{"uin":"IFFHLIP23205V012223","name":"Health Protector For Persons With Special Needs, IFFCO-TOKIO General Insurance Co.Ltd.","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/iffco-tokio-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Health Protector for Persons With Special Needs is an individual indemnity health policy for persons with listed disabilities and individuals with HIV/AIDS, with sum insured options of 4 lacs and 5 lacs and a 1 year policy period. It has a 20% co-pay on all claims, 30 days pre-hospitalisation, 60 days post-hospitalisation, 30 days initial waiting, and 48 months PED waiting for pre-existing diseases other than HIV/AIDS and disability.","analysis":{"state":"machine","analysed_at":"2026-10-19 20:00:12.299137+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents describe cover categories and individual basis, but do not name plan variants.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"1 Year","display":"1 Year","note":null,"quote":"Policy Period | 1 Year","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For emergency hospitalization, notice with full particulars must be sent within 24 hours from the date emergency hospitalization is required or before discharge, whichever is earlier. For planned hospitalization, notice must be sent at least 48 hours prior to admission.","display":"Emergency: within 24 hours or before discharge, whichever is earlier; planned: at least 48 hours before admission","note":null,"quote":"d.3 Notification of Claim Notice with full particulars shall be sent to the Company/TPA (if applicable} as under:\ni. Within 24 hours from the date of emergency hospitalization required or before the Insured Person's discharge from Hospital, whichever is earlier.\nii. At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.","sources":[{"clause":"16(II)(d)(vi)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-vi"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Duly Completed claim form.","Photo Identity proof of the patient","Medical practitioner's prescription advising admission.","Original bills with itemized break-up","Payment receipts","Discharge summary including complete medical history of the patient along with other details.","Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner","OT notes or Surgeon's certificate giving details of the operation performed (for surgical cases).","Sticker/invoices of the Implants, wherever applicable.","MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, wherever applicable.","NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque.","KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines","Legal heir/succession certificate, wherever applicable","Any other relevant document required by Company/TPA for assessment of the claim."],"display":"Claim form, ID proof, admission prescription, original itemised bills, receipts, discharge summary, reports, OT notes, implant invoices, MLR/FIR, NEFT and cancelled cheque, KYC above Rs 1 Lakh, legal heir certificate and other relevant documents","note":null,"quote":"d.4 Documents to be submitted The reimbursement claim is to be supported with the following documents and submitted within the prescribed time limit.\ni. Duly Completed claim form.\nii. Photo Identity proof of the patient\niii. Medical practitioner's prescription advising admission.\niv. Original bills with itemized break-up\nv. Payment receipts\nvi. Discharge summary including complete medical history of the patient along with other details. ... vii) Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner\nvii. OT notes or Surgeon's certificate giving details of the operation performed (for surgical cases). ... viii) Sticker/invoices of the Implants, wherever applicable. ... ix) MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, wherever applicable. ... x) NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque. ... xi) KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines ... xii) Legal heir/succession certificate, wherever applicable ... xiii) Any other relevant document required by Company/TPA for assessment of the claim.","sources":[{"clause":"16(II)(d)(vi)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-vi"},{"clause":"16(II)(d)(vii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-vii"},{"clause":"16(II)(d)(viii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-viii"},{"clause":"16(II)(d)(ix)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-ix"},{"clause":"16(II)(d)(x)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-x"},{"clause":"16(II)(d)(xi)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-xi"},{"clause":"16(II)(d)(xii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-xii"},{"clause":"16(II)(d)(xiii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-xiii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The Company shall settle or reject a claim within 30 days from receipt of the last necessary document. If investigation is warranted, it must complete investigation within 30 days and settle or reject the claim within 45 days from receipt of the last necessary document.","display":"30 days from last necessary document; 45 days if investigation is warranted","note":"Delay in payment attracts interest at 2% above the bank rate.","quote":"i) The Company shall settle or reject a claim as the case may be, 30 days from the date of receipt of last