IFFCO Tokio Health Insurance Claim Settlement

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A forerunner in the health insurance sector, IFFCO-Tokio health insurance is committed to providing a simple process for filing medical claims. The insurer guarantees a swift claim settlement process across the country in accordance with its standards, thanks to a vast network of almost 7,500 network hospitals. The simple and quick cashless claim process used by IFFCO-Tokio, whether through independent TPAs or immediately by IFFCO-Tokio, is well-liked. The choice of reimbursement or a cashless facility is available to policyholders for the settlement of claims. To facilitate a seamless transaction, the insurer provides policyholders with enough details and a high IFFCO-Tokio health insurance settlement ratio.

The Claim Process for Cashless Treatment for  IFFCO Tokio Health Insurance Claim Settlement

If you have IFFCO-Tokio health insurance, you might take advantage of cashless care at more than 7,500 network hospitals around the country that help in having a strong IFFCO-Tokio health claim ratio. Access to exceptionally high-quality medical treatments and care is increased as a result. This type of organisation should only use network hospitals.

You are not needed to pay anything for the cost of the medical services throughout this procedure. The health insurer is immediately due reimbursement for any medical expenses recognized by the health insurance policy.

The Following are the Steps in a Cashless Claim

The best thing about cashless compensation claims is that in an emergency, consumers may be sent to any associated hospital or healthcare facility and receive medical care without always struggling to pay for it.

The following procedures must be followed in order to submit a cashless IFFCO-Tokio health insurance claim settlement:

Planned Cashless  IFFCO Tokio Health Insurance Claim Settlement Process

If you want to receive treatment without paying for it, look for a hospital that is affiliated with IFFCO-Tokio. In the event of a scheduled admittance, notify the Third Party Administrator (TPA) 3 days in advance. Locate a cashless application form at the hospital's assistance desk, complete it, and email it to the TPA, along with any pertinent medical data. The TPA will inform the hospitals of its choice, which might be to approve the claim or to seek more documentation. If TPA approves a cashless claim, healthcare expenses will be paid immediately in accordance with the policy provisions. If the claim is denied by the TPA, the policyholder will be responsible for paying the hospital directly and may then request reimbursement in accordance with the terms and circumstances.

Emergency Cashless  IFFCO Tokio Health Insurance Claim Settlement Process

When looking for a hospital where you may receive cashless care, look for one that is affiliated with IFFCO-Tokio. In the event of emergency hospitalisation, notify the Third Party Administrator (TPA) as soon as possible after being admitted. A cashless registration form may be obtained at the hospital's help desk; fill it out, and send it, together with any pertinent medical records, to the TPA. The TPA will inform the hospitals of its choice, which might be to approve the claim or to seek more documentation. If TPA approves a cashless claim, healthcare costs will be paid immediately in accordance with the policy provisions. If the claim is denied by the TPA, the client will be responsible for paying the hospital directly and may then request reimbursement in accordance with the terms and circumstances.

The Cashless Claim Procedure after Admission

  1. Your pre-authorization petition and any relevant medical data will be forwarded to the insurance company by the hospital TPA.
  2. After you have been given the initial okay following the review of your claim request, your hospital operations may begin.
  3. The necessary paperwork must be provided to the facility's TPA, who might evaluate it and ask your insurance company for approval if a change to the permitted cashless sum while the individual is in the facility is necessary.
  4. On the day of release, the hospital's TPA will mail your accurate invoice and discharge certificate to the business.
  5. The insurance provider or its TPA grants an enlarged authorization for the full bill amount following a final evaluation of your claim application.
  6. Once a final authorization has been given, some non-payable expenditures are prohibited by law from being paid by the insurance plan. The hospital will charge you for these.

List of Documents Required for IFFCO Tokio Health Insurance Cashless Claim

To complete a cashless claim, the following documentation must be provided on the day of admission:

  1. IFFCO-Tokio provides a health card for cashless hospitalisation
  2. Proof of identity and age verification is necessary of the insured
  3. A doctor's order to check into a hospital
  4. All medical testing and results should be completed prior to admission to the hospital

The facility would then handle providing the last pieces of supporting documents for the cashless claim.

How to Check  IFFCO Tokio Health Insurance Policy Claim Status?

Clients of IFFCO-Tokio health insurance provider may monitor the progress of their insurance claims. Although the IFFCO-Tokio health insurance claim settlement ratio is high, there are additional factors to take into account when establishing the status of a claim.

The procedures for tracking an IFFCO-Tokio health insurance claim status offline and online are as follows:

The Online Process for  IFFCO Tokio Health Insurance Claim Settlement Status

  1. Locate the official IFFCO-Tokio health insurance company's website through the browser of your choice to find your  IFFCO-Tokio health insurance claim ratio.
  2. Click on the ‘Support’ above on the header of the page and select ‘Claim Status.’
  3. It will lead you to the page for Motor or Health Insurance Claim status.
  4. Choose the ‘Health Claim Status’ and provide either Policy Number or Claim Number with your number to check your claim status.
  5. You can also call 1800-103-5499/7993407777 to check the progress of your  IFFCO-Tokio Health Insurance Settlement ratio. 

