Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS Lifetime Health .

Insurance coverage that pays for medical and surgical expenses that are incurred by the insured person during the treatment of a disease or injury. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.

ManipalCigna Lifetime Health offers high sum insured coverage for medical expenses towards Inpatient hospitalization, Day Care Treatment, Pre and Post hospitalization expenses.

It also provides coverage towards Inpatient hospitalization for  AYUSH, Donor expenses, Robotic and Cyber Knife Surgery , Modern and Advance Treatment , HIV/AIDS & STD cover, Mental Care, Restoration of Sum Insured and much more as part of inbuilt features.

Policy also offers the Global Plan covering 27 major illnesses including cancer across the Globe

Policy also offers Optional packages like Health+, Women+ and Global+ to customize the coverages .

The optional packages and Critical illness add-on can be opted by paying additional premium.

You can buy this policy Online by visiting our website www.manipalcigna.com

Sum Insured1 (INR)

 

1For Covers 1 to 15:

50 Lacs/ 75 Lacs/ 100 Lacs/ 150 Lacs/ 200 Lacs/ 300 Lacs

Sum Insured2 (INR)

 

2For Covers 16 to 25 in Global Plan

50 Lacs/ 75 Lacs/ 100 Lacs/ 150 Lacs/ 200 Lacs/ 300 Lacs

Minimum age at entry is: 91 days (for Children); 18 years (for Adult)

Maximum age at entry: 25 years (for children under a floater); 65 (for Adults)

The age of eligibility of the insured for taking the policy is the Entry Age. Age will mean Completed age as on last birthday.

No, there is no exit age in this policy, it can be renewed lifetime.

Yes. Premium paid under the Policy shall be eligible for income tax benefit under Sec 80 D of the Income Tax Act and any amendments thereon.

Under individual option each insured has separate Sum Insured.

Under floater option all members in the policy have a single sum insured.

Unlike other mediclaim products of ManipalCigna Health Insurance, where optional covers are available, the Lifetime Health Product offers optional packages.

Lifetime Health product has 2 Base plans i.e. India Plan and Global Plan along with optional packages to choose from.

Here, optional package would mean that if an Insured Person opts for an optional package i.e.  Health+ or Women+ along with India Plan, then, all the benefits specified in the package would be available for utilisation. There is no provision to choose individual benefits specified under Health+ or Women+ package. The entire package as a whole needs to be opted.

Similarly, an Insured Person has an option to choose Health+, Woment+ or Global+ optional package if he opts for the Global Plan.

In a multi – individual policy you can propose to buy policy for self, lawfully wedded spouse  (same or opposite gender), children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunt, nephew and niece. Maximum 8 insured can be covered under single policy.

In a floater plan you can cover self, lawfully wedded spouse (same or opposite gender), children up to the age of 25 years, parents and parent in laws. Children from 91 days to 18 years will only be covered if one of the parents is the proposer.

 A floater cover can cover a maximum of 2 adults and 3 children under a single policy. Combinations allowed under 2 Adults are: Self & Spouse or Father & Mother or Father-in-law & Mother-in-law.

For a Global Plan residency should be Indian at the time of purchase, at subsequent renewals as well as at the time of claims.

Residency definition - An individual will be considered to be resident in India, if he/she is in India for a period or periods amounting in all to 182 days or more, in the preceding 365 days.

Expats/ Foreigners will not be covered in Global plan.

Insured Person shall disclose to Us in writing if in case there is any change in residency status (if Global Plan is opted), any material change in the health condition at the time of seeking Renewal of this Policy, irrespective of any claim arising or made. The terms and condition of the existing policy will not be altered.

Hospitalization Expenses Covers hospital expenses, for admission longer than 24 hours, up to the full Sum Insured. It includes

       i) Reasonable and customary charges for Room Rent for accommodation in Hospital room up to   

          room category offered under India Plan & Global Cover.

      ii) Intensive Care Unit charges

      iii) Operation theatre charges

      iv)  Fees of Medical Practitioner/ Surgeon,

      v) Anaesthetist,

      vi) Qualified Nurses,

      vii) Specialists,

      viii) Cost of diagnostic tests,

      ix) Medicines,

      x) Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices

         recommended by the attending Medical Practitioner and that are used intra operatively during a

        Surgical Procedure.

     xi) Expenses towards artificial life maintenance.

We will cover the expenses towards artificial life maintenance, including life support machine use, even where such treatment will not result in recovery or restoration of the previous state of health under any circumstances unless in a vegetative state, as certified by the treating Medical Practitioner.

  

There is a limit on room rent for hospitalization expenses incurred within India

  • For Sum Insured1 up to INR 200 Lacs - Covered up to any room except suite or higher category.
  • For Sum Insured1 INR 300 Lacs – Covered up to any room including suite category. 

There is no capping on the room rent, if an Insured opts for hospitalization expenses for treatment of Major illnesses outside India.

If the insured/policyholder is admitted in a room category that is higher than the one allowed under the Policy, then policyholder shall bear the rateable proportion of the total Associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the difference between the room rent of the entitled room category to the room rent actually incurred.

 

Pre-hospitalization expenses are medical expenses incurred immediately before the insured is Hospitalized & Post-hospitalization expenses are medical expenses incurred Immediately after the insured is discharged from the hospital.

        Pre & Post hospitalization claim is admissible provided:      

            i.    Such expenses are incurred for the same condition for which the insured Person’s was

hospitalized.

                          ii.   And an in-patient hospitalization claim is admissible for that hospitalization.

Pre-hospitalization expenses are covered up to 60 days preceding the date of Hospitalization and covered up to full Sum Insured for medical expenses incurred within and outside India.

Post – hospitalization expenses are covered up to 180 days immediately after discharge from the hospital and covered up to full Sum Insured for medical expenses incurred within and outside India.

AYUSH covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy for an illness or injury that occurs during the policy year.

ManipalCigna under this policy will cover in-patient hospitalization medical expenses towards the donor for harvesting the organ provided that:

1. The organ donor is any person in accordance with the Transplantation of Human Organs Act 1994               (amended) and other applicable laws and rules.

2. The organ donated is for the use of the Insured Person who has been asked to undergo an organ transplant on Medical Advice.

3. We have admitted a claim under in-patient hospitalization.

       4. We will not cover any pre or post hospitalization expenses towards the donor,

            a. Cost towards donor screening

            b. Cost  associated to the acquisition of the organ

     c. Any other medical treatment or complication in respect of the donor, consequent to   harvesting.

  d. Stem cell donation whether or not it is Medically Necessary Treatment except for Bone Marrow  Transplant.

    e. Expenses related to organ transportation or preservation.

Benefit under this cover is payable maximum up to the Sum Insured1 and any claim under this section will reduce the Sum Insured1.

It means medical treatment for an illness/disease/injury which normally would require care an treatment at a hospital but is actually taken while confined at home because:

- The condition of the patient is such that he/she cannot be moved to a hospital, or

- Hospital bed was unavailable provided that the treatment of the Insured Person continues at least 3 days in which case the reasonable cost of any Medically Necessary treatment for the entire period shall be payable.

Claims for pre-hospitalization and post-hospitalization expenses will be payable up to 60 days and 180 days respectively.

Benefit under this cover is payable maximum up to 10% of the Sum Insured1 opted and any claim under this section will reduce the Sum Insured.

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