FAQs on ManipalCigna Health Insurance Products

Frequently Asked Questions

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.

ManipalCigna Lifetime Health offers high sum insured coverage for medical expenses towards Inpatient hospitalization, Day Care Treatment, Pre and Post hospitalization expenses.

It also provides coverage towards Inpatient hospitalization for  AYUSH, Donor expenses, Robotic and Cyber Knife Surgery , Modern and Advance Treatment , HIV/AIDS & STD cover, Mental Care, Restoration of Sum Insured and much more as part of inbuilt features.

Policy also offers the Global Plan covering 27 major illnesses including cancer across the Globe

Policy also offers Optional packages like Health+, Women+ and Global+ to customize the coverages .

The optional packages and Critical illness add-on can be opted by paying additional premium.

You can buy this policy Online by visiting our website www.manipalcigna.com

Sum Insured1 (INR)

 

1For Covers 1 to 15:

50 Lacs/ 75 Lacs/ 100 Lacs/ 150 Lacs/ 200 Lacs/ 300 Lacs

Sum Insured2 (INR)

 

2For Covers 16 to 25 in Global Plan

50 Lacs/ 75 Lacs/ 100 Lacs/ 150 Lacs/ 200 Lacs/ 300 Lacs

Minimum age at entry is: 91 days (for Children); 18 years (for Adult)

Maximum age at entry: 25 years (for children under a floater); 65 (for Adults)

The age of eligibility of the insured for taking the policy is the Entry Age. Age will mean Completed age as on last birthday.

No, there is no exit age in this policy, it can be renewed lifetime.

Yes. Premium paid under the Policy shall be eligible for income tax benefit under Sec 80 D of the Income Tax Act and any amendments thereon.

Under individual option each insured has separate Sum Insured.

Under floater option all members in the policy have a single sum insured.

Unlike other mediclaim products of ManipalCigna Health Insurance, where optional covers are available, the Lifetime Health Product offers optional packages.

Lifetime Health product has 2 Base plans i.e. India Plan and Global Plan along with optional packages to choose from.

Here, optional package would mean that if an Insured Person opts for an optional package i.e.  Health+ or Women+ along with India Plan, then, all the benefits specified in the package would be available for utilisation. There is no provision to choose individual benefits specified under Health+ or Women+ package. The entire package as a whole needs to be opted.

Similarly, an Insured Person has an option to choose Health+, Woment+ or Global+ optional package if he opts for the Global Plan.

In a multi – individual policy you can propose to buy policy for self, lawfully wedded spouse  (same or opposite gender), children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunt, nephew and niece. Maximum 8 insured can be covered under single policy.

In a floater plan you can cover self, lawfully wedded spouse (same or opposite gender), children up to the age of 25 years, parents and parent in laws. Children from 91 days to 18 years will only be covered if one of the parents is the proposer.

 A floater cover can cover a maximum of 2 adults and 3 children under a single policy. Combinations allowed under 2 Adults are: Self & Spouse or Father & Mother or Father-in-law & Mother-in-law.

For a Global Plan residency should be Indian at the time of purchase, at subsequent renewals as well as at the time of claims.

Residency definition - An individual will be considered to be resident in India, if he/she is in India for a period or periods amounting in all to 182 days or more, in the preceding 365 days.

Expats/ Foreigners will not be covered in Global plan.

Insured Person shall disclose to Us in writing if in case there is any change in residency status (if Global Plan is opted), any material change in the health condition at the time of seeking Renewal of this Policy, irrespective of any claim arising or made. The terms and condition of the existing policy will not be altered.

Hospitalization Expenses Covers hospital expenses, for admission longer than 24 hours, up to the full Sum Insured. It includes

       i) Reasonable and customary charges for Room Rent for accommodation in Hospital room up to   

          room category offered under India Plan & Global Cover.

      ii) Intensive Care Unit charges

      iii) Operation theatre charges

      iv)  Fees of Medical Practitioner/ Surgeon,

      v) Anaesthetist,

      vi) Qualified Nurses,

      vii) Specialists,

      viii) Cost of diagnostic tests,

      ix) Medicines,

      x) Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices

         recommended by the attending Medical Practitioner and that are used intra operatively during a

        Surgical Procedure.

     xi) Expenses towards artificial life maintenance.

