FAQs on ManipalCigna Health Insurance Products

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ProHealth Select offers wide range of protection including Inpatient, Daycare, Pre and Post hospitalization benefits, Donor and Domiciliary cover. It provides Restoration of Sum Insured (SI) and Smart non- reducing Cumulative bonus as an inbuilt benefit.

Its Optional Cumulative Bonus Booster works on non-reducing basis and adds more to the policy every claim free year. You get unique choice of Re-assurance cover, Worldwide Emergency and Health Maintenance Benefit for OPD expenses.

You also have option to select Removal of Room Rent limit and Disease Specific Sub-limits. ManipalCigna offer Healthy Rewards as value added benefit associated with ProActiv Living Program.

All benefits are even offered for policies where Deductible or Voluntary co-pay has been opted.

Basic Covers

Value Added Covers

Optional Covers

Add on Cover

. In patient Hospitalization   cover

.Cumulative Bonus

. Deductible#

.Critical Illness Add   on

. Pre/Post Hospitalization   cover

.Healthy Rewards

. Voluntary Co-pay#

 

.Day Care treatment

 

. Cumulative Bonus Booster

 

.Domiciliary treatment

 

.Removal of Room Rent      Limit

 

. Ambulance Cover

 

. Re-Assurance

 

.Donor expenses

 

. Health Check-Up*

 

.Restoration of SI

 

. Worldwide Emergency   Cover*

 

.AYUSH Cover

 

. Disease Specific Sub-limits*

 

 

 

. Health Maintenance   Benefit*

 

#Voluntary Co-pay and Deductible cannot be taken under a single plan.

*Available for Plan A

#Above is the list of covers under the product and are applicable as per availability in the plan chosen.

You can call us at 1-800-10-24462 or visit the Branch and we will help you with the purchase process.

Alterations like increase or decrease in Sum Insured, change in product will be allowed at the time of renewal of policy. However, any such change request will be subject to underwriting decision or requirement of medical tests on a case to case basis.

You can choose from Sum Insured available under ProHealth Select Plan A and Plan B.

Plan A - 0.5, 1, 2, 3, 4, 5, 7, 10, 15, 20, 25 Lacs

Plan B - 3, 4, 5, 7, 10, 15, 20, 25 Lacs

Yes, the Minimum age at entry is: 91 days (for Children); 18 years (for adult)

Maximum age at entry: 23 years (for children under a floater); Lifetime (for adults)

The age 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.

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.

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as in-patient treatment.

Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted under a day care or as an in-patient.

For in-patient hospitalization we will pay for the below medical expenses:

• Room rent for accommodation in Hospital room up to a max. of Rs.3000/- per day

• Intensive Care Unit charges for accommodation in ICU up to a max. of Rs. 7000/- per day

• Operation theatre charges,

• Fees of Medical Practitioner,

• Anaesthetist,

• Qualified Nurses,

• Specialists,

• Cost of diagnostic tests,

• Medicines,

• 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.

Day care treatment is any treatment or surgery which requires less than 24 hour’s hospitalization due to advancement in technology and undertaken in a hospital / nursing home / Day care center as recommended by a medical practitioner. It is necessary for you to occupy a hospital bed either for some hours or a day.

Outpatient healthcare are commonly relating to specialist consultation and diagnostic test.

Essentially outpatient treatment relates to diagnosis stage of treatment where you do not need to occupy a hospital bed.

Sub limit defines the capping of insurance amount which reduces the premium of the plan. Same is as per the plan selected by customer.

Sub-limits are applicable on room rent and other expenses as follows:

- Hospital room charges covered up to 2% of Sum Insured, maximum up to Rs.3000,

- ICU charges up to 4% of Sum Insured, maximum up to Rs.7000.

Yes, applicable room rent limit can be removed by opting for Removal of Room Rent Limit benefit.

On selecting the option, coverage will be available up to Single Private Room.

Any form of Allopathic treatment & non- allopathic treatment such as AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy) treatments are covered under the plan. However, facilities & services availed for pleasure or rejuvenation or as a preventive aid like beauty treatment, panchakarma, purification, detoxification and rejuvenation are excluded

Domiciliary Hospitalization benefits cover the expenses on employment of qualified nurses, who are employed on the recommendation of the attending Medical Practitioner and who holds a certificate of a recognized Nursing Council.

However, the treatment has to be under a qualified Medical Practitioner only.

In this scenario, the medical treatment and expenses will be covered under Day Care Procedure.

Pre-existing Disease includes any condition, ailment or injury or related condition(s) for which insured had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter.

ManipalCigna under this policy will cover In-patient Hospitalization Medical Expenses towards the donor for harvesting the organ up to the limits of the Sum Insured, 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.

We will not cover:

a. Any pre or post hospitalization expenses

b. Cost towards donor screening

c. Cost directly associated to the acquisition of the organ

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

Re-assurance benefit provides automatic extension of policy (base + optional covers) for a period of 2 years from the policy expiry date on diagnosis of any of the listed Critical Illnesses or suffering from Permanent Total Disability. This benefit will be available only once in the lifetime of the insured person. You may choose to take this cover with additional premium. If Critical Illness add-on cover is opted, rider premium will apply during the 2-year period.

Health Check-up is available as an optional cover in ProHealth Select Plan A. For insured who have completed 18 years of age can avail a comprehensive health check-up with Our Network Provider once every year as per the table below.

