Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS ProHealth Cash .

ProHealth Cash is available under two plans with Optional covers and a maximum number of days of coverage per year.

Plan I. Basic Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover

Plan II. Enhanced Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover
  • Convalescence Benefit
  • Companion Benefit
  • Compassionate Benefit

Optional Covers

  • Day Care Treatment Benefit
  • Accidental Death (AD) and Permanent Total Disability (PTD) Cover

Maximum Coverage Limit (Number of days of coverage per policy year 
       •  60 days               •  90 days                    • 180 days

The Policy is limited to a maximum number of 450 days including all Daily Cash Benefits in the lifetime of an Insured Person.

Note:  A deductible of one day (24 continuous hours of Hospitalization) will apply and claim will become payable from day two of Hospitalization.

You will have option to choose a Daily Cash Benefit (DCB) from ₹500 (1 Unit) to ₹5000 (10 Units). The Sum Insured available under Personal Accident and Permanent Total Disability ranges from ₹50,000 to ₹25 Lacs. Eligibility of Accidental Death and Permanent Total Disability sum insured will be determined basis income with the maximum being 10 times of annual income.

Policy can be issued or renewed for one, two or three continuous years at the option of the policy holder. Premiums will be payable either by Single premium mode or in installments through Annual Mode in case of a 2 or 3 year policy.

The minimum entry age under this policy is 91 days and maximum age at entry is 65 years. To avail the Optional Cover for Accidental Death & Permanent Total Disability the minimum entry age is 5 years.

Once a child attains 18 years of age, he/she has the option to move in to an individual cover.

There is no cashless or re-imbursement option. This policy provides a fixed Daily Cash Benefit to an Insured Person for each continuous and completed period of 24 hours of Hospitalization resulting due to an Illness or Injury which occurs during the Policy Period.

For Accidental Death (AD) and Permanent Total Disability (PTD) lump sum benefit equal to the sum insured opted will be paid. Once an AD or PTD claim is paid, these benefits will cease and Hospital Daily Cash benefit will continue.

The Premium charged on the Policy will depend on the Plan, Daily Cash Benefit, Policy Tenure, Age, Optional Covers and Maximum Coverage Limit opted. Additionally the health status of the individual will also be considered.

The Policy can be issued on individual basis covering the following relationships - Self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren.

Policy covers medically necessary hospitalization (planned or emergency) outside India for any illness or injury within the policy period. Payment will be 3 times the DCB for each continuous and completed period of 24 hours of Hospitalization.

There is no room type/room rent limit under the policy. Payout will be as per the Daily Cash Benefit selected under the plan.

Policy covers medically necessary hospitalization for 10 days or more due to illness or injury within policy period under Convalescence benefit. Lump sum amount equal to 5 times DCB will be paid.

ProHealth Cash includes Companion benefit where additional 50% of DCB is payable for each continuous and completed period of 24 hours of hospitalization in respect of an accompanying person to take care of the insured.

Yes, above benefits are payable in addition to the hospital Daily Cash Benefit

For Day Care treatment for less than 24 hours lump sum payment equal to lower of 5 times DCB or ₹25, 000 will be made.

List of Day Care procedures includes:

1) Tympanoplasty

2) Mastoidectomy

3) Operations on the turbinates (nasal concha)

4) Operation of cataract

5) Tonsillectomy

6) Surgical treatment haemorrhoids

7) Lithotripsy/ Nephrolithotomy for renal calculus

8) Coronary angiography

9) Haemodialysis

10) Chemotherapy

11) Adenoidectomy

12) Division of the anal sphincter (sphincterotomy)

13) Reduction of dislocation under GA

14) Radiotherapy

15) Cystoscopic removal of stones

16) Therapeutic curettage

17) Appendectomy with/ without Drainage

18) Surgical treatment of anal fistulas

19) Excision of single breast lump

20) Surgery for ligament tear

On accidental death during the course of hospitalization, a lump sum amount equal to 10 times the DCB for each continuous and completed period of 24 hours of hospitalization will be paid to the nominee or legal heir under Compassionate Benefit.

You can opt for Critical Illness (CI) add-on cover with ProHealth Cash by paying appropriate additional premium. This Add-on Cover will be available for all Insured Persons between 18 to 65 years.

We will provide a lump-sum benefit amount equivalent to the Critical Illness Sum Insured (minimum ₹50,000; maximum ₹25 lacs) on the first diagnosis of the covered critical illness. Eligibility of sum insured will be 10 times of your gross annual income.

A waiting period of 90 days from the date of issuance of first policy and survival period of 30 days following the diagnosis of critical illness shall apply.

Note: For list of 11 covered critical illnesses refer CI add-on prospectus.

You can avail the following discounts on your policy.

a. Family Discount of 10% for covering 3 or more family members under the same policy.

b. Long Term Discount of 7.5% and 10% on selecting a 2 and 3 years single premium policy respectively.

c. Online Renewal Discount of 3% p.a. if the customer chooses for NACH or standing instruction (where payment is made either by direct debit of bank account or credit card) option, applicable from next renewal of the policy.

You can claim tax deduction u/s 80D as per IT Act'1961 for premium paid towards this policy. For premiums paid in cash, tax benefit u/s 80D shall not be applicable. Please consult your tax advisor for more details.

The below waiting periods will apply on the policy.

First 30 days waiting period - From the policy inception date a period of 30 days will apply before you can claim in respect of any hospitalization except for accidents.

Pre-existing Disease Waiting Period - All Pre-existing Diseases / Illness / Injury / conditions, will not be covered until 48 months of continuous covers have elapsed since inception of the first Policy with Us.

Two Year Waiting Periods - A waiting period of 24 months will apply for listed illnesses and treatments.

Before you buy this policy, please acquaint yourself with the product brochure, policy benefits, exclusions and premium details & discuss with our advisor/company representatives.

Once you have understood the policy details, fill up the proposal form and provide all the required details correctly.

Submit the proposal form along with the premium and any other documents (if necessary)

You may be required to undergo medicals as per sum insured and age band chosen.

Based on the above details we will process your proposal and inform you about the decision.

Yes, you can take cover for yourself, spouse and children on individual basis in one policy.

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