FAQs on ManipalCigna Health Insurance Products

Categories Navigation

Frequently Asked Questions

Nested Applications

Categories Navigation

Asset Publisher

Hospital which has an agreement with Manipal cigna health insurance and claim processing TPA for providing cashless treatment to Manipal cigna customer is referred as Network hospital. All other hospitals outside this mutual network are referred to as non-network hospitals. Network hospitals were negotiated for treatment cost and stay cost to minimise the expenses.

You can use following link search hospital in your area. (Link)

A third-party administrator (TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. They are an organization that processes health insurance claims behalf of Insurance company.

You should carry telehealth card provided by the company with this Policy, along with a valid photo identification proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by the Company).

KYC means “Know Your Customer”. It is a process by which Insurance company need to obtain information about the identity and address of the customers as per regulation. Generally, an identity proof with recent photograph and an address proof of proposer are the two basic mandatory KYC documents needed in if claim payable is more than Rs.1 lac.

Personalized Cancelled Cheque of the Policy Holder. Alternatively, you can also provide the snapshot of the bank statement / pass book which contains only the details of Account number, Account holder’s name, IFSC Code and Branch details of policyholder’s personal account.

This benefit covers reimbursement of outpatient expenses incurred by Insured person up to the limits specified under the plan. It can be used to cover diagnostic tests, medical aids, drugs, prosthetics, dental treatments and alternative forms of medicines.

Please find the attached link hmb claim process. (Claim process Link)

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

If the Insured Person has completed 18 years of Age, the Insured Person may avail a comprehensive health check-up with Our Network Provider as per the eligibility details mentioned in the plan opted. Health Check Ups will be and arranged by Us and conducted at Our Network Providers.
For Protect plan – Available once every 3rd Policy year
For Plus, Preferred and Premier Plan – Available at each renewal

STEP 1-You/Insured Person will be eligible for an annual health check-up during the Policy Year. The list of medical tests which You are eligible for will be available along with the Policy document.
STEP 2-The Insured Person shall seek appointment by calling Our call centre.
STEP 3-The Insured Person will be guided to the nearest medical centre for conducting the medical examination. Reports of the Medical Tests can be collected directly from the centre. A copy of the medical reports will be retained by the medical centre which will be forwarded to Us along with the invoice for reimbursement.

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

This is benefit insured can avail when he was outside of India other than Medical treatment. The treatment is Medically Necessary and has been certified as an Emergency by a Medical Practitioner, where such treatment cannot be postponed until the Insured Person has returned to India.

In an unlikely event of You/Insured Person requiring Emergency medical treatment outside India, the same shall be availed at his/her own cost. You/Insured Person, must notify Us either at the call centre or in writing within 48 hours of such admission. You shall file a claim for reimbursement in accordance with Claim Process of the Policy.

This benefit covers reimbursement of outpatient expenses incurred by Insured person up to the limits specified under the plan. It can be used to cover diagnostic tests, medical aids, drugs, prosthetics, dental treatments and alternative forms of medicines.

Please find the attached link hmb claim process. (Claim process Link)

You can submit Your request for an expert opinion by calling Our call centre or register request through email. We will schedule an appointment or facilitate delivery of Medical Records of the Insured Person to a Medical Practitioner. The expert opinion is available only in the event of the Insured Person being diagnosed with Covered Critical Illness.

You need to visit www.medibuddy.in/ecard . entering the Policy Number and Name you will prompted with OTP on register mobile and email. On verification of the OTP you can view your E card.

You need to call the Toll Free Helpline 1800-419-1159 or write to cigna@mediassistindia.com in the event of planned or emergency hospitalisation.

The following details are to be provided to the Company at the time of intimation of Claim:

  • Policy Number
  • Name of the Policyholder/Patient
  • Name of the Insured Person in whose relation the Claim is being lodged
  • Nature of Illness / Injury
  • Name and address of the attending Medical Practitioner and Hospital
  • Date of Admission
  • Any other information as requested by us

When a patient is treated in a network hospital (definition above), ManipalCigna Health Insurance directly settles the bill with hospitals. This is dependant on the claim request being approved by the hospital beforehand. However, there will always be a few items that the insurer is not allowed to pay as per regulation. These will always have to be settled directly with the hospital.

In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from  us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, Pace Maker Implantation, Total Knee Replacement, other planned surgeries / treatments  etc.

In Emergency Hospitalization the patient is admitted to the network hospital in an emergency situation, for e.g. severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 24 hours of admission to the hospital for cashless treatment.

Please find the detail process flow step by step as attached link (cashless infographics).

The authorisation letter will be sent to your registered email id and also available with TPA desk of the hospital.

Yes, a request for authorization of cashless treatment may be declined due to following common reasons.

a) The treatment which insured is going for is not covered under scope of policy terms and condition.

b) Inadequate sum insured.

c) Inadequate /Misrepresentations/wrong information

d) Ailment or treatment being taken falls under waiting period or policy exclusion

This only means that cashless facility is declined by the insurer and does not mean that the patient cannot undergo the treatment at the hospital. The bill that the insured incurs can still be submitted for evaluation for a reimbursement claim, even if he or she is at a network hospital.

To see the process for Reimbursement Claim click here <link to reimbursement inforgraphic)

When the insured has availed the treatment at the hospital and settled his bills, he can submit the expenses he has incurred at the hospital for reimbursement. However he must ensure that he collects all the documents as per check list from hospital at the time of discharge. Original documents need to be submitted to the insurance company within 15 days of discharge.

To see the process for Reimbursement Claim click here <link to reimbursement inforgraphic)

You have to download the claim form from our website www.manipalcigna.com Alternatively, you can contact your Health advisor or visit nearest ManipalCigna Health Insurance branch.