necessary document. ... iii) However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document- In such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document.","sources":[{"clause":"3(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-3-i"},{"clause":"3(iii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-3-iii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"For grievance relating to servicing the policy, the insured may write to the policy issuing office or regional office first. If not satisfied, the insured may contact the grievance officer at chiefgrievanceofficer@iffcotokio.co.in, toll free 1800-103-5499, e-mail support@iffcotokio.co.in, or courier the Chief Grievance Officer at IFFCO Tower, Plot no. 3 Sector -29, Gurgaon – 122001.","display":"Policy issuing office or regional office first; then grievance officer at chiefgrievanceofficer@iffcotokio.co.in / 1800-103-5499 / support@iffcotokio.co.in","note":null,"quote":"Grievance-In case of any grievance relating to servicing the Policy, the insured person may submit in writing to the Policy issuing office or regional office for redressal. ... If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at chiefgrievanceofficer@iffcotokio.co.in\nFor updated details of grievance officer, kindly refer the following Website: https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal Toll free: 1800-103-5499 E-mail: support@iffcotokio.co.in Courier: Chief Grievance Officer IFFCO-Tokio General Insurance Co Ltd IFFCO Tower, Plot no. 3 Sector -29, Gurgaon – 122001","sources":[{"clause":"15","heading":"Redressal of Grievance","page":22,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-15-3"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"4 lacs and 5 lacs","display":"4 lacs and 5 lacs","note":null,"quote":"Sum insured available (in INR) | 4 lacs and 5 lacs","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to covered accident claims; does not apply if the Insured Person has Continuous Coverage for more than twelve months.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"1","heading":"Waiting Periods","page":15,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-4"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":48},"display":"48 months","note":"Pre-existing disability has 24 months waiting. For HIV/AIDS cover, the benefits table states that an initial waiting period of 30 days applies.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months for pre-existing disability/ 48 months for all pre-existing conditions other than HIV/AIDS and Disability (as mentioned in Policy Schedule) of continuous coverage after the date of inception of the first policy with insurer. ... Waiting Period and specific Sublimit for HIV AIDS Cover | For HIV/AIDS cover:\nWaiting Period and specific Sublimit for | a. Initial waiting period of 30 days will be applicable","sources":[{"clause":"1","heading":"Waiting Periods","page":15,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-4"},{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"months","amount":24},"display":"24 months","note":"Not applicable for claims arising due to an accident; if the condition also falls under the PED waiting period, the longer waiting period applies.","quote":"Expenses related to the treatment of the listed Conditions; surgeries/treatments shall be excluded until the expiry of 24 months (as mentioned in Policy Schedule) of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"1","heading":"Waiting Periods","page":15,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps.","Benign prostate hypertrophy","Cataract and age-related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non-Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident.","Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.","Varicose Veins and Varicose Ulcers"],"display":"Benign ENT disorders, tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty, hysterectomy, benign tumours/cysts/polyps, BPH, cataract, gastric/duodenal ulcer, gout/rheumatism, hernia, hydrocele, arthritis, piles/fissures/fistula, pilonidal sinus/sinusitis, spinal diseases, urinary/gall bladder/bile duct calculi and varicose veins/ulcers","note":null,"quote":"24 Months waiting period.\na) Benign ENT disorders\nb) Tonsillectomy\nc) Adenoidectomy\nd) Mastoidectomy\ne) Tympanoplasty\nf) Hysterectomy\ng) All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps.\nh) Benign prostate hypertrophy\ni) Cataract and age-related eye ailments\nj) Gastric/ Duodenal Ulcer\nk) Gout and Rheumatism\nl) Hernia of all types\nm) Hydrocele\nn) Non-Infective Arthritis\no) Piles, Fissures and Fistula in anus\np) Pilonidal sinus, Sinusitis and related disorders\nq) Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident.\nr) Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.