We will cover the expenses towards artificial life maintenance, including life support machine use, even where such treatment will not result in recovery or restoration of the previous state of health under any circumstances unless in a vegetative state, as certified by the treating Medical Practitioner.

  

There is a limit on room rent for hospitalization expenses incurred within India

  • For Sum Insured1 up to INR 200 Lacs - Covered up to any room except suite or higher category.
  • For Sum Insured1 INR 300 Lacs – Covered up to any room including suite category. 

There is no capping on the room rent, if an Insured opts for hospitalization expenses for treatment of Major illnesses outside India.

If the insured/policyholder is admitted in a room category that is higher than the one allowed under the Policy, then policyholder shall bear the rateable proportion of the total Associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the difference between the room rent of the entitled room category to the room rent actually incurred.

 

Pre-hospitalization expenses are medical expenses incurred immediately before the insured is Hospitalized & Post-hospitalization expenses are medical expenses incurred Immediately after the insured is discharged from the hospital.

        Pre & Post hospitalization claim is admissible provided:      

            i.    Such expenses are incurred for the same condition for which the insured Person’s was

hospitalized.

                          ii.   And an in-patient hospitalization claim is admissible for that hospitalization.

Pre-hospitalization expenses are covered up to 60 days preceding the date of Hospitalization and covered up to full Sum Insured for medical expenses incurred within and outside India.

Post – hospitalization expenses are covered up to 180 days immediately after discharge from the hospital and covered up to full Sum Insured for medical expenses incurred within and outside India.

AYUSH covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy for an illness or injury that occurs during the policy year.

ManipalCigna under this policy will cover in-patient hospitalization medical expenses towards the donor for harvesting the organ provided that:

1. The organ donor is any person in accordance with the Transplantation of Human Organs Act 1994               (amended) and other applicable laws and rules.

2. The organ donated is for the use of the Insured Person who has been asked to undergo an organ transplant on Medical Advice.

3. We have admitted a claim under in-patient hospitalization.

       4. We will not cover any pre or post hospitalization expenses towards the donor,

            a. Cost towards donor screening

            b. Cost  associated to the acquisition of the organ

     c. Any other medical treatment or complication in respect of the donor, consequent to   harvesting.

  d. Stem cell donation whether or not it is Medically Necessary Treatment except for Bone Marrow  Transplant.

    e. Expenses related to organ transportation or preservation.

Benefit under this cover is payable maximum up to the Sum Insured1 and any claim under this section will reduce the Sum Insured1.

It means medical treatment for an illness/disease/injury which normally would require care an treatment at a hospital but is actually taken while confined at home because:

- The condition of the patient is such that he/she cannot be moved to a hospital, or

- Hospital bed was unavailable provided that the treatment of the Insured Person continues at least 3 days in which case the reasonable cost of any Medically Necessary treatment for the entire period shall be payable.

Claims for pre-hospitalization and post-hospitalization expenses will be payable up to 60 days and 180 days respectively.

Benefit under this cover is payable maximum up to 10% of the Sum Insured1 opted and any claim under this section will reduce the Sum Insured.

If the Insured Person is of Age 18 years or above at the start of the policy, then he/she may avail a comprehensive health check-up at Our Network. Health Check Ups will be arranged by Us and conducted at Our Network. This benefit will be available once a Policy Year starting from the first Policy Year.

Health Check Up grid is defined basis Sum Insured opted, Age of the Insured and Gender.

In case of Gender selected as “Others”, insured has a choice if he/she would like to avail Health Check test offered against Male or Female.