You may submit the Claim Form along with the documents for reimbursement of the claim to the nearest ManipalCigna branch or head office at your own expense within 15 days from the date of discharge from the Hospital. Please ensure you carry the original documents with you.

List of necessary claim documents to be submitted for reimbursement are as following:

  • Claim form completely filled and duly signed.
  • Copy of photo ID of patient / KYC documents if applicable.
  • PAN card if claimed amount is more than 1 Lakh
  • Original Hospital Discharge summary
  • Operation Theatre notes in case of surgery
  • Original Hospital Main Bill
  • Original Hospital Break up bill
  • Original Investigation reports , X Ray, MRI, CT films, HPE, ECG
  • Doctors Consultation letters/ reference slip for investigation.
  • Original Pharmacy Bills
  • MLC/ FIR report
  • Implant Invoices, strikers for Lenses, stents if applicable.
  • Original cancelled cheque with pre printed name of proposer on it.

Completed claim forms and documents must be furnished to us within the stipulated timelines. If the timeline is missed, and the insured can show that the delay was for reasonable and unavoidable, along with proof of the same, the claim will still be accepted.

Yes, we may investigate claims at our own discretion to examine validity of claim.

Generally we provide the decision on claims within 7 (Seven) working days of the receipt of the last ‘necessary’ document. However in certain special cases, the timelines increase. These take no more than 30 days.

You will get information on status of your claims as following way-

  • You can call Toll Free Helpline for claims 1800-419-1159 or in writing for claim status on email cigna@mediassistindia.com
  • You will receive an update on status of your claim through SMS and emails on the registered contact details with us. Hence, it is important that your contact details are updated with us at all times.
  • You can track your claims on www.manipalcigna.com/claims.
  • You can track your claims on the website and mobile app of TPA MediBuddy from track your claim section.
  • SMS "CLAIMS <claim number>" to +91 96631 49992 to know the claim status
  • You can also reach out to your health advisor or connect with our health relationship managers to get an update or clarification on the claim.

Claim amount can be deducted for any of the following reasons:-

  1. Non-Medical expenses such as telephone bills, snacks etc. are non-payable,
  2. Treatment details without proper bills or prescription,
  3. Sum Insured exhausted,
  4. Amount exceeding specified Sub-limits
  5. Co Payment applicable,
  6. Capping of expenses for any particular treatment or benefit,
  7. Original reports/bills not available,
  8. Expenses related to any investigations/treatment not related to ailment for which patient is admitted."

Non-medical expenses are those that are related to food, travel, personal comfort, convenience, hospital routine disposable etc. During the time of hospitalisation stay, the insured person and his/her family members are likely to incur the above mentioned expenses. (List attachment link).( please attach latest IRDA list for non payable items in this link)

It is an agreed amount by insured that he will bear the cost of medical expenses up to specified amount in policy. The Insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies, which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured.

Yes, we may investigate claims at our own discretion to examine validity of claim.

Voluntary co-pay - It is percentage of claim amount agreed by insured that he will bear the cost of medical expenses up to specified percentage in policy, basis he will availed the discount in premium.

Mandatory Co-pay - A Compulsory Co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and above irrespective of age of entry in to the Policy.

Zonal Co-pay – If insured availed the medical treatment in hospital zone higher than actual eligible zone as per policy.

  • Policy waiting period
  • Pre-existing disease
  • Non-disclosure of diseases
  • Policy terms and condition
  • Mispresentation, Inflation in bills and Fraudulent claims
  • Ailment sub limit /Sum insured Exhausted
  • If a claim is rejected by an insurance company, the claim can be resubmitted for evaluation within 15 days for re-consideration of the decision.
  • If you choose to stay in a room that is of a higher category than your eligibility, your cover will still be as per your policy terms and conditions. There will also be a proportionate calculation of the hospitalization costs, excluding pharmacy, investigations and consumables.

Staying in a higher category of room does not mean that your claim will be rejected. It only means that the amount that is settled will be less than the entire incurred bill.

  •  If you are eligible for a particular room category and admitted in higher category room, the proportionate incremental percentage will be calculated and applied over all bill component of the payable amount excluding pharmacy, investigations and consumables and same amount will be deducted in your final claim amount.

      e.g. If you admitted room that costs Rs. 5,000, while you are eligible for a room type that costs Rs. 3,000, there will be proportionate deduction of 33%  on all charge heads except pharmacy, investigations and consumables.

Critical Illness insurance is a policy that pays an amount equal to the sum insured upon first diagnosis of a critical illness covered under the policy.

A basic health insurance policy generally pays hospitalization bills. But will a health insurance be enough if you are diagnosed of a critical illness. To help you tide over such medical exigencies, there are critical illness insurance plans that you should consider. Known as defined benefit plans, these pay you lump sum so that you can pay for the incidents. In that sense these work as income supplements.

Some health insurance plans come bundled with critical illness (as rider or add-on), but a standalone critical illness plan is more comprehensive both in terms of illnesses covered and the amount of cover it offers.

It is a health insurance plan that strengthens your existing plan to give you a higher sum insured and a wider cover to meet your medical expenses. You can take it as an independent policy or as a top up to your existing plan

One can choose between 1 year, 2 years and 3 years term.

In cases where your existing medical cover is not sufficient enough to cover your medical expenses, Super Top Up helps increase the sum insured and provider wider coverage at an affordable premium.

No, as per the guidelines of ManipalCigna ProHealth Insurance, medical check-up shall be required only if:

  • any insured member covered is greater than 55 years
  • Or sum insured >50 lakh.
  • Insured member >45 years and up to 55 years will undergo an underwriting call and medicals (if required) will be scheduled.

Pre-existing diseases refer to any condition, ailment, injury or illness that you have been diagnosed with or had symptoms of 36 months before taking your policy.