The Offline Process for  IFFCO Tokio Health Insurance Claim Settlement Status

You can go to the bottom of an online portal and select the "contact us" option to access the official branch locator if you are unable to follow the status of your claim request online. The address, phone number, and email of the branch closest to you will be provided by the locator once you enter your state and city. Alternatively, you can ask a customer service agent at the IFFCO-Tokio health insurance company location closest to you for the same information by stopping by your nearest branch. To give you more updates on your policy, they could ask you for information such as your insurance intimation number, insurance ID card number, etc.

The Claim Process for Reimbursement Treatment for  IFFCO Tokio Health Insurance Claim Settlement

If for whatever reason a patient was unable to use the cashless treatment option at a network hospital and had to receive treatment elsewhere, a reimbursement procedure would then be in effect. Before submitting an insurance claim for reimbursement, the expenses must be paid for. The claim must be accompanied by all relevant documentation, such as hospitalisation records, medical expense receipts, and other related papers. The steps are as follows:

  1. Inform IFFCO-Tokio about the hospitalisation as soon as possible following the hospitalisation but no later than seven days after release.
  2. Please mention your ‘policy certificate number’ before communicating. Choose and obtain a medical procedure or therapy.
  3. Pay the hospital's costs, then submit a claim for reimbursement.
  4. Download the claim form for reimbursement of IFFCO-Tokio health insurance claim settlement from the insurer's website.
  5. At the time of discharge, gather all necessary supporting documentation, such as medical records, invoices, IDs, and so on, and send it to the insurance company's office together with the claim form.

List of Documents Required for IFFCO Tokio Health Insurance Reimbursement Claim

The following details must be provided at the time a claim is made for the IFFCO-Tokio health claim settlement ratio:

  1. The claim form and medical certification
  2. Discharge information
  3. Medical expenses
  4. Medication prescriptions
  5. Final invoices
  6. Reports from diagnostic tests, such as an x-ray or an ECG

To swiftly and efficiently resolve claims, IFFCO-Tokio must receive the following paperwork:

  1. Investigation reports (original)
  2. Summary of hospital discharge
  3. The pharmacy bills, FIR or, if necessary, a post-mortem report together with the prescription
  4. Legitimate receipts, invoices, a departure report
  5. Legitimate medical bills and a valid photo ID
  6. Results of the test and a report from the physician treating you
  7. Surgeon's bill, the type of operation performed, a properly filled out claim form, and any supporting documentation
  8. The original appointment notes, as well as the physician's findings
  9. A voided check with your identity or your bank's details

Please be aware that during the registration or processing claim, the company may require additional documentation to verify your claim.

Incurred Claim Ratio (ICR) of  IFFCO Tokio Health Insurance

The top insurance provider should be selected using the incurred claims ratio. You can use this to assess whether or not the company has the resources to pay the claims. Each year, the Insurance Regulatory and Development Authority of India (IRDAI) publishes its annual report, which includes the ICR figures. According to the incurred claims ratio, IFFCO-Tokio General Insurance, a relatively new company, has topped the list with 99.49 per cent for the financial year 2020–21.

IFFCO Tokio Health Insurance Claim Settlement Ratio (CSR)

The IFFCO-Tokio health claim settlement ratio indicates the possibility that your insurance claims will be paid. It is calculated by dividing the total number of submitted claims by the total number of resolved claims. For the fiscal year 2020–2021, the claim settlement ratio of IFFCO-Tokio was 81.67 per cent for claims resolved in less than three months and 12.8 per cent for claims resolved in more than three months.

IFFCO Tokio Health Insurance Claim Settlement FAQs

  • 1. How much time do you have to resolve a claim?

    The enterprise typically replies to claims in seven working days after receiving the final "necessary" document. The deadlines, nevertheless, are occasionally extended. The maximum duration for these is 30 days. 

  • 2. What causes the claim amount to be decreased?

    Any of the following factors might result in a claim's amount being reduced:

    • Not having the necessary documentation or prescriptions.
    • Delay in informing the insurance company. 
    • False claim request.
    • Claim falls under the list of exclusions, etc.
  • 3. How many hospitals provide cashless services under IFFCO-Tokio health insurance?

    At more than 7,500 network hospitals, you may receive care without paying cash.

  • 4. In the event that the claimant loses the original policy document, what substitute requirements are there?

    If the claimant has lost the original policy bond, they must submit the indemnity bond for loss of policy document, which must be produced on INR 200 stamp paper and duly notarized.

  • 5. How soon should a claimant contact the insurer that they want to use a cashless facility or get their money back in an emergency or scheduled situation?

    When hospitalisation is planned, the insurer must be informed three days before the hospitalisation. However, in the event of emergency hospitalisation, the insurance company providing the coverage must be notified as soon as a covered person is hospitalised.

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