\ns) Varicose Veins and Varicose Ulcers","sources":[{"clause":"1","heading":"Waiting Periods","page":15,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-4"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"years","amount":8},"display":"8 continuous years","note":"Applies separately to enhanced sum insured from the date of enhancement; limits, sub limits, co-payments and deductibles still apply.","quote":"After completion of eight continuous years under the policy no look back to be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of 8 continuous years would be applicable from date of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract.","sources":[{"clause":"12","heading":"Moratorium Period","page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-12-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured can port this policy to the same product of other insurers as per portability guidelines. If continuously covered without lapse, accrued continuity benefits in waiting periods are given, and waiting periods are reduced by continuous preceding years of coverage.","display":"Porting allowed to the same product of other insurers with waiting-period credit for continuous preceding coverage","note":null,"quote":"The Insured Person will have the option to port the Policy to same product of other insurers as per extant Guidelines related to portability, If such person is presently covered and has been continuously covered without any lapses under this health insurance plan with an Indian General/Health insurer as per Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under: ... i) The waiting periods specified in Section 5 shall be reduced by the number of continuous preceding years of coverage of the Insured Person under the previous health insurance Policy. ... ii) Portability benefit will be offered to the extent of sum of previous sum insured and accrued bonus (as part of the sum insured), portability benefit shall not apply to any other additional increased Sum Insured.","sources":[{"clause":"9","heading":"Portability","page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-9-3"},{"clause":"9(i)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-9-i"},{"clause":"9(ii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-9-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"RENEWABILITY - LIFELONG","note":"From the prospectus.","quote":"RENEWABILITY - LIFELONG","sources":[{"clause":null,"heading":"SALIENT FEATURES","page":1,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8624#c-salient-features"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading shall apply on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"v) No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"10","heading":"Renewal of Policy","page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-10-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["Investigation & Evaluation- Code- Excl04","Rest Cure, rehabilitation, and respite care- Code- Excl05","Obesity/ Weight Control: Code- Excl06","Change-of-Gender treatments: Code- Excl07","Cosmetic or plastic Surgery: Code- Excl08","Hazardous or Adventure sports: Code- Excl09","Breach of law: Code- Excl10","Excluded Providers: Code- Excl11","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- Excl12","Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. Code- Excl13","Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure. Code- Excl14","Refractive Error: Code- Excl15","Unproven Treatments: Code- Excl16","Sterility and Infertility: Code- Excl17","Maternity: Code Excl18","Any medical treatment taken outside India.","Hospitalization for donation of any body organs by an Insured including complications arising from the donation of organs.","Nuclear damage caused by, contributed to, by or arising from ionising radiation or contamination by radioactivity","War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority.","Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or as may be necessitated due to an accident.","Treatment with alternative medicines or Treatment, experimental or any other treatment such as acupuncture, acupressure, magnetic, osteopath, chiropractic, reflexology and aromatherapy.","Suicide, lntentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) and any violation of law or participation in an event/activity that is against law with a criminal intent.","Vaccination or inoculation except as post bite treatment for animal bite.","Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy and expenses related to Domiciliary hospitalization shall not be covered."],"display":"Excl04 to Excl18 plus outside India treatment, organ donation by insured, nuclear/war risks, circumcision, alternative/experimental treatment, suicide/intentional self-injury, vaccination except post-bite, OPD and domiciliary hospitalization exclusions","note":null,"quote":"2 Investigation & Evaluation- Code- Excl04 ... 3 Rest Cure, rehabilitation, and respite care- Code- Excl05 ... 4 Obesity/ Weight Control: Code- Excl06 ... 5 Change-of-Gender treatments: Code- Excl07 ... 6 Cosmetic or plastic Surgery: Code- Excl08 ... 7 Hazardous or Adventure sports: Code- Excl09 ... 8 Breach of law: Code- Excl10 ... 9 Excluded Providers: Code- Excl11 ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- ... Excl12 ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. Code- Excl13 ... Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure. Code- Excl14 ... 13 Refractive Error: Code- Excl15 ... 14 Unproven Treatments: Code- Excl16 ... 15 Sterility and Infertility: Code- Excl17 ... Maternity: Code Excl18 ... 1. Any medical treatment taken outside India.\n2. Hospitalization for donation of any body organs by an Insured including complications arising from the donation of organs.\n3. Nuclear damage caused by, contributed to, by or arising from ionising radiation or contamination by radioactivity from: ... 4. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority.\n5. Injury or Disease caused by or contributed to by nuclear weapons/materials.\n6. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or as may be necessitated due to an accident.\n7. Treatment with alternative medicines or Treatment, experimental or any other treatment such as acupuncture, acupressure, magnetic, osteopath, chiropractic, reflexology and aromatherapy.\n8. Suicide, lntentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) and any violation of law or participation in an event/activity that is against law with a criminal intent.\n9. Vaccination or inoculation except as post bite treatment for animal bite. ... 11. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy and expenses related to Domiciliary hospitalization shall not be covered.","sources":[{"clause":"2","heading":"Investigation & Evaluation- Code- Excl04","page":16,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-2-4"},{"clause":"3","heading":"Rest Cure, rehabilitation, and respite care- Code- Excl05","page":16,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-3-3"},{"clause":"4","heading":"Obesity/ Weight Control: Code- Excl06","page":16,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-4-3"},{"clause":"5","heading":"Change-of-Gender treatments: Code- Excl07","page":16,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-5-3"},{"clause":"6","heading":"Cosmetic or plastic Surgery: Code- Excl08","page":16,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-6-3"},{"clause":"7","heading":"Hazardous or Adventure sports: Code- Excl09","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-7-3"},{"clause":"8","heading":"Breach of law: Code- Excl10","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-8-2"},{"clause":"9","heading":"Excluded Providers: Code- Excl11","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-9-2"},{"clause":"10","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-10-2"},{"clause":"Excl12","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-excl12"},{"clause":"11","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-11-2"},{"clause":"12","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-12-2"},{"clause":"13","heading":"Refractive Error: Code- Excl15","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-13-2"},{"clause":"14","heading":"Unproven Treatments: Code- Excl16","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-14-2"},{"clause":"15","heading":"Sterility and Infertility: Code- Excl17","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-15-2"},{"clause":"16","heading":"Maternity: Code Excl18","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-2"},{"clause":"16(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii"},{"clause":"16(d)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-d"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The insured may cancel with 15 days' written notice. Refund is on short-term rates for the unexpired policy period: up to 30 days 75.00%, 31 to 90 days 50.00%, 91 days to 180 days 25.00%, and 181 days to 365 days 0.00%; no refund if any claim has been admitted, lodged or any benefit availed.","display":"15 days' written notice; refund 75.00% up to 30 days, 50.00% for 31 to 90 days, 25.00% for 91 to 180 days, 0.00% for 181 to 365 days; no refund if a claim/benefit exists","note":null,"quote":"The Insured may cancel this Policy by giving 15 days' written notice, and in such an event, the Company shall refund premium on short term rates for the unexpired Policy Period as per the rates detailed below. ... Timing of Cancellation | 1 Yr\nUp to 30 days | 75.00%\n31 to 90 days | 50.00%\n91 days to 180 days | 25.00%\n181 days to 365 days | 0.00%\nNotwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by You under this Policy.","sources":[{"clause":"7","heading":"Cancellation","page":20,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-7-4"},{"clause":null,"heading":"Refund of Premium (basis Policy Period)","page":20,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-refund-of-premium-basis-policy-period"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"India only; any medical treatment taken outside India is excluded.","display":"India only","note":null,"quote":"1. Any medical treatment taken outside India.","sources":[{"clause":"16(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":15},"display":"fifteen days","note":"Applicable on new individual health insurance policies and not on renewals.","quote":"The insured person shall be allowed free look period of fifteen days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":"14","heading":"Free Look Period","page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-14-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"For yearly payment mode.","quote":"Grace Period | For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Adults: 18 years to 65 years. Children: Newborn to 17 years.","display":"Adults: 18 years to 65 years; Children: Newborn to 17 years","note":null,"quote":"Eligibility | Policy can be availed on Individual basis. Age eligibility for adults: 18 years to 65 years\nAge eligibility for Children: Newborn to 17 years","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Yearly"],"display":"Yearly","note":"The documents state yearly payment mode in the grace-period row; no half-yearly, quarterly or monthly mode is stated.","quote":"Grace Period | For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No add-on or optional cover for extra premium is stated in the provided documents.