Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

You can use following link search hospital in your area. (Link)

A third-party administrator (TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. They are an organization that processes health insurance claims behalf of Insurance company.

KYC means “Know Your Customer”. It is a process by which Insurance company need to obtain information about the identity and address of the customers as per regulation. Generally, an identity proof with recent photograph and an address proof of proposer are the two basic mandatory KYC documents needed in if claim payable is more than Rs.1 lac.

Personalized Cancelled Cheque of the Policy Holder. Alternatively, you can also provide the snapshot of the bank statement / pass book which contains only the details of Account number, Account holder’s name, IFSC Code and Branch details of policyholder’s personal account.

Please find the attached link hmb claim process. (Claim process Link)

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

If the Insured Person has completed 18 years of Age, the Insured Person may avail a comprehensive health check-up with Our Network Provider as per the eligibility details mentioned in the plan opted. Health Check Ups will be and arranged by Us and conducted at Our Network Providers.
For Protect plan – Available once every 3rd Policy year
For Plus, Preferred and Premier Plan – Available at each renewal

STEP 1-You/Insured Person will be eligible for an annual health check-up during the Policy Year. The list of medical tests which You are eligible for will be available along with the Policy document.
STEP 2-The Insured Person shall seek appointment by calling Our call centre.
STEP 3-The Insured Person will be guided to the nearest medical centre for conducting the medical examination. Reports of the Medical Tests can be collected directly from the centre. A copy of the medical reports will be retained by the medical centre which will be forwarded to Us along with the invoice for reimbursement.

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

This is benefit insured can avail when he was outside of India other than Medical treatment. The treatment is Medically Necessary and has been certified as an Emergency by a Medical Practitioner, where such treatment cannot be postponed until the Insured Person has returned to India.

In an unlikely event of You/Insured Person requiring Emergency medical treatment outside India, the same shall be availed at his/her own cost. You/Insured Person, must notify Us either at the call centre or in writing within 48 hours of such admission. You shall file a claim for reimbursement in accordance with Claim Process of the Policy.

Please find the attached link hmb claim process. (Claim process Link)

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

You need to call the Toll Free Helpline 1800-419-1159 or write to cigna@mediassistindia.com in the event of planned or emergency hospitalisation.

The following details are to be provided to the Company at the time of intimation of Claim:

  • Policy Number
  • Name of the Policyholder/Patient
  • Name of the Insured Person in whose relation the Claim is being lodged
  • Nature of Illness / Injury
  • Name and address of the attending Medical Practitioner and Hospital
  • Date of Admission
  • Any other information as requested by us

When a patient is treated in a network hospital (definition above), ManipalCigna Health Insurance directly settles the bill with hospitals. This is dependant on the claim request being approved by the hospital beforehand. However, there will always be a few items that the insurer is not allowed to pay as per regulation. These will always have to be settled directly with the hospital.

In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from  us has to be taken minimum 48 hours prior to the date of hospitalization. E.g. Cataract, Pace Maker Implantation, Total Knee Replacement, other planned surgeries / treatments  etc.

In Emergency Hospitalization the patient is admitted to the network hospital in an emergency situation, for e.g. severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 24 hours of admission to the hospital for cashless treatment.

Please find the detail process flow step by step as attached link https://www.manipalcigna.com/claims

The authorisation letter will be sent to your registered email id and also available with TPA desk of the hospital.