Pre-existing waiting period for ManipalCigna Super Top-Up Insurance Plan is 24 months (as per plan). That means, your pre-existing diseases declared at the time of policy purchase will be covered after 4/3/2 years subject to continuous renewals.

A compulsory co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and above irrespective of the age of entry into the Policy. Co-pay will be applied to the admissible claim amount. For persons who have opted for a Waiver of Mandatory Co-pay the same will not apply.

In case the Insured has selected the Voluntary co-pay under Optional Cover and/or chooses to avail treatment outside his Zone of Cover, then the co-pay percentages will apply in conjunction.

ProHealth Cash is available under two plans with Optional covers and a maximum number of days of coverage per year.

Plan I. Basic Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover

Plan II. Enhanced Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover
  • Convalescence Benefit
  • Companion Benefit
  • Compassionate Benefit

Optional Covers

  • Day Care Treatment Benefit
  • Accidental Death (AD) and Permanent Total Disability (PTD) Cover

Maximum Coverage Limit (Number of days of coverage per policy year 
       •  60 days               •  90 days                    • 180 days

The Policy is limited to a maximum number of 450 days including all Daily Cash Benefits in the lifetime of an Insured Person.

Note:  A deductible of one day (24 continuous hours of Hospitalization) will apply and claim will become payable from day two of Hospitalization.

ManipalCigna  Lifestyle Protection Critical Care plan not only assures you financial support in critical times but also gives you access to a worldwide network of hospitals. Moreover, it brings you the best-in class medical care and services.

This plan is brought to you by ManipalCigna Health insurance, ManipalCigna Health insurance is a joint venture between Manipal Group, an eminent player in the field of healthcare delivery and higher education in India and Cigna Corporation, a global health services company with over 200 years of experience.

The Key Benefits under this policy includes:

A.  Critical Illness Cover for 15 or 30 illnesses as per plan
B.  Medical Second Opinion
C.  Access to Online Wellness Program

The Policy is available for a Sum Insured from Rs 1 Lac to 3 Crores. Higher cover is available subject to underwriting on case to case basis. You can choose to opt for a Basic Plan covering 15 Critical Illnesses or Enhanced Plan covering 30 Critical Illnesses.

The following Critical Illnesses are covered under the Policy.

1. Cancer of specific severity

2. First Heart Attack - of Specific Severity

3. Open Chest CABG

4. Open Heart Replacement or Repair of Heart Valves

5. Coma of Specified Severity

6. Kidney Failure Requiring Regular Dialysis

7. Stroke Resulting in Permanent Symptoms

8. Major Organ / Bone Marrow Transplant

9. Permanent Paralysis of Limbs

10. Motor Neurone Disease with Permanent Symptoms

11. Multiple Sclerosis with Persisting Symptoms

12. Primary Pulmonary Hypertension

13. Aorta Graft Surgery

14. Loss of Hearing

15. Loss of Sight

16. Coronary Artery Disease

17. Aplastic Anaemia

18. End Stage Lung Disease

19. End Stage Liver Failure

20. Major Burns

21. Fulminant Hepatitis

22. Alzheimer's Disease

23. Bacterial Meningitis

24. Benign Brain Tumor

25. Apallic Syndrome

26. Parkinsons Disease

27. Medullary Cystic Disease

28. Muscular Dystrophy

29. Loss of Speech

30. Systemic Lupus Erythematous

Policy can be issued or renewed for one, two or three continuous years as opted by the insured person.

The minimum age at entry under this policy is 18 years and maximum age at entry is 65 years. Renewals will be available for lifetime.

If the insured person is diagnosed for the first time with a covered critical illness, we will make payment upto the sum insured under the policy, provided the waiting periods are met.

The received amount can be used to pay hospitalization expenses.  There is no hospitalization cover or cashless benefit under this policy.

Every health insurance question, answered.

A hospital which has an agreement with ManipalCigna Health Insurance and one of it’s claim processing TPAs for providing cashless treatment to ManipalCigna customer is referred as Network hospital. All other hospitals outside this mutual network are referred to as non-network hospitals. In network Hospital you have benefit of getting cashless facility which is not available in non-network hospitals.

You can use following link search hospital in your area.(Link)

A third-party administrator (TPA) is an IRDAI (Insurance Regulatory and Development Authority of India) approved specialized healthcare service provider. They are an organization that processes health insurance claims on behalf of Insurance company.

You should carry health card provided by the company with this Policy, along with a valid photo identification proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by the Company).

  • KYC means “Know Your Customer”. It is a process by which Insurance company obtains information about the identity and address of the customers as per regulations. Generally, an identity proof with recent photograph and an address proof of proposer are the two basic mandatory KYC documents needed if claim payable is more than Rs.1 lac.

Original Personalized Cancelled Cheque of the Policy Holder. 

This benefit covers reimbursement of outpatient expenses incurred by Insured person up to the limits specified under the plan. It can be used to cover diagnostic tests, medical aids, drugs, prosthetics, dental treatments and alternative forms of medicines.

To see the process to claim Health Maintenance Benefit click here <link to reimbursement inforgraphic>

You can submit Your request for an expert opinion by calling Our call center or emailing us. We will schedule an appointment or facilitate delivery of your medical records to a medical Practitioner. The expert opinion is available if you are diagnosed with any of our Critical Illnesses.

You can download your e-health care on www.manipalcigna.com/claims. You can also visit www.medibuddy.in/ecard . Enter your policy number, name and OTP that will be sent on your register mobile and email. On verification of the OTP you can view your E card.

Add - for details of rest of the TPAs, please visit our website or write to us at-xxx (customer care details of MCHI, phone 1800-419-1159 and email-cigna@mediassistindia.com)

No for this benefit you can apply on reimbursement only. Post discharge please collects all mandatory documents from hospital and sends to MCHI H.O. 

