Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS ProHealth Select .

ProHealth Select offers wide range of protection including Inpatient, Day care, Pre and Post hospitalization benefits, Donor and Domiciliary cover. It provides Restoration of Sum Insured (SI) and Smart non- reducing Cumulative bonus as an inbuilt benefit.

Its optional Cumulative Bonus Booster works on non-reducing/reducing/guaranteed basis (as selected) and adds more flexibility to the policy coverage.You get unique choice of Re-assurance cover, Worldwide Emergency and Health Maintenance Benefit for OPD expenses.

You also have option to select Removal of Room Rent limit and Disease Specific Sub-limits. ManipalCigna offer Healthy Rewards as value added benefit associated with ProActiv Living Program.

All benefits are even offered for policies where Deductible or Voluntary co-pay has been opted.

Basic Covers

Value Added Covers

Optional Covers

Add on Cover

. In patient Hospitalization   cover

.Cumulative Bonus

. Deductible#

.Critical Illness Add   on

. Pre/Post Hospitalization   cover

.Healthy Rewards

. Voluntary Co-pay#

 

.Day Care treatment

 

. Cumulative Bonus Booster

 

.Domiciliary treatment

 

.Removal of Room Rent      Limit

 

. Ambulance Cover

 

. Re-Assurance

 

.Donor expenses

 

. Health Check-Up*

 

.Restoration of SI

 

. Worldwide Emergency   Cover*

 

.AYUSH Cover

 

. Disease Specific Sub-limits*

 

 

 

. Health Maintenance   Benefit*

 

#Voluntary Co-pay and Deductible cannot be taken under a single plan.

*Available for Plan A

#The covers are available as per the plan chosen.

You can call us at 1-800-10-24462 or visit the Branch and we will help you with the purchase process.

Alterations like increase or decrease in Sum Insured, change in product will be allowed at the time of renewal of policy. However, any such change request will be subject to underwriting decision or requirement of medical tests on a case to case basis.

You can choose from Sum Insured available under ProHealth Select Plan A and Plan B.

Plan A - 0.5, 1, 2, 3, 4, 5, 7, 10, 15, 20, 25 Lacs

Plan B - 3, 4, 5, 7, 10, 15, 20, 25 Lacs

Yes, the Minimum age at entry is: 91 days (for Children); 18 years (for adult)

Maximum age at entry: 23 years (for children under a floater); Lifetime (for adults)

The age eligibility of the insured for taking the policy is the Entry Age. Age means completed age as at the inception date.

No, there is no exit age in this policy.

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.

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as in-patient treatment.

Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted under a day care or as an in-patient.

For in-patient hospitalization, we will pay for the below medical expenses:

• Room rent for accommodation in Hospital room up to a max. of Rs.3000/- per day

• Intensive Care Unit charges for accommodation in ICU up to a max. of Rs. 7000/- per day

• Operation theatre charges,

• Fees of Medical Practitioner,

• Anaesthetist,

• Qualified Nurses,

• Specialists,

• Cost of diagnostic tests,

• Medicines,

• 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.

Day care treatment is any treatment or surgery which requires less than 24 hour’s hospitalization due to advancement in technology and undertaken in a hospital / nursing home / Day care center as recommended by a medical practitioner. It is necessary for you to occupy a hospital bed either for some hours or a day.

Outpatient healthcare are commonly relating to specialist consultation and diagnostic test.

Essentially outpatient treatment relates to diagnosis stage of treatment where you do not need to occupy a hospital bed.

Sub limit defines the capping of insurance amount which reduces the premium of the plan. Same is as per the plan selected by customer.

Sub-limits are applicable on room rent and other expenses as follows:

- Hospital room charges covered up to 2% of Sum Insured, maximum up to Rs.3000,

- ICU charges up to 4% of Sum Insured, maximum up to Rs.7000.

Yes, applicable room rent limit can be removed by opting for Removal of Room Rent Limit benefit.

On selecting the option, coverage will be available up to Single Private Room.

Any form of Allopathic treatment & non- allopathic treatment such as AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy) treatments are covered under the plan. However, facilities & services availed for pleasure or rejuvenation or as a preventive aid like beauty treatment, panchakarma, purification, detoxification and rejuvenation are excluded

Domiciliary Hospitalization benefits cover the expenses on employment of qualified nurses, who are employed on the recommendation of the attending Medical Practitioner and who holds a certificate of a recognized Nursing Council.

However, the treatment has to be under a qualified Medical Practitioner only.

In this scenario, the medical treatment and expenses will be covered under Day Care Procedure.

Pre-existing Disease means any condition, ailment or injury or disease:

a.  That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement; 

or

b.  For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

ManipalCigna under this policy will cover In-patient Hospitalization Medical Expenses towards the donor for harvesting the organ up to the limits of the Sum Insured, 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.

We will not cover:

a. Any pre or post hospitalization expenses

b. Cost towards donor screening

c. Cost directly associated to the acquisition of the organ

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

Re-assurance benefit provides automatic extension of policy (base + optional covers) for a period of 2 years from the policy expiry date on diagnosis of any of the listed Critical Illnesses or suffering from Permanent Total Disability. This benefit will be available only once in the lifetime of the insured person. You may choose to take this cover with additional premium. If Critical Illness add-on cover is opted, rider premium will apply during the 2-year period.

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