Original copies of all reports will be shared with the policyholder. Coverage under this value added cover will not be available on reimbursement basis and any claim under this section will not reduce the Sum Insured under India Plan and Global Plan.

For complete details on list of Health Check-up test available, refer policy terms and condition or prospectus available on our website (Download Section).

Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer.

We will cover the Medical Expenses incurred towards Medically Necessary Robotic or Cyber knife  Surgery of the Insured Person subject to the Illness/ Injury being covered under Hospitalization Expenses  certified by an authorised Medical Practitioner.

Benefit under this cover is payable maximum up to the Sum Insured1 opted and any claim under this section will reduce the Sum Insured.

Modern and Advanced Treatment methods will be covered when conducted under In-patient hospitalization or as a Day Care Treatment.

  Below is the list of modern and advanced treatment covered under this Product

Uterine Artery Embolization and HIFU

Balloon Sinuplasty

Deep Brain stimulation

Oral chemotherapy

Immunotherapy – Monoclonal Antibody to be given as injection

Intra vitreal injections

Stereotactic radio surgeries

Bronchial Thermoplasty

Vaporisation of the prostate (Green laser treatment or holmium laser treatment)

IONM ( Intra Operative Neuro Monitoring)

Stem cell therapy – Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

Benefit under this cover is payable maximum up to the Sum Insured1 and any claim under this section will reduce the Sum Insured.

Yes,  We will cover medical expenses towards Medically Necessary Treatment taken during in-patient hospitalization, arising out of a condition caused by or associated to 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 variations thereof or sexually transmitted diseases (STD).

The cover is available subject to below conditions:

i. The purpose of Hospitalization is to avail Medically Necessary treatment.

ii. The necessity of the Hospitalization is certified by an authorised Medical Practitioner.

iii. For conditions other than STD, the Insured Person should be a declared HIV positive.

iv. We will pay for Pre-hospitalization and Post- hospitalization medical expenses maximum up to 60 days

and 180 days respectively. 

We will cover medical expenses incurred towards  medically necessary treatment taken during In-patient hospitalization, arising out of a condition caused by or associated to a Mental illness, Stress, Anxiety, Depression or a medical condition impacting mental health.

Benefit under this cover is payable maximum up to the Sum Insured1 provided treatment is prescribed by a medical practitioner and the purpose of hospitalization is to treat the insured person towards mental illness. Any claim under this section will reduce the Sum Insured accordingly.

Under this benefit the Sum Insured if insufficient due to claims paid or payable during the policy year, will be restored to 100% for any number of times in a policy year with below conditions:

a. The Sum Insured is insufficient as a result of previous claims in that Policy Year.

b. The Restored Sum Insured shall not be available for claims towards an Illness/ disease/ Injury (including its complications) for which a claim has been paid in the current Policy Year for the same Insured Person.

c. The Restored Sum Insured will be available only for indemnity claims made by Insured Persons in respect of future claims that become payable under Section II of the Policy and shall not apply to the first claim in the Policy Year.

d. Such restoration of Sum Insured will be available for any number of times, during a Policy Year to each insured in case of an individual Policy and can be utilised by Insured Persons who stand covered under the Policy before the Sum Insured was exhausted.

e. If the Policy is issued on a floater basis, the Restored Sum Insured will also be available on a floater basis.

f. If the Restored Sum Insured is not utilised in a Policy Year, it shall not be carried forward to subsequent Policy Year. For any single claim during a Policy Year the maximum Claim amount payable shall be up to the Sum Insured. 

g. During a Policy Year, the aggregate indemnity claims amount payable, subject to admissibility of the claim, shall not exceed the sum of:

i. The Sum Insured

ii. Restored Sum Insured

In case, the Policyholder who is also an Insured Person under the Policy suffers from Permanent Partial Disablement, Permanent Total Disablement or death due to an injury caused by an accident within 365 days from the date of the event or he/she is diagnosed with a Critical Illness, listed under this cover, We will pay the next Renewal Premium of the Policy, for a policy tenure of 1 year. The premium shall be paid towards existing Insured Persons covered under the same policy, with benefits same as the expiring Policy.