No, Pro health cash benefit is neither legible for cashless facility and nor for day care treatments.

GST is indirect tax which will subsume all indirect taxes excluding basic custom duty. It is a destination based tax on consumption of goods and services. It will be levied at all stages right from manufacture up to final consumption with credit of taxes paid at previous stages available as setoff.

GST is effective from 1st Jul 2017.

Yes, you can get the GST amount from your policy document.

Payment done prior by 30th Jun 17 will attract Service tax. GST will be applicable on the payments done from 1st Jul 17 onwards.

Yes, in the GST regime the tax rate applicable is 18% instead of current 15% in the Service tax regime. There will be a 3% increment in tax rate which will in turn increase the premium amount. This is effective from 1st July 2017, and applicable on the premium paid on or after 1st July 2017.

GST paid on insurance premium is eligible as input credit only when State Government notifies the service.

In case you have GST registration number, you must provide it to us.
As per GST return rules, service providers need to upload the transactions done with registered and unregistered person separately in GSTR-1 (Outward supply return).
And, if you are a GST registered person, you also need to show these transactions in your GSTR2 (Input Credit Return) separately under GST paid but not eligible for credit.

No. GST is indirect tax and applicable to business entities only. So, if you are carrying out any business or profession and your yearly turnover from business is more than INR 20 Lacs per annum, then you need to register under GST.(For more information on registration, please refer GST registration rules uploaded on GST portal)

Please refer the below list:
 

STATE LOCATION ADDRESS GSTIN PROVISIONAL ID
Maharashtra Mumbai 401/ 402, Raheja Titanium, Western Express Highway Goregaon (East), Mumbai - 400 063 27AAECC7904J1ZI
Mumbai 5th Floor, F5-6, Pinnacle Business Park, Shanti Nagar Mahakali Road, Andheri (East)Mumbai - 400093 27AAECC7904J1ZI
Pune Unit no. 403-405, 4th Floor, Gera Legend, North Main Road, Near German bakery Koregaon Park, Pune – 411001 27AAECC7904J1ZI
Gujrat Ahmedabad 201, 2nd Floor, Megha House,b/s HDFC Mutual Fund Office,Opp Mayor's Residence, Mithakali Six Road, Navrangpura, Ahmedabad - 380009 24AAECC7904J1ZO
Karnataka Bangalore - Jayanagar Rajat Tower, 2nd Floor, 4/21, 11th Main, 4th Block, Jayanagar, Bangalore - 560011 29AAECC7904J1ZE
Mangalore Raj Tower, Grd Flr, office # 3, Balmatta Rd Mangalore – 575001. Opp Roop Hotel 29AAECC7904J1ZE
Chandigarh Chandigarh 1st Floor, SCO 149/150, Sector – 9-C,Next To Yes Bank,Madhya Marg, Chandigarh - 160009 04AAECC7904J1ZQ
Tamilnadu Chennai New No 104 Old No 90, Ganesha Tower, Dr Radhakrishnan Salai,Opp Standard Chartered Bank, Mylapore, Chennai – 600004 33AAECC7904J1ZP
Coimbatore 2nd floor, Sasha Building, East Venkataswamy Road, R S Puram, Coimbatore - 641002 33AAECC7904J1ZP
Kerala Cochin 7th Floor, Mathewsons Centre Point, Mamangalam,Above Kotak Mahendra Bank,Nr Mamangalam Church, Ernakulam, Cochin - 682025 32AAECC7904J1ZR
Delhi Delhi CignaTTK Health Insurance Company Ltd., 32-B, Pusa Road, Rajinder Nagar, Opp. Pillar no. 122 of Metro station, Karol Bagh, New Delhi - 110005 07AAECC7904J1ZK
Telangana Hyderabad No. 201A , 2nd Floor , Shangrila Plaza, Road No.2, Banjara Hills,Nr Jublie Check Post Hyderabad – 500033. 36AAECC7904J1ZJ
West Bengal Kolkata Unit 317 & 318, 3rd Floor, Krishna Building, 224A, Acharya Jagdish Chandra Bose Road,Opp to La Martiniere Girls School. Kolkata – 700017. 19AAECC7904J1ZF
Rajasthan Jaipur Office No. 111, 1st Floor, Trimurty’s V-Jai City Point, Plot No. D-52, Ahimsa Circle, C-Scheme, Jaipur-302001 (Rajasthan) 08AAECC7904J1ZI
Uttar Pradesh Lucknow 19 - A, Punjab National Bank Building, Vidhan Sabha Marg, Behind – Akashvani, Hazrat Gunj, Lucknow – 226001 09AAECC7904J1ZG
Noida Office no 316, 3rd Floor, Krishna Apra Plaza, P-3, Sector – 18, Landmark – Near to Metro station, Noida, UP – 201301 09AAECC7904J1ZG
Odisha Bhubaneshwar Room No. 13, 2nd floor, Deendayal Bhavan, Ashok Nagar , Unit-II, Bhubaneswar, Dist-Khurdha, (Orissa) - Pin -751009 21AAECC7904J1ZU
Punjab Ludhiana SCO 146, 1st Floor, Feroz Gandhi Market, Opp. Ludhiana Stock Exchange, Ludhiana – 141001 03AAECC7904J1ZS
Haryana Gurgaon NM-28, 2nd Floor, Old DLF, Sector -14, Gurgaon, Haryana-122001 06AAECC7904J1ZM

Corona Kavach Policy, ManipalCigna also known as Covid standard health insurance policy is developed by IRDAI and made available by ManipalCigna Health Insurance Company. It is designed to cover COVID related hospitalization/home care treatment expenses. The policy also provides coverage towards Pre and Post hospitalization, Road ambulance, AYUSH treatment with an option of Hospital daily cash.

You can contact our sales advisor at any of our branches (list available on website www.manipalcigna.com) or can call our Toll free customer care number 1800-102-4462 for details.

