Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS Global Health Group Policy .

The Group policy is designed for health needs of the globally mobile population and their families whilst working/ travelling for work in India and overseas. A Corporate/ Group can purchase this policy for Its members and their family and employees and dependents. Also an Affinity (non-employer -employee) group like customers of a bank holding savings account, members of a club etc can opt for this policy.

 Min Age at entry for Adult is 18 Years and Max is 95 Years, Dependent Children can be covered

from day 1 of birth up to 25 years of age.

Minimum number of members required to buy a group policy is 7 or as prescribed by IRDAI from

time to time. Also the group should not be formed with the sole purpose of buying health

insurance.

The policy is issued for a term of 1 Year only.

We offer a wide range of Sum Insured options from $ 5000. The policy can be

issued in any of the below mentioned currency:

USD (US Dollar), AED (Arab Emirates Dirham), AUD (Australian dollar), Euro, GBP (Great Britain

Pound),HKD (Hong Kong Dollar), SGD (Singapore Dollar), Dollar) and INR (Indian Rupees).

However the premium towards the policy will be charged in Indian rupees only.

A comprehensive group plan that provides health care solution to Employer – Employee and Non Employer – Employee segments (Affinity Groups like Bank Savings A/c holders, Club Membership holders, Students of Educational Institutes and more). Product offers a set of benefits including:

• Tailor made package for essential in-patient care extendable to cover medical travel expenses too
• Multiple solution for Hospitalization, Daycare to Out-patient treatment expenses 
• Range of different options to combine with Hospitalization/Out-patient expenses
• Maternity Expenses, New Born cover, Emergency Evacuation, Repatriation, Out of area cover, Dental, Vision cover, Hospice and palliative care, Travel vaccination, Complementary treatments, Cancer cover and more
• Host of options for cost effective plans - Co-pay, Deductible, Waiting period inclusion and Maximum limit on Out of pocket expense
• Wellness package for Health and Well-being
• Easy access to quality health care around the world

Plan offers an all-round health protection towards In-patient hospitalization, Day Care, Outpatient
expenses and customized optional covers.
 

In-patient hospitalisation covers medical expenses of an insured person for illness or injury that requires hospitalization for more than 24 hours up to the Sum Insured specified under the Policy Schedule/ Certificate of Insurance. These medical expenses includes.


i. Room charges                                                                                                                                        
ii. Charges for accommodation in ICU/CCU/HDU,
iii. Hospitalization charges,
iv. Operation theatre cost,
v. Surgical Procedures,
vi. Minor Surgical Procedures,
vii. Day Care Treatment,
viii. AYUSH Treatment for In-patient Hospitalization (In India Only),
ix. Medical Practitioner fees,
x. Specialist fee,
xi. Surgeon’s fee,
xii. Anaesthetist fee
xiii. Radiologist fee,
xiv. Pathologist fee,
xv. Assistant Surgeon fee,
xvi. Qualified Nurses fee,
xvii. Medication,
xviii.Cost of diagnostic tests as an In-patient such as but not limited to radiology, pathology tests, X-rays, MRI and CT scans, physiotherapy and drugs, consumables, blood, oxygen.
xix. Surgical appliance and/or Medical Appliance.

Under Base 1 cover per day room rent allowance is restricted up to Private room for Hospitalisation outside India and any hospital room except suite and above, for hospitalisation in India .For ICU hospitalization, the limit is capped upto Sum Insured opted under Base 1.

Yes, we will reimburse expenses incurred toward transportation of the insured person by a registered ambulance provider to a hospital for treatment of illness or injury. Cover against Air Ambulance is also available up to Sum Insured, if opted.

Medical expenses incurred towards treatment on an out-patient basis are covered up to the Sum

Insured selected. Any one or combination of the following can be opted under the cover:


i) Consultation with Medical Practitioners & Specialist

ii) Prescribed Medicines, Drugs, Dressing

iii) Diagnostic Test.

Day care procedures cover medically necessary treatment or surgery undertaken for illness / 
conditions which require less than 24 hours of hospitalization. We cover all Day care procedures
up to full sum insured opted under Base 1.
 

 A serious medical condition or symptom due to an injury or sickness which arises suddenly and
unexpectedly and requires immediate care and treatment by a medical practitioner within 24
hours or else could result in a life threatening situation or long term impairment.
Eg: Heart Attack, stroke, severe allergic reaction etc.
 

It covers expenses towards evacuation of the insured person to the nearest facility capable of
providing adequate care in case of emergency due to lack of adequate medical facilities available
locally. It also covers travel cost of accompanying person due to medical necessity.
Transportation will be provided by medically equipped aircraft, commercial airline, train or
Ambulance.
Under this benefit one can opt for any one or combination of the following can be opted under the
cover:
•  Emergency Evacuation - 
•  Medical Repatriation
•  Repatriation of Mortal Remains

Expenses will not be payable towards   emergency evacuation, repatriation and transportation
cost towards:
•  Any form of treatment which is not covered under the plan.
•  Any form of non- emergency travel cost.
•  Routine or minor medical problem, tests and exams where there is no significant risk.
•  A condition which would allow for treatment at future date.

Yes, under Out-patient Expenses you have option to include cover against over the counter medicines.

It covers cost towards a qualified nurse arranged by the hospital to visit insured person’s home to
give expert nursing services immediately after hospitalisation, provided the specialist/medical
practitioner who is treating the insured person has recommended these service in writing.
 

We cover medical expenses towards Human Immunodeficiency Virus (HIV)/or HIV related illnesses, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related complex (ARC) and/or any mutant derivative or variation thereof including pre and post diagnosis consultation, routine check-ups, drugs, dressing, hospital accommodation and nursing fees provided this optional cover is opted in respect of the insured person.

Yes, In-patient psychiatric or psychological treatment of an insured person is covered only if opted. Waiting period if any and coverage amount will be specified under the Policy Schedule/Certificate of Insurance.

Yes, these are available as optional covers. If opted, coverage details and Sum Insured will be
specified under Policy Schedule/Certificate of Insurance.

Any one or combination of following with separate or combined Sum Insured can be selected.

i. Routine or Elective Caesarean.
ii. Complicate Pregnancy – Covers medical expenses arising during antenatal stages or pregnancy or childbirth which require obstetric procedure and post natal check-up upto 6 weeks.
iii. Pre & Post Natal Care – Covers costs up to 6 weeks, prescribed pre natal vitamins & associated delivery cost.
iv. New Born Cover- Covers medical expenses towards treatment of the new born until discharge or no. of days specified.  
v. Maternity Assistance & Mid-wife charges
vi. Birthing Classes Charges

Yes, We will cover medical expenses of an insured person which are incurred towards pre and/or post hospitalization provided Out-patient Cover is opted and specified under the Policy Schedule/ Certificate of Insurance.

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