In case of any change in Policy benefits, complete premium will be paid by the Policyholder.

The cover is available subject to below conditions:

• If only one insured is covered under the Policy who is proposer, policy will not be renewed in case of death of the Policyholder.

• The Proposer is not added in the middle of the Policy Year.

• There is no change in covers, Sum Insured, benefit structure, limits and conditions applicable under the Policy, at the renewal.

• No new member is being added under the renewed Policy.

 In case of Multi Year Policy by default when the benefit triggers it will renewed only for 1 year.

 After the policy year in which premium waiver benefit is availed proposer has a choice to opt for a multi- Year Policy again.

   Once a claim has been accepted and paid under this Benefit, this cover will automatically terminate in respect of that Proposer. During Renewal if the Proposer of the policy changes then this benefit can again trigger if new Proposer Undergoes CI, PA, PTD during the policy. Claims under this section will not reduce the Sum Insured.

This optional package is available to all Insured Persons covered under India Plan and Global Plan. Selection of this package is allowed at Policy level only. If opted, benefits under the package will be available for each Insured Person on individual basis, for individual as well as family floater policies.

We will cover the reasonable and customary expenses towards air ambulance in India if an Insured person opts for Health+ optional package.

The benefit under this cover is payable maximum up to Rs. 10 Lacs once a policy year for each Insured Person within India only on medical emergency basis. Claim under this section will not reduce the Sum Insured1 or Sum Insured2.

If an Insured Person opts for a Global Plan, we will cover the Reasonable and Customary expenses incurred towards transportation of an Insured Person by a registered healthcare or Ambulance service provider to a Hospital for treatment of a Major Illness covered under the Policy, necessitating the Insured Person’s admission to the Hospital. The service is available outside India within the opted Area of Cover. Air Ambulance can be availed once in a Policy Year by each Insured Person.

We will cover the expense towards Non-Medical items, listed under list I, Annexure III of the Policy Wording available on our website (download section) and cost towards buying of medical devices, prescribed to the Insured Person by the treating Medical Practitioner, during or after hospitalization for a Medically Necessary Treatment. Benefit under this cover is payable maximum up to Rs. 2 Lacs and once in 3 Policy Years.

The cover is available subject to below conditions:

- Hospitalization claim is admissible under Section II.1 ’Hospitalization Expenses’ and the expenses on Non-medical items or Medical devices are related to the same Illness/ Injury.

- The need for Medical device is prescribed by an authorised Medical Practitioner during hospitalization or within 180 days of post-hospitalization period. Any purchase of the medical device should be done within 30 days of such recommendation.

Any claim under this section will not reduce the Sum Insured1 or Sum Insured2 and any balance amount, if not utilised will not be carried forward.

Medical devices would include.

1. Artificial limb

13. Traction splint

25. Orthopedic Supports and Braces

2. Cannula

14. Ventilator

26. Rollators

3. Catheter

15. Wheelchair

27. Urinary Bag Holders

4. Colostomy bag

16. Ankle Rehabilitation

28. Urinary Bags

5. CPAP machine

17. Back Support Belts

29. Prosthetic device

6. Feeding tube

18. Gel Heel Pads

30. Pulse oximeter

7. Glucose meter

19. Heel And Elbow Suspension

31. Insulin Aids

8. Heating pad

20. Hernia and Abdominal Support

32. Insulin Pen Needles

9. Hospital bed

21. Hot and Cold Therapy Wraps

33. Insulin Syringes

10. Infusion pump

22. Lancets And Lancing Devices

11. Nebulizer

23. Nebulizer Accessories

12. Oxygen concentrator

24. Nebulizers

Yes, We will cover the Medical Expenses incurred towards Medically Necessary Hospitalization of the Insured Person for Bariatric Surgery and its complications. This cover is available after a Waiting Period of 2 years from the inception of the ‘Health+’ with Us, with respect to the Insured Person. Benefit under this cover is payable maximum up to Rs. 5 Lacs and claim under this section will not reduce the Sum Insured.

