). It unveils the speed of claim procedure as well as the productivity in terms of profit earning. The incurred claim ratio of IFFCO Tokio is 102%, which speaks about the efficiency of claim settlement and the stability of the insurer at the same time.