Overview
The Iffco Tokio Individual Health Protector plan offers health coverage with sum insured options up to ₹20 lakhs, catering to individuals and families. It features no co-payment, unlimited restoration of sum insured, and no room rent restrictions [for SI 5L and above], allowing policyholders to choose any hospital room. The plan also covers ambulance charges [charges 1% of the sum insured or Rs. 2500, whichever is less for each hospitalization] and pre-post hospitalization cover [60-90 days respectively]. Additional benefits include wellness programs and free health check-ups [offered based on Sum Insured — every 2 claim-free years for up to ₹5L, every claim-free year for ₹5–10L, and annually irrespective of claims for above ₹10L].
Experts Review
Written by Nikhil Nair
Senior Writer
The Iffco Tokio Individual Health Protector plan is a decent mid-tier health insurance policy that covers essential health needs with some attractive features. Its USPs include unlimited restoration of sum insured within the policy year, no co-payment, and no restrictions on room rent, which provide flexibility and peace of mind during hospitalization. The plan also covers domiciliary hospitalization up to 20% of the sum insured, daycare, and Ayush treatments.
However, the plan has some limitations. While it offers a broad network of 7900+ hospitals and no co-payment, the maximum ambulance coverage is capped at ₹2,500 per hospitalization, which may be insufficient in some cases. The plan has a capping on disease-wise limits and has room rent restrictions [for Sum Insured below ₹5 lakhs]. Additionally, the waiting period for pre-existing diseases is 36 months, which is on the higher side compared to some competitors.
Iffco Tokio’s average claim settlement ratio stands at 95 [as an avg. of 2021-24], which is competitive in the industry. Premiums for this plan are generally 5-10% lower than comparable policies with similar coverage, making it a cost-effective option for basic to moderate health insurance needs.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No significant drawbacks found.
Iffco Tokio
Key Insights
Founded
2000
Iffco Tokio was established 25 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
91% claims settled in 30 Days
Iffco Tokio settles 91% of all claims it receives demonstrating strong credibility.
Network Hospitals
7,900+
Iffco Tokio has a limited network of 7,900 hospitals, which may restrict access to cashless services for policyholders.
Complaints
22 complaints per 10,000 claims registered
Iffco Tokio experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment between 10% and 25% to reduce premiums.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Customisable
Modifies the room rent restriction to Any Room.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Add-ons
Consumables Protector
Recommended
Covers list of 68 non-medical items as per list I
Critical Illness
Gets sum insured doubled in case a life-threatening disease is diagnosed to help you manage treatment costs.
Room Rent Waiver
Modifies the room rent restriction to Any Room.
Voluntary Co-Payment
Choose a co-payment between 10% and 25% to reduce premiums.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Intra-articular injections
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 1 years.
12 Months waiting period:
Surgical treatment for Tonsillitis/ Adenoids
Tympanoplasty / Septoplasty
Fistula in anus, Anal Sinus, Piles
Any type of Carcinoma / Sarcoma/ Blood Cancer
Waiting Period
30 days Initial waiting period
1 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard overall. However, specific illness waiting period is better than usual.
Customer Reviews
R
Ravi Shankar
Unlimited restoration of sum insured is a great benefit for an individual plan.
M
Meena Kumari
No restrictions on room rent is a big advantage, can choose any room.
A
Alok Jain
Domiciliary hospitalization up to 20% of sum insured is a useful feature.
V
Varsha Kulkarni
Waiting period for PEDs is 36 months, which is on the higher side.
A
Anita Roy
Maximum ambulance coverage capped at ₹2,500 per hospitalization is too low for many cities.
F
Fatima Sheikh
Wellness programs and free health check-ups every two years are nice additions.
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Frequently Asked Questions
Does Individual Health Protector have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Individual Health Protector have room rent restrictions?
Does Individual Health Protector offer a restoration benefit?
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