If the Insured Person is hospitalised consecutively for a certain number of days or more and there is hospitalization claim admissible then we will pay a lump sum amount towards convalescence, provided the stay in the hospital is Medically Necessary. We offer convalescence benefit under Health+ & Global +.Under Health+ benefit is payable on consecutive hospitalization for 10 days or more, wherein a lump sum amount of Rs. 50,000 is paid. This amount is paid over and above base SI opted under India Plan. Under Global+ package this benefit is payable on 15 days or more consecutive hospitalization, wherein a lump sum amount of Rs. 10 Lacs is paid, provided the Hospitalization is towards treatment of a covered Major Illness and is availed outside India, in the opted Area of Cover. The benefit is payable only once towards each covered Major Illness, in the lifetime of the Insured Person. The amount is paid over and above SI opted under Global Cover.

If the Insured Person is hospitalised for a medically necessary treatment due to Major Illness or accident for each continuous and completed period of 24 hours of Hospitalization, we will pay lump sum amount as daily cash benefit as defined in your policy schedule. This benefit is available under Health+ and Global+ optional package.

For more details on the limits on Hospi Cash, kindly refer the policy terms and conditions.

This optional package is available to female of Age 12 years and above at the commencement of Policy with Us with respect to the Insured Person. Selection of this package is allowed at Policy level only. For cases where female child turns 12 years of Age after the commencement of the Policy, selection of ‘Women+’ shall be allowed at the first renewal immediately after this instance.If opted, benefits under the package will be available to each eligible female on individual basis, for Individual as well as family floater policies.

Benefits available under Women+ Package        

1. Breast Cancer Screening

4. Ovarian Cancer Screening

7. Psychiatric and Psychological Consultations

2. Cervical Cancer Screening

5. Osteoporosis  Screening

3. Cervical Cancer Vaccination

6. Gynecological Consultations

For more details refer policy schedule or terms & conditions.

No. Worldwide Emergency covers medical expenses incurred during the policy year for emergency treatments for an illness or injury sustained or contracted outside of India which cannot be postponed until the Insured Person has returned to India. The medical expenses payable shall be limited to Inpatient hospitalization and shall be made in India and in Indian Rupees on reimbursement basis.

Global benefits under Global Plan will be available towards treatment of major illness/es as opted for planned and emergency procedures. All claim will be admissible on cashless or reimbursement basis within the opted area of coverage.

It covers expenses towards evacuation of the insured person to the nearest facility capable of providing adequate care in case of emergency treatment caused by Major illness due to lack of adequate medical facilities available locally.. This medical facilities is available outside India within the opted Area of Cover Our medical assistance service provider may arrange for the transportation of the Insured Person by medically equipped specialty aircraft, commercial airline, train or Ambulance depending upon the medical needs and available transportation specific to each case.

We will also cover the Reasonable and Customary Charges incurred towards the repatriation of the Insured Person from outside India, within the opted Area of Cover, on an Emergency basis to:

        i) his/her residence in India; or

       ii)  Hospital near his residence, in India.

The cover is payable maximum up to the Sum Insured2 and any claim under this section will reduce the Sum Insured.

If an Insured Person travels outside India for treatment of a covered Major Illness, we will cover the cost of vaccine up to the Sum Insured opted under Global Cover. The benefit is available for vaccination/s mandatorily prescribed by the World Health Organization (WHO) for traveling to an intended destination, outside India, or while traveling back to India after availing treatment of a covered Major Illness.  

The benefit is available once in a policy year.  For the purpose of this benefit, vaccination shall be performed in India only. Any claim under this section will reduce the Sum Insured.

 One can opt for Area of Covers available under the Global Plan as per their requirement and premium will be charged accordingly. Option to select any one as Area of Cover (Outside India), applicable to Global covers is as below:

i.  Worldwide

ii. Worldwide excluding United States and Canada.