The minimum entry age is 1 day for children and 18 years for adults. Maximum entry age limit for adults is 65 years. Dependent Children will be covered up to 25 years in a floater policy.

 Policy can be bought on an Individual basis as well as on family floater basis.

Individual plan can be bought for self, lawfully wedded spouse, dependent children, parents, parent in laws.

A family floater plan can cover self, lawfully wedded spouse, dependent children up to the age of 25 years, parents, parent in laws. A floater cover can cover a maximum of 2 adults and 3 dependent children under a single policy.

No PPMC will be required for this policy.

5% discount in premium shall be provided to health care workers.

Health care workers include - Doctors, AYUSH practitioners, Physiotherapists, Nurses and Midwives, Pharmacists, Ward boys and orderlies, Lab Assistants, Lab technicians, Dentists, Hospital employees, Diagnostic center employees, Pharmacy employees, ASHA, health workers and Aanganwadi workers.

This policy is available for 3 ½ months (105 days), 6 ½ months (195 days) and 9 ½ months (285 days).

Following are the coverages available under the policy

  1. Covid Hospitalization Cover
  2. Home Care Treatment Expenses
  3. Ambulance Cover
  4. AYUSH Treatment
  5. Pre Hospitalization
  6. Post Hospitalization
  7. Hospital Daily Cash (optional)

Home Care Treatment means treatment availed by the Insured Person at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre, which in normal course would require care and treatment at a hospital but is actually taken at home provided that:

a. The Medical practitioner advices the Insured person to undergo treatment at home.

b. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the home care treatment.

c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.

Coverage available maximum up to 14 days per incident, including pre-hospitalization expenses for a period of 15 days and post hospitalization expenses for a period of 30 days.

In case of Covid hospitalization, patient can stay at the hospital until the recovery. There is no such restriction on number of days. Coverage available maximum up to the Sum Insured and shall be a part of the overall sum insured in the policy.

Following is a partial list of the policy exclusions. Please refer to the policy terms and conditions available on our website www.manipalcigna.com (download section) for the complete list of exclusions:

a. Admission primarily for investigation & evaluation
b. Admission primarily for rest Cure, rehabilitation and respite care
c. Any claim in relation to Covid where it has been diagnosed prior to Policy Start Date.
d. Day Care treatment and OPD treatment

Any expenses incurred on OPD basis will not be covered under this policy. Only medically necessary treatment certified by registered medical practitioner in pre-hospitalization and post-hospitalization period will be covered.

Hospital Daily Cash is available under optional cover. 0.5% of sum insured per day for each 24 hours of continuous hospitalization is available provided company has accepted in-patient hospitalization claim.

Renewal is not available in this policy.

All medical treatment for the purpose of this insurance will have to be taken in India only.

In general, one has to submit a filled and signed proposal form along with a payment instrument to apply for health cover under this policy.

In case, any additional documents are required, we will contact you.

This policy constitutes the complete contract of insurance. This Policy cannot be modified by anyone (including an insurance agent or broker) except the company. Any change made by the company shall be evidenced by a written endorsement signed and stamped.

The policyholder may be changed during the Policy Period only in case of his/her demise or him/her moving out of India. The new policyholder must be the legal heir/immediate family member. Such change would be subject to acceptance by the company and payment of premium (if any).

Base cover under Corona Kavach Policy is offered on indemnity basis while optional cover of Hospital daily cash is available on benefit basis.

Yes, medical expenses incurred on hospitalization for COVID-19 treatment are covered on Positive diagnosis of Covid in a government authorized diagnostic center including the expenses incurred on treatment of any comorbidity.

The claim will be honored if you are hospitalized, subject to medical reports being positive for COVID-19 from a government authorized diagnostic center.

Yes. expenses incurred for road ambulance will be covered up to Rs. 2000 per hospitalization availed only in relation to Covid.

Only home care treatments on the advice of a registered medical practitioner and at a facility designated by the Government as hospital for the treatment of Covid positive insured person is covered under the policy.

Coverage includes:

i. Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home.

ii. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses.

iii. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor / surgeon or to the hospital

iv. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, ventilator charges, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, PPE Kit, gloves, mask and such similar other expenses.

v. Road Ambulance subject to a maximum of Rs.2000/- per hospitalization

The medical expenses incurred for COVID hospitalization under AYUSH system of medicine will be covered in AYUSH hospital provided. Treatment taken in

a. Central or State Government AYUSH Hospital or

b. Teaching hospital attached to AYUSH College recognized by the Central Government/Central Council of Indian Medicine/Central Council for Homeopathy; or

c. AYUSH Hospital with in-patient healthcare facility of any recognized system of medicine, registered with the local authorities.

For details refer policy terms and condition available on our website www.manipalcigna.com (download section)

There is only single premium payment mode available under this policy.

One can claim under Cashless/Reimbursement basis under this policy.

Notification of claim with full particulars shall be sent to the Company/TPA.

i. In case of emergency hospitalization/cashless home care treatment within 24 hours.

ii. in case of a planned Hospitalization 48 hours prior to admit in Hospital.

For details refer policy terms and condition available on our website www.manipalcigna.com (download section)

The list of documents to be submitted includes:

i. Duly filled and signed Claim Form

ii. Copy of Insured Person’s passport, if available (All pages)

iii. Photo Identity proof of the patient (in case of no passport)

iv. Medical practitioner’s prescription advising admission

v. Original bills with itemized break-up

vi. Payment receipts

vii. Discharge summary including complete medical history

viii. Investigation reports from Authorized diagnostic centre for COVID

ix. OT notes or Surgeon’s certificate giving details (if operated)

x. Sticker/Invoice of the Implants, wherever applicable.

xi. NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque

xii.  KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines

xiii. Legal heir/succession certificate, wherever applicable

xiv. Any other relevant document required by Company/TPA for assessment of the claim.

The list of documents to be submitted includes:

i. Duly filled and signed Claim Form

ii. Copy of Insured Person’s passport, if available (All pages)

iii. Photo Identity proof of the patient (in case of no passport)

iv. Medical practitioners’ prescription advising hospitalization

v. A certificate from medical practitioner advising treatment at home or consent from the insured person on availing home care benefit.

vi. Discharge Certificate from medical practitioner with date of start and completion of home care treatment.

vii. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained.

In the case of demise of the insured person coverage of policy automatically ends. However, in this policy cover will continue for the remaining Insured persons till the end of policy period. This is called as automatic change in coverage.

Pre hospitalization:  Medical expenses incurred 15 days prior to the date of hospitalization/home care treatment.
Post hospitalization:  Medical expenses incurred 30 days from the date of discharge from the hospital/completion of home care treatment.

Above treatment will get covered provided inpatient hospitalization/home care treatment claim is admissible by the Insurance Company.

One can avail tax benefit under sec.80 D as per IT Act. This section is subject to revision in tax laws.

If premiums are paid in cash no tax benefits are allowed under section 80D.

If you need to speak to us about the product, services or claims, contact our Customer Care Toll free 1800- 102- 4462 or you can write to us at customercare@manipalcigna.com for assistance.

The Sum Insured options available under this policy includes Rs. 50000, 1 lac, 1.5 lacs, 2 lacs, 2.5 lacs, 3 lacs, 3.5 lacs, 4 lacs, 4.5 lacs, 5 lacs.

Corona Rakshak Policy is developed by IRDAI and made available by ManipalCigna Health Insurance Company. It is designed to provide lump sum benefit equal to 100% of the Sum Insured on positive diagnosis of Covid, requiring hospitalisation for a minimum continuous period of 72 hours. The positive diagnosis of Covid shall be from a government authorised diagnostic centre.

A person can consider investing in corona-specific plan for fixed benefits. Such plan helps you to get additional coverage for Personal Protective Equipment (PPE) kits and other consumables required during the treatment of Covid-19, which your base policy may or may not cover. The fixed benefit payout also takes care of incidental expenses. However, for maximum value a comprehensive health insurance plan that protects against a wide range of illnesses including coronavirus, will be more suitable.

You can contact our sales advisor at any of our branches (list available on website www.manipalcigna.com) or can call our Toll free customer care number 1800-102-4462 for details.

Policy can be availed by persons between the age of 18 years and 65 years (inclusive of both ages). Proposer with higher age can obtain policy for adult members of the family, without covering self.

The Policy can be availed on Individual basis only.

Policy can be availed for Self and the following family members

i. legally wedded spouse;

ii. Son & Daughter (Min 18 years and max 65 years);

ii. Parents and Parents-in-law.

No pre-insurance medical examination test is required, irrespective of the sum insured and age of the insured.

No, there is no discount applicable under this policy.

The Sum Insured options available under this policy are Rs. 50000, 1 lac, 1.5 lacs, 2 lacs and 2.5 lacs.

This policy is available for 3 ½ months (105 days), 6 ½ months (195 days) and 9 ½ months (285 days).

The policy provides individual coverage which pays lump-sum amount upon testing positive and requiring hospitalization.

There is no such restriction on number of days. Coverage available is maximum up to the Sum Insured.

We will not pay any claims arising out of or attributable to any of the following:

▪ Investigation & Evaluation

i. Expenses related to any admission primarily for diagnostics and evaluation purposes.
ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment

▪ Any diagnosis which is not related and not incidental to COVID is not covered in this Policy
▪ Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized under this Policy
▪ Any claim with respect to COVID manifested prior to commencement date of this policy or during the waiting period.
▪ Cover under this Policy shall cease if the Insured Person travels to any country placed under travel restriction by the Government of India.

The policy provides lump sum benefit equal to 100% of the Sum Insured on positive diagnosis of Covid, requiring hospitalisation for a minimum continuous period of 72 hours. The positive diagnosis of Covid shall be from a government authorised diagnostic centre. On lump sum payment, the coverage amount can be used for medical and non-medical expenses as per need.

Renewal is not available in this policy.

All claims under the policy shall be payable in India and in Indian currency only. Cover under this Policy shall cease if the Insured Person travels to any country placed under travel restriction by the Government of India.

In general, one has to submit a filled and signed proposal form along with a payment instrument to apply for health cover under this policy.

In case, any additional documents are required, we will contact you.

This policy constitutes the complete contract of insurance. This Policy cannot be modified by anyone (including an insurance agent or broker) except the company. Any change made by the company shall be evidenced by a written endorsement signed and stamped.

The policyholder may be changed during the Policy Period only in case of his/her demise or him/her moving out of India. The new policyholder must be the legal heir/immediate family member. Such change would be subject to acceptance by the company and payment of premium (if any).

Yes, the policy provides lump sum benefit equal to 100% of the Sum Insured on positive diagnosis of Covid, requiring hospitalization for a minimum continuous period of 72 hours. The positive diagnosis of Covid shall be from a government authorised diagnostic centre.

Hospital means any institution established for in-patient care and day care treatment of disease/ injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under Schedule of Section 56(1) of the said Act, OR complies with minimum criteria as specified in Policy Terms and Conditions.

For the purpose of this policy any other set-up designated by the Government as hospital for the treatment of Covid shall also be considered as hospital.

There is only single premium payment mode available under this policy.

Upon the happening of the covered event, which may give rise to a claim under this policy, notice with full particulars shall be sent to the Company within 15 days from the date of occurrence of the event / diagnosis of COVID.

The insured person may submit the necessary documents to TPA (if applicable)/Company within the prescribed time limit of 30 days of date of discharge from hospital following positive diagnosis for Covid.

The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.

For complete details on claim process refer Policy Terms and Conditions available on our website (download section).

The claim is to be supported with the following documents and submitted within the prescribed time limit of 30 days from the date of discharge from hospital following positive diagnosis for COVID.

i. Duly filled and signed Claim Form
ii. Copy of Insured Person’s passport, if available (All pages)
iii. Photo Identity proof of the patient (if insured person does not own a passport) Medical practitioner’s prescription advising admission
iv. Medical practitioner’s prescription advising admission
v. Discharge summary including complete medical history of the patient along with other details.
vi. Investigation reports including Insured Person’s Test Reports from Authorized diagnostic centre for COVID.
vii. NEFT Details (to enable direct credit of claim amount in bank account)  and cancelled cheque
viii. KYC (Identity proof with Address) of the proposer, where  claim liability is above Rs 1 Lakh as per AML Guidelines
ix. Legal heir/succession certificate, wherever applicable.
x. Any other relevant document required by Company/TPA for assessment of the claim.

One can avail tax benefit under sec.80 D as per IT Act. This section is subject to revision in tax laws.

If premiums are paid in cash no tax benefits are allowed under section 80D.

If you need to speak to us about the product, services or claims, contact our Customer Care Toll free 1800- 102- 4462 or you can write to us at customercare@manipalcigna.com for assistance.

  • Click on ‘Buy Now’ tab on the home page and update your details to get the quote in ‘Quick Quote’
  • You can also buy the policy by visiting the ManipalCigna branch or call our customer care at 1800-102-4462, if calling from outside India, please dial +91 22 4985 410.

Click on ‘Plans’ tab on the home page and the drop down will give you the list of all our plans. You can select a plan to check the specific benefits of the plan.

You can buy a ManipalCigna Health Insurance plan for minimum 1 year or maximum 3 years.

The minimum entry age to get the ManipalCigna policy is 18 years. There is no maximum age limit.

Medical examination is not mandatory before buying a policy. However, depending on Age and Medical health of the insured, the medical examination might be requested.

  • ProHealth Group Insurance Policy covers a defined group of people, for example employees of an organization, members of a society or professional association or an affinity group.
  • The plan has been designed to provide medical coverage to members of the group in the event of hospitalization due to illness or injury.
  • This plan offers a comprehensive protection with base covers and a range of multiple options to choose as per the need of the group.
  • You will need to register for the first time. To Register -
  • Click on ‘My Account’ tab on the home page.
  • On the next page again click on the ‘My Account’ tab.
  • In the drop down, please click on ‘Register’ and enter the Policy number, Email ID and DOB of the proposer and click on ‘Register’
  • Click on ‘Forgot Password’ and you will need to update your registered Email Id and DOB of the proposer and click on ‘Email new password’ receive the new password.
  • You can login using the new password and change it.

All you need to know about your policy is easily available online. You can easily modify or request to modify your personal and policy related details. You can access your document locker provides convenience and easy access to important policy related documents e.g.  Premium receipts. Policy kit, Health cards etc.

We recommend making the premium payment before the policy end date to enjoy the policy benefits. In case of unavoidable circumstances, the provision of 30 days grace period is available to pay the premium, however, policy benefits ceases during this period. 

For insured that have completed 18 years of age can avail a comprehensive health check-up with ManipalCigna network provider once every 3rd Policy year for Protect/Accumulate Plan and at each renewal for Plus, Preferred and Premier Plan. Details of the medical tests are available in the policy terms and condition.                 

To fix an appointment login to your account and select a convenient date / time. Alternatively, you can  call our toll-free number 1800-102-4462 to schedule a health check-up. On receipt of your request you will receive a call to confirm your appointment at your nearest diagnostic centre.

ProActiv Living is a unique program that is designed to encourage and reward policyholders to be physically active. Professional assistance is provided for lifestyle management along with healthy reward points that can be earned on completion of Health Risk Assessment and Targeted Risk Assessment. These health reward points translate into lower health insurance premiums or increased benefits upto 10% of the premium amount.

Login to ‘My account’ by visiting https://www.customer.manipalcigna.com/user/login
to download the soft copy of policy document and health card.

Alternatively, you can use our interactive voice response service through our toll-free number 1800-102-4462

You can track the status of your welcome kit, by visiting (https://www.customer.manipalcigna.com/user/login) Login to My account and select the option  ‘track document’ for policy dispatch details. You can also track on courier website with help of the courier details.

To download the terms and conditions of the policy, you can visit our website https://www.manipalcigna.com/downloads/products

A free look period of 15 days from the date of receipt of the policy is available to the policyholder to review the terms and conditions of the policy. The policyholder may seek cancellation of the policy during this period and shall get a refund of premium paid after adjusting the cost of medical check-up expenses, service tax etc. incurred on the policy, if any. Free look cancellation is not applicable at the time of renewal.

  • A short –scale cancellation is when a policyholder cancels an insurance policy before the expiration date. Short scale cancellations do not entitle policyholders to a refund proportionate to the period of coverage left in the policy term.
  • Please follow the link to download the policy terms and condition.                                                                                https://www.manipalcigna.com/downloads/products

Through our toll-free number 1800-102-4462, if calling from outside India, please dial +91 22 4985 410. 

But if you still have any questions, do not hesitate to send an email at customercare@manipalcigna.com and for policy alterations write to us at mychangerequest@manipalcigna.com

For list of our branches visit https://www.manipalcigna.com/contact-us

You can get the list on our website (https://www.manipalcigna.com/home#locator), please select a nearest hospital in your city/state.

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
• Smart choice of - 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.

Sub-limit covers the medical expenses towards specified treatment/illness /surgical procedure upto the limit specified in the policy schedule. In case of multiple Sub-limits applicable to a single claim then lower value of such Sub limit shall apply.

