Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS Super Top Up .

Super Top up is a back up to existing medical insurance (personal health insurance or health insurance provided by employer or other group). A regular health insurance policy has a Sum Insured limit, beyond which it does not cover any medical expenses. This is when a Super Top Up policy is useful, it becomes effective soon after the Sum Insured from an existing health plan is exhausted or insufficient to settle claim.

Super Top Up health insurance plans are an added protection in such scenarios, when the maximum payout from a basic health policy gets exhausted or insufficient.

Top Up health insurance plans cover policies that offer an additional coverage, beyond the threshold limit of the existing health insurance policy.

(that is, each claim to surpass the threshold limit for any amount to be paid from the Top up policy)

Super Top Up plans are similar to top-up plans, except that Top Up plan covers a single claim above the threshold limit, while Super Top Up plan covers the total of all hospitalization bills above the threshold limit.

In other words, under Top Up Policies deductible amount selected is reduced from every claim however under Super Top Up, claim becomes payable when the total of all the claims together exceeds the deductible limit within a policy year.

It is very important. Deductible can make or break the efficacy of your health insurance plan. It is the amount that you have to pay for – either out-of-pocket or from your basic health insurance policy – before your health insurance top up kicks in.

Choosing a very high deductible (say, more than the base Policy sum insured) means you will have to take care of the excess amount yourself. Always calculate the amount of deductible by taking in your medical history and the kind of costs you anticipate in the next 5 years. If you are nearing 50 years, a super Top Up will be more beneficial, since the risk of ailments is higher as you grow older.

No, you need not. If you don't have a health plan, you can still purchase a Super Top Up plan. However, in this case you will end up paying the expenses out-of-pocket until you exceed your deductible limit and the Super Top Up sum insured kicks in. Hence, it is ideal to have a basic health insurance plan, however not mandatory.

Your existing Mediclaim policy will continue to cover pre-existing diseases however fresh waiting period of 48 months will be applied with ManipalCigna Super Top up policy.

An option is available to reduce your waiting period from 48 to 24 months on payment of additional premium at time of first purchase.

A Specific illness waiting period of 24 months shall apply to the treatment whether medical or surgical for all medical expenses along with their complications. List of Treatment is mentioned in policy terms & condition under section III (Waiting period). (Document available on our website download section).

If these diseases are pre-existing or subsequently found to be pre-existing then pre-existing waiting period will be applied. For Ported policy continuity benefit will be available.

We may apply a risk loading on the premium payable (excluding Statutory Levies and Taxes) or Special Conditions on the policy based upon the health status of the persons proposed for insurance and declarations made in the Proposal Form. These loadings will be applied from inception date of the first Policy including subsequent Renewal(s) with Us. Additional waiting periods may be applied upto a maximum of 48 months from the date of inception of first policy. 

We shall inform you about the applicable risk loading or special condition through a counter offer letter and you would need to revert with consent and additional premium (if any), within 7 working days of the issuance of such counter offer letter.

Yes, We will cover payment of medical expenses of an insured person in case of medically necessary dialysis treatment irrespective of number of times insured person is hospitalized. This treatment will start getting covered after the deductible limit is exhausted/insufficient till Sum Insured opted.

Yes, AYUSH covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy for an illness or injury that occurs during the policy year. Coverage is available upto the sum insured provided:

i. Treatment is taken in a government Hospital or in any institute recognised by government and/or accredited by government authority.


ii. Facilities and services availed for pleasure or rejuvenation or as a preventive aid like beauty treatments, Panchakarma, purification, detoxification and rejuvenation etc. is an exclusion under this benefit.

Yes, you can cover self, spouse & children on individual & family floater basis. For parents, a separate family floater plan to be opted. Extended family like brother and sister of the Policyholder who are children of same parents, grandparents, grandchildren, parent in laws, son in law, daughter in law, Uncle, Aunt, Niece and Nephew can be covered on individual basis.

No, ManipalCigna Super Top Up plan covers all valid hospitalization bills above the threshold limit of Deductible amount. Once the Deductible limit is exhausted and Super Top Up policy kicks in, no further co-pay is applicable during settlement of claims.

We will require you to undergo a medical check-up based on your age and the Sum Insured opted as provided in the grid below.

    Pre-policy Check-up

Sum Insured (Lacs)

Age Group (Years)

Medical Tests

1 Lac to 30 Lacs

Up to 55

No Test

56 – 65

Tele Underwriting

>65

Medical Test 

 

Wherever any pre-existing disease or any other adverse medical history is declared, insured member may have to undergo specific tests. Medical tests will be facilitated by us and conducted at Our network of diagnostic centres.

The Sum Insured and Deductible combination are:

Deductible

 (INR in Lacs)

Sum insured

 (INR in Lacs)

3, 3.5

3, 6

4, 4.5

4, 8

5, 5.5

5, 10, 15,20

7.5

10, 15, 20

10

10, 20, 30

Minimum age at entry: Child – 91 days, Adult – 18 Years

Maximum age at entry: Child – 23 Years, Adult – No Limit

Yes, You will receive a 7.5% premium discount for 2 years and 10% for 3 years for single premium policy term respectively.

You can make one time single premium payment or choose Monthly, Quarterly, Half yearly or Yearly premium payment mode.

In case of premium payment mode other than Single and Yearly, a loading will be applied on the premium.

 

Premium payment mode

Monthly

Quarterly

Half yearly

% Loading on premium

5.50

3.50

2.50

No, there is no room rent capping, any category of hospital room can be opted up to the policy Sum Insured.

Individual cover means each insured member has their own defined Sum Insured. In a family floater plan, the limit of the Sum Insured opted can be utilised by any one or all the members covered in the policy.

While porting and or renewing a policy, ManipalCigna should have information of medical and claim history from other insurance company (as applicable). Basis our underwriting guidelines, we may subject your proposal for medical underwriting and restrict terms of the cover or accept at standard rates. Failure to provide any vital information may lead to complication at the time of claim settlement or cancellation of policy.

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