In the first year, after upgrade of the ‘Area of Cover’, if the treatment is availed in United States or Canada, for each claim arising due to a Pre-existing disease, a co-payment of 50% will be applicable. This condition will be applicable only for the first year following the change of AOC.

The Insured Person can choose to change his Area of Cover only at the time of renewal.

If the Insured Person undergoes medically necessary chemotherapy or radiotherapy as a Day Care Treatment without 24 hours of Hospitalization in India, then we will pay a cash benefit of Rs.2,500 for each sitting of Chemotherapy/Radiotherapy, maximum up to 12 sittings in a Policy Year if Insured Person opts for Health+ optional package.  Claims under this section will not reduce the Sum Insured.

Global Chemotherapy and Radiotherapy coverage is also available outside India, within the opted Area of Cover, if Global+ optional package is opted by the Insured Person. We will pay a cash benefit of Rs.25,000 for each sitting of maximum up to 12 sittings per person in a Policy Year when conducted in a Day Care Treatment (without Inpatient Hospitalization). Claims under this section will not reduce the Sum Insured.

If the Insured Person travels outside India, for the treatment of a covered Major Illness/es, We will pay a cash benefit, as per the opted Area of Cover, on account of travel expenses and associated costs, with respect of the Insured person. The benefit is available if the Insured Person opts for Global+ optional package.

Cash benefit based on Area of Cover (Outside India):

  1. Worldwide  – Rs. 5 Lacs
  2. Worldwide excluding USA and Canada – Rs. 3 Lacs

This benefit is available once in the lifetime of the Insured Person for each Major Illness covered under the Policy.

Claims under this section will not reduce the Sum Insured1 or Sum Insured2

At the time of buying a health insurance you need to provide details of the illnesses you have suffered during your lifetime. The insurer refers such cases to their medical panel to differentiate between pre-existing and newly contracted illnesses.

Note: Insurance is a contract based on good faith and any wilful non-disclosure of facts might lead to problems in Future including Policy cancellation without any refund of premium.

Pre-existing diseases/illness/injury/conditions will be covered post 24 months of continuous cover in Lifetime Health product.

24 months waiting period is applicable on specific ailments. Below list is only indicative and not exhaustive, for more details refer policy terms & conditions.

i.     Cataract,

ii.     Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus unless necessitated by malignancy myomectomy for fibroids,

iii.    Knee Replacement Surgery (other than caused by an Accident), Non-infectious Arthritis, Gout, Rheumatism, Oestoarthritis and Osteoposrosis, Joint Replacement Surgery (other than caused by Accident), Prolapse of Intervertibral discs(other than caused by Accident), all Vertibrae Disorders, including but not limited to Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal,

iv.   Varicose Veins and Varicose Ulcers,

v.    Stones in the urinary uro-genital and biliary systems including calculus diseases etc..

 A higher cover does not indicate or entitle the insured to preferential treatment in hospitalization and claim.

      Irrespective of the cover chosen you would get high quality service and treatment at our network hospitals

After completion of eight continuous years under this policy no look back would be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of eight continuous years would be applicable from date of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub limits, co-payments as per the policy.

a. Long Term policy discount - Long term discount, on the premium, of 7.5% for selecting a   2 year policy term and 10% for selecting 3 year policy term. The discount is available only with ‘Single’ premium payment mode.

b. Worksite Marketing Discount - A discount of 10% will be available on polices which are sourced through worksite marketing channel.

c. Family Discount – A discount of 15% on the premium for covering 2 or more members under the same Policy under the individual policy option.

d. Online Renewal discount: A discount of 3% on the premium from next renewal, if the premium is received through NACH or standing instruction (where payment is made either by direct debit of bank account or credit card).

e. Loyalty discount – A discount of 5% on the premium from 4th Policy Year to 7th Policy Year and discount of 10%   from 8th Policy Year.

