Health Insurance Claims FAQ's | ManipalCigna Health Insurance

Frequently Asked Questions

Content with PRODUCTS Saral Suraksha Bima .

An accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.

Saral Suraksha Bima Policy is a standard personal accident product developed by IRDAI and made available by ManipalCigna Health Insurance company to take care of unexpected expenses arising from accidental death or permanent total disablement or permanent partial disablement.

Saral Suraksha Bima comes with other benefits like Temporary Total Disablement, Hospitalisation Expenses due to Accident and Education Grant that assures financial support to the dependent children.

Policy covers permanent total disablement of loss of sight of both eyes, hands, feet, physical separation or loss of use of hand or foot or loss of sight of one eye and physical separation or loss of use of hand or foot due to accident.

Policy covers permanent partial disablement of eye, ears, hand, feet, toes, fingers, loss of hearing and loss of metacarpus due to accident.

Yes, the policy covers Temporary Total Disablement (TTD) of the Insured Person if he/she sustains an Injury in an Accident during the Policy Period and which completely incapacitates the Insured Person from engaging in any employment or occupation of any description whatsoever which the Insured Person was capable of performing at the time of the Accident.

The TTD benefit is payable as 0.2% of the Base Sum Insured per week for a maximum 100 weeks, provided temporary total disablement exceeds 4 weeks.

Under family basis, members are eligible for cover as a percentage of the earning members sum insured.

Family Member

Sum Insured

Earning member 

Eligibility of Sum Insured will be up to a maximum of 10 times of Annual Income

Non-earning Spouse

60% of Sum Insured of Earning member

Dependent Children

30% of the Sum Insured of Earning member

Dependent Parents/parent in laws

30% of the Sum Insured of Earning member

Sum Insured is calculated as a maximum of 10 times of gainful annual Income of the Proposer or Earning member to be insured.

Yes, The policy covers hospitalisation expenses due to accident up to 10% of the base sum insured without any capping on room rent / category. Hospitalisation expenses due to accident is an optional cover in the product.

The coverage is worldwide except for the optional cover “Hospitalization expenses due to accident”. The coverage of optional cover “Hospitalization expenses due to accident”, is limited to medical treatment taken in India only.

No, hospital daily cash benefit is not available in Saral Suraksha Bima policy.

The Premium for the policy depends on the Sum Insured, Optional Covers and Premium payment mode.

Premium modes available in the policy are Yearly, Half Yearly, Quarterly and Monthly. Premium payment mode can only be selected at the inception of the Policy or at the renewal of the Policy. In case of premium payment modes other than Single or Yearly, a loading will be applied on the premium. Loading grid  applicable for Half-yearly, Quarterly and Monthly payment mode.

Premium payment mode

% Loading on premium

Monthly

5.5%

Quarterly

3.5%

Half yearly

2.5%

Proposals with a medical history / any disability may be required to undergo tele underwriting and/or physical medical tests on a case to case basis after assessment of each individual risk. Cost of the Pre Policy Medical Tests will be borne by the Company.

There is no tax benefit for the premium paid towards Saral Suraksha Bima policy.

We will increase the sum insured by 5% for every claim free year up to a maximum of 50%. For example, if you have coverage of Rs. 5 Lacs, an additional Sum Insured of Rs. 25,000 will be allowed as Cumulative Bonus every year, maximum up to 50%. Similarly, if a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued. Cumulative Bonus is applicable only on the Base covers.

Few key exclusions under this policy are:

Any claim for death or disablement arising due to War and war like occurrence, civil war, hostilities etc

Any claim for death, disablement from intentional self-injury , intoxicating liquor or drugs etc

Any claim for death, disablement due to participation as a professional in hazardous or adventure sports. 

Any claim resulting or arising from or any consequential loss or Ionizing radiation or contamination by radioactivity.

Any loss arising out of the willful participation in an illegal act or any violation or attempted violation of the law.

Expenses related to any admission primarily for diagnostics and evaluation purpose.

Above list is only indicative and not exhaustive. Please refer policy terms and conditions for complete details.

Alteration in sum insured and addition/deletion of insured person are allowed at the time of renewal subject to underwriting.

You can place a request for cancellation any time within the policy period. Premium will be refunded on short period basis for the unexpired policy period. No refund will be processed for cancellation of policies with Premium Payment Mode as Half-yearly, Quarterly or Monthly.

Yes, Hospitalisation expenses due to accident is available, as an optional cover in the policy on indemnity basis through Cashless/Reimbursement.

 Saral Suraksha Bima offers one time Education Grant of 10% of base sum insured, for per dependent child, on the admissible claim due to Death or Permanent Total Disability of the Insured Person.

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