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available during the grace period.","display":"Coverage is not available during the grace period","note":null,"quote":"iii) At the end of the Policy Period, the policy shall terminate and can be renewed within the Grace Period to maintain continuity of benefits without Break in Policy. Coverage is not available during the grace period.","sources":[{"clause":"10","heading":"Renewal of Policy","page":21,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-10-3"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room Rent, Boarding and Nursing Expenses are covered up to a maximum of 1% of the Sum Insured per day.","display":"1% of the Sum Insured per day","note":null,"quote":"i) Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to maximum of 1% of the Sum Insured per day.","sources":[{"clause":"1","heading":"Inpatient Care","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-3"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-applicable","value":null,"display":null,"note":"The product states a room rent percentage limit, not a room category.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU / ICCU expenses are covered up to a maximum of 2% of the Sum Insured per day.","display":"2% of the Sum Insured per day","note":null,"quote":"ii) Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses of maximum upto 2% of Sum Insured per day.","sources":[{"clause":"1","heading":"Inpatient Care","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-1-3"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":"The documents state room rent and ICU percentage limits, but do not clearly state proportionate reduction of associated charges for occupying a room above entitlement.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"Each and every claim is subject to a 20% co-payment on the admissible and payable claim amount; the amount payable is after deducting the co-payment.","display":"20% on every admissible claim","note":null,"quote":"d.5 Co-payment Each and every claim under the Policy shall be subject to a Co-payment of 20% applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The amount payable shall be after deduction of the co-payment.","sources":[{"clause":"16(II)(d)(xiii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-xiii"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":"No deductible amount is stated for this product.","quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"quote-verified","value":["Cataract: Rs. 40,000/-, per each eye in one policy year","Modern Treatment: up to 50% of Sum Insured"],"display":"Cataract up to Rs. 40,000/- per eye per policy year; modern treatments up to 50% of Sum Insured","note":"Modern treatment applies to the listed procedures in the policy.","quote":"The company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of Rs. 40,000/-, per each eye in one policy year. ... The following procedures will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment in a Hospital up to 50% of Sum Insured, specified in the Policy Schedule, during the Policy Period.","sources":[{"clause":"6","heading":"Cataract Treatment","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-6-2"},{"clause":"7","heading":"Modern Treatment","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-7-2"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days prior to the date of admissible Hospitalization","note":"Claimed on reimbursement basis only and only if the related inpatient, AYUSH or modern-treatment claim is accepted.","quote":"The Company shall indemnify Pre-Hospitalization Medical Expenses incurred, related to an admissible Hospitalization requiring Inpatient care, for a fixed period of 30 days prior to the date of admissible Hospitalization covered under the Policy during the policy period.","sources":[{"clause":"3","heading":"Pre-Hospitalization Medical Expenses","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-3-2"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"60 days from the date of discharge","note":"Claimed on reimbursement basis only and only if the related inpatient, AYUSH or modern-treatment claim is accepted.","quote":"The Company shall indemnify Post Hospitalization Medical Expenses incurred, related to an admissible Hospitalization requiring Inpatient Care, for a fixed period of 60 days from the date of discharge from the Hospital, following an admissible hospitalization covered under the Policy during the policy period.","sources":[{"clause":"4","heading":"Post-Hospitalization Medical Expenses","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-4-2"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"All day care treatments in Annexure B are covered, and the minimum 24 consecutive hours hospitalisation requirement does not apply to Day Care Treatment.","display":"All day care treatments in Annexure B; 24-hour hospitalisation limit does not apply","note":null,"quote":"iv. All day care treatments (Annexure B)\nNote:\na) Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible. However, the time limit shall not apply in respect of Day Care Treatment.","sources":[{"clause":null,"heading":"Other expenses","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-other-expenses"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalization is not covered.","display":"Not covered","note":null,"quote":"11. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy and expenses related to Domiciliary hospitalization shall not be covered.","sources":[{"clause":"16(d)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-d"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered during each policy year up to 100% of the sum insured in any AYUSH Hospital.","display":"Covered up to 100% of sum insured in any AYUSH Hospital","note":null,"quote":"The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to 100% of sum insured as specified in the policy schedule in any AYUSH Hospital.","sources":[{"clause":"2","heading":"AYUSH Treatment","page":13,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-2-3"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Listed modern treatments are covered, wherever medically indicated, either as inpatient or day care treatment in a hospital, up to 50% of the Sum Insured. The list includes Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain stimulation, Oral chemotherapy, Immunotherapy, Intra Vitreal injections, Robotic surgeries, Stereotactic radio Surgeries, Bronchial Thermoplasty, prostate vaporisation, IONM and specified stem cell therapy.","display":"Covered up to 50% of Sum Insured for listed procedures including robotic surgeries, oral chemotherapy, immunotherapy and specified stem cell therapy","note":null,"quote":"The following procedures will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment in a Hospital up to 50% of Sum Insured, specified in the Policy Schedule, during the Policy Period.\na) Uterine Artery Embolization and HIFU (High intensity focused ultrasound)\nb) Balloon Sinuplasty\nc) Deep Brain stimulation\nd) Oral chemotherapy\ne) lmmunotherapy- Monoclonal Antibody to be given as injection.\nf) Intra Vitreal injections\ng) Robotic surgeries\nh) Stereotactic radio Surgeries\ni) Bronchial Thermoplasty\nj) Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)\nk) IONM- (Intra Operative Neuro Monitoring) I) Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"7","heading":"Modern Treatment","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-7-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"quote-verified","value":"Hospitalization for donation of any body organs by an insured, including complications arising from the donation of organs, is excluded.","display":"Not covered for organ donation by an insured","note":null,"quote":"2. Hospitalization for donation of any body organs by an Insured including complications arising from the donation of organs.","sources":[{"clause":"16(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance expenses are reimbursed up to a maximum of Rs.2000/- per hospitalisation, if immediate ambulance services are required and the related inpatient, AYUSH or modern-treatment claim is accepted.","display":"Road ambulance up to Rs.2000/- per hospitalisation","note":"The ambulance service must be by a healthcare or Registered Ambulance Service Provider, and original bills and payment receipt must be submitted.","quote":"Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalisation. ... v) The Company has accepted a claim under Section 1 (Inpatient Care) above in respect of the same period of Hospitalization or Section 2(AYUSH Treatment) or Section 7 (Modern Treatments).","sources":[{"clause":"5","heading":"Emergency Ground Ambulance","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-5-2"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"not-stated","value":null,"display":null,"note":"No restoration or refill of sum insured is stated.","quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"not-stated","value":null,"display":null,"note":"No no-claim bonus or cumulative bonus benefit is stated.","quote":null,"sources":[],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Non-payable items in Annexure-A are not covered. List I includes items such as GLOVES and MASK.","display":"Non-payable items in Annexure-A are not covered, including GLOVES and MASK in List I","note":null,"quote":"17. Non-Payable items: The expenses that are not covered in this Policy are placed under List-I of Annexure-A ... List I – List of non-payable Items ... 56 | GLOVES ... 60 | MASK","sources":[{"clause":"16(d)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-d"},{"clause":"Annexure A","heading":null,"page":29,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-annexure-a"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity is excluded. Medical treatment expenses traceable to childbirth, including complicated deliveries and caesarean sections during hospitalization, are excluded except ectopic pregnancy; miscarriage unless due to an accident and lawful medical termination of pregnancy during the policy period are also excluded.","display":"Excluded, except ectopic pregnancy; miscarriage excluded unless due to accident","note":null,"quote":"Maternity: Code Excl18 ... i) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy. ... ii) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"16","heading":"Maternity: Code Excl18","page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-2"},{"clause":"16(i)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-i"},{"clause":"16(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"The documents state entry eligibility for children from newborn to 17 years, but do not state a separate newborn baby cover benefit.