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. (Refer policy terms & condition for more details)    

Instalment option is available only for 1 year policy term.

In case of fresh policy where monthly payment frequency selected we would recover 3 months premium mandatory upfront followed by monthly frequency from 4th month onwards.

Alterations like increase/ decrease in Sum Insured or Change in Plan, addition/deletion of members, optional packages, payment frequency will be allowed at the time of Renewal of the Policy. This is subject to underwriting decision or requirement of medical tests on a case to case basis.

For more details, please refer the policy terms and conditions.

The insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable.

On cancellation of policy, premium will be refunded as per grid below only if no claim has been made under the policy or no benefits availed. The Insured may cancel this Policy by giving 15 days written notice, and in such an event, the Company shall refund premium on short term rates for the unexpired Policy Period as per the rates detailed below.

          

 

Refund Grid as % of Premium

Policy Cancelation Within

Policy Year-1

Policy Year-2

Policy Year-3

0-30 Days

85.00%

87.50%

89.00%

31-90 Days

75.00%

80.00%

82.50%

91-181 Days

50.00%

70.00%

75.00%

182-272 Days

30.00%

60.00%

70.00%

273-365 Days

0.00%

50.00%

60.00%

366-456 Days

NIL

 

 

 

 

 

 

 

35.00%

55.00%

457-547 Days

25.00%

45.00%

548-638 Days

15.00%

40.00%

639-730 Days

0.00%

30.00%

731-821 Days

NIL

 

 

 

25.00%

822-912 Days

15.00%

913-1003 Days

5.00%

1004 and more Days

0.00%

        

The above grid is applicable to policies issued with Premium Payment mode ‘Single’ or ‘Yearly (with Policy Tenure 1 Year)’. For ‘Yearly’ premium payment mode with Policy Tenure 2/3 years, premium shall be refunded basis above grid for ‘Policy Year- 1’.

No refund will be processed for cancellation of policies with Premium Payment Mode as Half-yearly, Quarterly or Monthly.

The Company may cancel the policy at any time on grounds of misrepresentation, non- disclosure of material facts, fraud by the insured person by giving 15 days written notice. There would be no refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud.

We may require you to undergo a medical check-up based on your age, gender, Sum Insured & coverage opted.

If you need to speak to us about your treatment plan, contact our customer care no.

1800- 102- 4462 can write to us at customercare@manipalcigna.com  for assistance.

No. The Health card is purely a means of identifying you. It has no payment capabilities.

 Your ManipalCigna Health Card should be used when accessing treatment within network providers.

The policy kit is sent to the registered email address in our records. In a rare scenario of not receiving the same or enquiry on any change request placed, kindly call us at our Toll Free (India): 1800- 102- 4462 or write to us at customercare@manipalcigna.com  for assistance

You will receive an update on status of claim through SMS and emails on the registered contact details with us. Hence it is important that your valid contact details are updated with us at all times. In case of cashless claims, we will issue the authorization letter to the hospital through fax or email.

The Company at its sole discretion, reserves the right to modify, add or restrict any network hospital for cashless services available under the policy. Before availing the cashless service the policy/holder insured person is required to check the applicable list of network hospitals. Please contact our Customer Care no. 1800- 102- 4462 or you can write to us at customercare@manipalcigna.com for assistance (in case of claims with in India).

For queries related to claims and coverage of treatment outside of India, please refer to contact details stated in the Certificate of Insurance or Health Card issued.

If for any reason, such as an emergency, you can't call us before getting treatment, you'll need to pay for your treatment yourself and send your invoice and claim form to us. We'll reimburse you, less any deductibles / Co-payment (if applicable).

There is no cumulative bonus or no claim bonus in ManipalCigna Lifetime Health Policy.

Nomination is a right conferred on the insurance holder to appoint a person to receive the policy

monies in the event of his or her death. Nomination is required for valid discharge of claim. The same shall be applicable in line with guidelines issued by the IRDAI.