Yes, emergency medical expenses incurred by the insured person outside opted area will be

payable only if opted under the policy and pre-authorized. Coverage towards In-patient and/or

out-patient and No. of days covered will be specified in the policy schedule (if opted)

It covers cost associated with the palliative care or hospice care for In-patient, Day care or Out-patient treatment and accommodation, nursing care, prescribed medicines & physical and psychological care, following diagnosis that the insured person condition is terminal with life expectancy less than 6 months within the policy period.

It covers medically necessary out-patient expenses towards Physiotherapy, Acupuncture and Acupressure, Chiropody and Chiropractic, Osteopathy, Homeopathy, Ayurveda. Coverage details will be stated in the policy schedule.

Travel Vaccinations are medically required vaccinations taken by the Insured only before commencement of his/her travel.

Adult Vaccinations are medically required preventive vaccinations that can be taken anytime within the policy period.

Dental expenses cover is available on optional basis. It covers expenses incurred by the insured person towards:

Class 1 (Investigative & Preventative Treatment) , Class 2 (Basic Restorative, Periodontal Treatment), Class 3 (Major Restorative & Orthodontic Treatmen)

Note: Orthodontic treatment and associated costs shall be available for children below 18 years of Age only and a pre-authorization need to obtained from Us in writing for claims

Infertility Treatment cover (if opted) provides for medical expenses towards diagnostic infertility services undertaken by the insured person to determine cause of infertility, treatment and procedures. Coverage amount and limits on maximum treatment/attempts will be specified under the Policy Schedule/ Certificate of Insurance

The Policy provides Hospital Daily Cash option to take care of the incidental expenses during hospitalization period. Hospital Daily Cash benefit provides protection for you, your spouse as well as children (as covered). The benefit will be paid for each completed 24 hours of hospitalization.

Coverage amount and limits on maximum days covered will be specified under the policy Schedule / certificate of Insurance.

Policy provides option to select Disability Cover wherein lump sum benefit is paid if any accident

      results in disability of the insured person within 365 days from the date of accident. The type and

      nature of disability forms a part of policy terms & conditions.

Maximum limit on Out-of pocket means the over-all amount an insured will bear out of his pocket

      during the policy year against all admissible claim.

     Illustration:

Scenario of Insured opting for a Co-pay and Maximum Limit on Out of Pocket Expenses in the Policy

Amount (Rs)

Sum Insured

30000000

Co-pay

20%

Maximum limit on Out of Pocket Expenses (Rs)

60,000

 

Claim 1

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

40,000

Amount Paid by Insurer

1,60,000

Balance Sum Insured

2,98,40,000

Maximum limit on Out of Pocket Expenses Balance -

Rs 60,000 (Originally Opted) – Rs 40,000 paid by Customer Out of his Pocket

Rs 20,000

 

Claim 2

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

However Balance limit under Maximum Cap on Out of Pocket Expenses that Customer will bear is Rs 20,000. Hence Customer will bear only 20,000

20,000

Amount Paid by Insurer

1,80,000

Balance Sum Insured

2,96,60,000

Maximum limit on Out of Pocket Expenses Balance -

Rs 60,000 (Originally Opted) – Rs 40,000 paid by Customer Out of his Pocket in first claim + Rs 20,000 paid by Customer Out of his Pocket in second claim

0

 

Claim 3

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

However Balance limit under Maximum Cap on Out of Pocket Expenses that Customer will bear is Rs 0 after 2nd Claim. Hence Customer will bear nothing out of his pocket.

Once the Maximum Limit for Out of Pocket is reached – Customer will not bear anything out of this Pocket and Co-pay will not apply.

0

Amount Paid by Insurer

2,00,000

Balance Sum Insured

2,94,60,000

In Health insurance deductibles and copayments are methods of cost-sharing.

      Deductible can be applied on each and every claim or aggregate of all claims made by the insured
      person in that Policy Year. Whether deductible opted is on per claim /event/ visit/ session/ person/
      family basis will be stated in policy schedule/ Certificate of Insurance.

      Co-pay is a fixed percentage that is to be borne by the insured person for each and every claim, 
      remaining payable amount will be borne by Insurance company. Whether Co- Payment opted per 
      claim/per event/per visit/per session basis will be stated in Policy schedule/ Certificate of    
      Insurance.
      Deductible and Co-pay, both can be applied in the same single plan (if both are opted).
 

A Corporate can purchase this policy for their Employees and Dependents, or groups/ associations with commonality of purpose can purchase this policy for their members and dependents. Affinity groups would include Co-operative Society, NGO, Bank/Mutual Fund customer group, holders of the same credit card and members of the same social or cultural association and so on.

Yes, pre-existing diseases will be covered from day 1 unless waiting period if any is specified under the Policy Schedule/ Certificate of Insurance.

The Policy is issued in the name of the Company / Employer / Affinity Group, so the Company/Affinity Group is therefore the owner of the Policy and is known as the Policy Holder. The Policy then states that all benefits are paid to the Employees/Group members, who are therefore the Insured Persons.

ManipalCigna Global Health Group Policy offers below area of cover:

South Asia, Asian Middle East, African, Asia Pacific including or excluding Hong Kong & Singapore, India, Europe, Canada, Latin America & Caribbean island countries.

Note : (For a specific group, the area of cover may be limited to any particular country or region Eg:- A Group can opt coverage for only Germany which is part of Europe).

Area of coverage opted in the policy will be detailed in the Policy Schedule/ Certificate of Insurance.

The policy is available on a Group platform for Employer – Employee and Non Employer – Employee/Affinity Group (for eg. Bank’s saving A/c holders, students of educational institutes, Club Members). The policy provides coverage to Employee’s Dependent Partner/Spouse, Dependent Children, and Parents.