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"quote-verified","value":"Mental Illness is one of the listed disabilities for which the policy is designed. Inpatient hospitalisation arising due to the pre-existing disability covered is indemnified, with a 24 months waiting period for treatment of the pre-existing disability.","display":"Covered as a listed disability for inpatient hospitalisation, after 24 months for pre-existing disability treatment","note":null,"quote":"15. Mental Illness ... The Company will indemnify reasonable and customary charges for medical expenses incurred towards Inpatient Hospitalisation arising due to the pre-existing disability covered, or condition as listed under The Rights of Persons With Disabilities Act, 2016 subject to the terms and limits mentioned below.\ni) Any treatment for the pre-existing disability covered, will have a waiting period of 24 months from the first policy inception date.","sources":[{"clause":"B","heading":"PREAMBLE","page":5,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-b"},{"clause":null,"heading":"SPECIFIC CONDITION APPLICABLE FOR PERSONS WITH DISABILITY","page":14,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-specific-condition-applicable-for-persons-with-d"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":"No preventive health check-up benefit is stated.","quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"Outpatient diagnostic, medical and surgical procedures or treatments are not covered.","display":"OPD not covered","note":null,"quote":"11. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy and expenses related to Domiciliary hospitalization shall not be covered.","sources":[{"clause":"16(d)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-d"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"No city or zone-based premium or treatment-location co-pay is stated.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless treatment may be taken in a network provider and is subject to preauthorization by the Company or its authorized TPA. The Company/TPA issues a pre-authorization letter to the hospital after verification.","display":"Available at network providers, subject to preauthorization by the Company or authorized TPA","note":null,"quote":"i) Treatment may be taken in a network provider and is subject to preauthorization by the Company or its authorized TPA, ... iii) The Company/ TPA upon getting cashless request form and related medical information from the insured person/ network provider will issue pre-authorization letter to the hospital after verification.","sources":[{"clause":"16(II)(d)(i)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-i"},{"clause":"16(II)(d)(iii)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-iii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims may be handled by the Company or TPA for cashless preauthorization or reimbursement processing, but TPA services do not include claim settlement or claim rejection.","display":"Company/TPA for processing; claim settlement and rejection are not TPA services","note":null,"quote":"d.6 Services Offered by TPA Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of preauthorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the policy. The services offered by a TPA shall not include:\ni. Claim settlement and claim rejection.","sources":[{"clause":"16(II)(d)(xiii)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-16-ii-d-xiii"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":false,"display":"Individual basis only","note":null,"quote":"Coverage Basis | Individual basis only","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":26,"url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672#c-table-of-benefits"}],"law":[]}],"documents":[{"kind":"wording","label":"Special Needs","pages":39,"fetched_at":"2026-10-17 19:46:13+00","source_url":"https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/policy-wording-special-needs.pdf","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8672"},{"kind":"prospectus","label":"Health Protector For Persons With Special Needs, IFFCO-TOKIO General Insurance Co.Ltd.","pages":17,"fetched_at":"2026-10-17 19:44:46+00","source_url":"https://www.iffcotokio.co.in/content/dam/iffcotokio/prospectus/health/prospectus_special_needs.pdf","url":"https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223/document/8624"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"IFFCO TOKIO General Insurance official website","url":"https://www.iffcotokio.co.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims","url":"https://www.iffcotokio.co.in/claims","note":null},{"purpose":"claim","kind":"insurer","name":"Register a claim","url":"https://www.iffcotokio.co.in/claims/register-a-claim","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renew policy","url":"https://www.iffcotokio.co.in/renew-policy","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health Protector For Persons With Special Needs, IFFCO-TOKIO General Insurance Co.Ltd. (UIN IFFHLIP23205V012223), IndiaInsurances, https://indiainsurances.com/policy/iffco-tokio-general-insurance/health-protector-for-persons-with-special-needs-iffco-tokio-general-insurance-co-iffhlip23205v012223"}