In case nominee declared is minor (less then age 18) then appointee details needs to be provided.

A Minor should not be declared as Appointee.

Exclusion are situation or conditions where in ManipalCigna is not liable to pay the benefit to the  Insured person in the event of claim. List of exclusion forms a part of Policy Terms & condition.

Premium will be calculated based on the Plan, Deductible, Sum Insured opted, Policy Tenure, Age, Policy type, Optional  Cover, Premium Payment mode, opted Area of Cover  and Add on Benefits. All Premiums are age based and will vary as per the change in age.

For premium calculation of floater policies, Age of eldest member would be considered.

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

 If your current Health Insurance policy’s Base Sum Insured (excluding the Cumulative Bonus) is equal or above Rs. 10 lacs then we will give you the continuity benefit on entire Sum Insured that you will opt while buying the policy.

If the Base Sum Insured is less than Rs.10 lacs, continuity benefit will be offered up to the existing policy Sum Insured.

While buying the policy you will need to select “Yes” for the question” Would you like to subscribe to important alert on WhatsApp?” in the application form.

Yes, one can buy ManipalCigna Critical Illness Add On cover along with Lifetime Health product. The Add On cover will be available on benefit basis by paying appropriate additional premium. This Add-on Cover will be available for all Insured Persons between 18 to 65 years.

We will provide a lump-sum benefit amount equivalent to the Critical Illness Sum Insured in the first diagnosis of the covered critical illness.

A waiting period of 90 days from the date of issuance of first policy and survival period of 30 days following the diagnosis of critical illness shall apply.

Note: For list of 11 covered critical illnesses refer CI add-on prospectus.

The Critical Illness Rider Sum Insured available shall be equal to Sum Insured.

Yes. If a customer opts for Global Plan, customer has the option to choose ‘Cancer Treatment’ or ‘ All Major Illnesses’  for treatment that will be covered outside India, as per the opted Area of Cover.  

If Cancer Treatment is opted under a Policy, all claims under covers specified under section II.16 to II.25 will be limited to the ‘Cancer Treatment’ only.

An Insured Person may avail tele-consultations with our Medical Practitioner(s) through our network. These consultations would be available through tele/chat mode.

This is an assistance service provided hence any claim under this section will not reduce the Insured1 or Sum Insured2

If the Insured Person is hospitalised for a Medically Necessary treatment of an Illness/ Injury, covered under the Policy, We will offer assistance and support to You through Our concierge services.

For the purpose of this benefit, concierge services may include personal Hospital visit/s by Our representative, assistance in claim documentation and collection of documents at discharge, for speedy claim settlement.

This benefit is only a value added service provided by Us and if availed, will not reduce the Sum Insured1 or Sum Insured The benefit is available once in a Policy year for each Insured Person.

These services shall be available only on pre-intimation of a planned Hospitalization and intimation of an Emergency Hospitalization as per the process defined in policy terms and conditions.

For the complete list of locations, where the service is available, You may contact Our customer care services at 1800- 102- 4462 or write to us at customercare@manipalcigna.com or visit Our website.

 Grace Period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.

If the insured person has opted for instalment premium payment option i.e. Half Yearly, Quarterly or  Monthly, a grace period of 15 days for Monthly mode and 30 days for Half-Yearly & Quarterly, mode would be given to pay the instalment premium due for the Policy. During such grace period, coverage will not be available  from the instalment premium payment due date till the date of receipt of premium by the Company however continuity  benefit will be paid within the stipulated grace Period. No interest will be charged if the instalment  premium is not paid on due date however if premium  not received within the grace period of the policy, then policy will be terminated and all claims that fall beyond such instalment due date shall not be covered as part of the policy.

Note: We will not be liable to pay for any claim arising out of an Injury/ Accident/ Condition that occurred during the Grace Period.

Migration means, the right accorded to health insurance policyholders (including all members under family cover and members of group Health insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the same insurer.

Portability means the right accorded to an individual health insurance policyholder (including all members under family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer.