Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS Arogya Sanjeevani Policy .

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.

Arogya Sanjeevani Policy is a standard health insurance product developed by IRDAI and made available by ManipalCigna Health Insurance company to take care of basic health care needs of insuring public. It takes care of your hospitalization needs due to illness, injury.

Following are the key benefits available under Arogya Sanjeevani Policy :

I.  In-patient hospitalization
II.  Pre-hospitalization
III.  Post hospitalization
IV.  AYUSH Cover (in-patient only)
V.  Day care treatment
VI.  Ambulance cover
VII.  Cataract Treatment
VIII.  Cumulative Bonus
IX.  Modern Treatments

Exclusions are conditions where ManipalCigna is not liable to pay for expenses incurred by the insured person in the event of a claim. List of exclusion forms a part of Policy terms & conditions.

  1. Rs 50,000
  2. Rs 1 Lac
  3. Rs 1.5 Lacs
  4. Rs 2 Lacs
  5. Rs 2.5 Lacs
  6. Rs 3 Lacs
  7. Rs 3.5 Lacs
  8. Rs. 4 Lacs
  9. Rs 4.5 Lacs
  10. Rs 5 Lacs
  11. Rs 5.5 Lacs
  12. Rs 6 Lacs.
  13. Rs 6.5 Lacs
  14. Rs 7 Lacs.
  15. Rs 7.5 Lacs
  16. Rs 8 Lacs.
  17. Rs 8.5 Lacs
  18. Rs 9 Lacs.
  19. Rs 9.5 Lacs
  20. Rs 10 Lacs

Yes, there is an option of including up to 2 adults and 3 children under floater policy.

Minimum entry age for Adult is 18 years and for children it is 3 months (91 days)

Maximum entry age for Adult is 65 years and for children it is 25 years (Children should be financially dependent).

Relationships covered are: self, legally wedded spouse, parents, parents-in-laws, dependent children.

Pre policy medical checkup will be required for the insured aged 55 years and above and for the rest of the ages will be required subject to underwriting (on case to case basis).

We will cover hospital accommodation expenses with limit of 2% subject to maximum of Rs. 5,000/- per day for room rent, and charges for stay in Intensive Care Unit with limit of 5% subject to maximum of Rs. 10,000/- per day.

There will be waiting period of 48 months for pre-existing diseases. Loading (if any) will be subject to the underwriting decision and applicable on acceptance by the policy holder.

The applicable waiting periods are listed below:

Pre-existing Diseases Waiting Period: Pre-existing diseases will be covered after 48 months of continuous coverage under this plan.

First 30 days Waiting Period: A waiting period of 30 days from the Inception Date of the Policy will be applicable for all hospitalization claims except in case of accidents and policies accepted under portability norms.

Waiting Period for specific illness: Waiting Period of 24/48 months will be applicable for some specific illnesses as mentioned in policy terms and conditions.

We will cover in-patient medical expenses up to the limit of Sum Insured towards non-allopathic treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy for hospitalization arising due to accident or illness undertaken in a government hospital or government recognized institute.

No, maternity and related expenses are not covered under this policy except ectopic pregnancy.

Yes, all Day care treatments are covered under this policy.

The following procedures will be covered (wherever medically indicated) either as inpatient or as a part of day care treatment in a hospital up to 50% of Sum Insured, specified   in the policy schedule, during the policy period:

A. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
B. Balloon Sinuplasty
C. Deep Brain stimulation
D. Oral chemotherapy
E. immunotherapy-  Monoclonal Antibody to be given as injection
F. Intra vitreal injections
G. Robotic surgeries
H. Stereotactic radio surgeries
I. Bronchical Thermoplasty
J. Vaporization of the prostrate (Green laser treatment or holmium laser treatment) 
K. IONM - (Intra Operative Neuro Monitoring)
L. Stem cell therapy:  Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.

Yes, we will indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or Rs. 40,000/-, whichever is lower, per each eye in one policy year.

Yes, you can renew this policy for lifetime except on grounds of fraud, moral hazard, misrepresentation by the insured person.

The Product may be offered to the above person, subject to the following criteria being met.

  • NRI Proposer/Proposed Insured Persons must have an Indian Address for communication.
  • Foreign nationals desirous of this product must be residing in India for a period of 180 days at least. Valid Visa, all pages of passport, employment details and residence proof need to be submitted in all such cases.
  • Proposer must be in India at the time of signing the proposal form
  • Those currently working or settled in India are eligible for the cover. Eg. NRI/PIO who has returned back to India and gainfully employed.
  • Medical tests wherever applicable will be conducted in India only and Proposal Form to be signed in India by the Proposer Only.

 

Policy will be applicable all over India. Policy will not cover any treatments taken outside India. All claims under the policy shall be payable in Indian currency only.

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