Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS FlexiCare Group Insurance Policy .

In day to day lives, we are exposed to many risks associated with accidents, illnesses, surgery and travel and with the ever increasing costs associated with hospitalization, it can mean a drain on the precious savings. Not anymore. With the ManipalCigna FlexiCare Group Insurance Policy, one can provide employees, members of any affinity group the optimum cover they require.

It offers easy protection against listed perils, events, ailments, risks, with a full range of benefits available on standalone basis (i.e. a single cover can be opted to design a group protection) or in combination (i.e. bundle of multiple covers from same or different segment like accident, illness, surgery, travel etc.).

We, at ManipalCigna, also understand the importance of simple and small changes in lifestyle that enables well-being. That’s where our health and wellness solutions come into picture. This is holistically designed based on multiple parameters of health and wellness. It's fast, it's accessible & it's easy to use. Choose cover from wellness package to add to the core cover and a customized group protection solution is ready.

A Corporate can purchase this policy for their Employees and Dependents, or groups / associations with commonality of purpose can purchase this policy for their members and dependents. Affinity groups for example would include Cooperative Society, Bank / Mutual Fund customer group and holders of the same credit card etc.

The Policy is issued in the name of the Company / Employer / Affinity Group, so the Company / Affinity Group is therefore the owner of the Policy and is known as the Policy Holder. The Policy then states that all benefits are paid to the Employees / Group members, who are therefore the Insured Persons.

The policy is issued for a term of 1 year*.

Short period cover: For Accident Section only, Policy can be issued for a term less than one year to provide coverage to specific events or specified period.

On-duty Cover: For Group Personal Accident Section only, Policy can be issued for restricted time period of the day e.g. Work duty hours only etc.

*(Term more than 1 year is available only for Credit Linked Policy).

Proposal acceptability will be subject to underwriting approach, group demographics, risk parameters and other attributes including company underwriting guidelines.

Proposal acceptability will be subject to underwriting approach, group demographics, risk parameters and other attributes including company underwriting guidelines.

Minimum number of members required to issue a group policy is 7.

Nomination is a right conferred on the insurance holder to appoint a person to receive the policy monies in the event of his or her death. You can change your nomination any time before the date of policy termination. Nomination is required for valid discharge of claim.

Medical tests may be required subject to underwriting approach and assessment designed depending on group demographics, policy type, age, health status of the persons and other parameters.

Yes, the policy allows Companies / Affinity group to tailor make different benefit structures for Employees / Group members, which will result in different benefit tables as per group on the policy schedule.

Under cashless hospitalization the insured patient does not have to settle the hospitalization expenses at the time of discharge from the hospital apart from the non-admissible expenses. Cashless facility is only available at our network hospital wherein bills will get settled down by ManipalCigna.

To purchase/renew the policy, please get in touch with us at 1800-102-4462 or visit any of our branches. For more details log on to our website www.manipalcigna.com

Cover under the policy for any particular insured person shall automatically terminate on the earliest happening of the following events:

i. Premiums owed under the Policy is not received within the Grace Period
ii. Non-Indian Nationals returning to their country of domicile
iii. There is misrepresentation, fraud, non-disclosure of material fact
iv. On death of the insured person
v. Insured Person ceases to be a member of the group
vi. Cover will end for spouse or any unmarried partners
vii. If an employee/ member gets divorced or the unmarried partners no longer live together or a civil/ contractual partnership is dissolved, then the spouse or unmarried, civil/contractual partner will no longer be considered as a Dependent for the purposes of this Policy.

Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license.

Tax benefit is applicable for Contributory policy (where insured member pays premium towards the policy) for Mediclaim, Surgery related covers.

There will be no renewal discount for a claim free year under the policy.

Renewal within 30 days of grace period from policy expiry date is permissible, and policy will be considered as continuous for the purpose of waiting period.

For renewals after 30 days of grace period, new proposal form needs to be submitted and same will be treated as fresh proposal.

For instalment premium policy, revival period applicable is 15 days.

Note: Wherever Premiums are not received within the grace/revival period, the Policy will be terminated and all claims that fall beyond such instalment due date shall not be covered as part of the policy.

Any person (Employee/Group Member) may be added to policy as an insured person during the policy period provided that the application of cover has been accepted by us, additional premium, on pro-rata basis in respect of such member has been received by us and we have issued an endorsement confirming the addition.

Any Insured Person who is covered under the Policy may be deleted upon request by policy holder during the policy period. Refund of premium can be made on pro-rata basis, provided that no claim is paid / outstanding in respect of that insured person or his/her dependents.

We offer a wide range of Sum Insured options (depending on the type of cover) from  ₹ 500 up to ₹ 5 Cr.

Issuance on member health card will be subject to cover type, policy type, business approach and claims process designed for a particular group/channel partner.

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