 

ProHealth Select

Sum Insured

Age
(in years)

List of tests

 (A)

0.5, 1, 2, 3 Lacs

From 18 years onwards

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT

 (A)

4 ,5, 7, 10 Lacs

18 to 40 years

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT

More than 40 Years

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT
For females only - TSH

 (A)

15, 20, 25 Lacs

18 to 40 years

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT

More than 40 years
(For males)

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT
, TMT

More than 40 years
(For females)

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT
, TSH, TMT

 

Full explanation of Tests is provided here:

Vitals – include (height/weight, BMI and BP, abdominal girth), FBS- Fasting Blood Sugar, CGT – Gamma-Glutamyl Transpeptidase, ECG-Electrocardiogram, CBC-ESR- Complete Blood Count-Erythrocyte Sedimentation Rate, SGPT- Test Serum Glutamic Pyruvate Transaminase, SGOT – Serum Glutamic Oxaloacetic Transaminase, TSH –Thyroid Stimulating Hormone, TMT – Tread Mill Test

It means an increase in the Sum Insured granted by the insurer for a claim free policy period without an increase in the premium. The percentage of increase in sum insured is 5% each year. The maximum accumulation is up to 100%

It allows an increase in the Sum Insured by a fixed percentage as per below option. Cumulative Bonus Booster if opted will be in place of Cumulative Bonus in the base policy.

Option A) 10% increase in Sum Insured, maximum up to 100%. This will not reduce in case of a claim under the Policy. or

Option B) 25% increase in Sum Insured, maximum up to 100%. This will not reduce in case of a claim under the Policy. or

Option C) 50% Increase in Sum Insured, maximum up to 100%. This will reduce by 50% in case of claim under the Policy, but in no case shall the Sum Insured be reduced. or

Option D) 10% increase in Sum Insured, maximum up to 200% irrespective of a claim under the Policy.

Healthy Rewards are points earned for each year of premium payment. Points can also be earned by enrolling and completing our array of wellness programs.

Details of reward points that can be accrued are listed below.

Program Type

Points to be earned as a percentage of
previous Policy Period Premium

Health Risk Assessment (HRA)

0.50%

Targeted Risk Assessment (TRA)

0.50%

Online Lifestyle Management Program (LMP)

1%

Chronic Condition Management Programs

1%

Participating in ManipalCigna Sponsored Programs and Worksite or Online/Offline Health Initiatives

2%

Health Check Up

0.5%

Reward Points, wherever offered under any specific Sponsored Program will be the same for all customers.

These earned points can be used to get a discount in the premium from 1st renewal or as equivalent value while availing services through any of Our Network Providers or redeemed for equivalent value of Health Maintenance Benefit within policy year (applicable if HMB opted in ProHealth Select Plan A).

Each specific program can be opted only once by a particular Insured Person.

There will be no limitation to the number of programs one can enrol in a single policy period.

This benefit provides for reimbursement of expenses incurred for availing emergency medical assistance due to illness, injury sustained or contracted outside the territorial limits of India.

The benefit amount will be limited to the sum insured available under ProHealth Select Plan A.

Expenses will be limited to in-patient and day care hospitalization only. All payments will be in Indian rupees on reimbursement basis and as per the Exchange rate published by RBI (Reserve Bank of India) on the date of payment to the hospital.

The premium rate calculated for the given policy is on an annual basis and cannot be bifurcated to monthly period.

Also the coverage is available for the term opted under the policy.

Accordingly, the refund of premium option is not available in this scenario.

Our ProHealth Select Plan A also provides optional benefit for worldwide emergency coverage outside of India.

Health Maintenance benefit is available as an optional cover in ProHealth Select Plan A. It covers all medical expenses incurred on out-patient basis.

We will cover costs incurred towards:

- Diagnostic tests, preventive tests, drugs, prosthetics, medical aids, prescribed by the specialist Medical Practitioner up to the limits specified in the Schedule.

- Towards Dental Treatments and Alternative Forms of Medicines wherever prescribed by a Medical Practitioner.

Deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. It’s a cost sharing mechanism that helps reducing the insurance premium.

One can opt a deductible of Rs. 1/2/3/4/5 lacs in ProHealth Select Plan A or B. ManipalCigna will cover all admissible medical expenses beyond the deductible amount.

Deductible amount will be applied on each policy year on the aggregate of all admissible claims in that policy year.

Example - Say, one opts for Plan A of Rs. 5 lacs with deductible of Rs. 2 lacs for 1 year period.

His first claim amounts to Rs. 1.5 lacs due to accident. He has to bear the medical expenses out of pocket or using any other health insurance as claim is within deductible limit. However, on submission of claim documents, Deductible amount will be reduced by the claim admissible amount (1.5 lacs). Remaining deductible applicable is Rs. 50,000. In the same year, he submits a claim for jaundice of Rs.1 lac. ManipalCigna will pay Rs. 50,000 out of 5 lacs after adjusting balance deductible of Rs. 50,000.

Yes, deductible can be removed at renewal. Continuity benefit will be available with fresh waiting period for the deductible amount that’s being removed from the expiring policy and on any additional sum insured in the renewal policy.

The disease-wise capping limits payment in case of pre-specified diseases. You can select Disease Specific Sub-limit on an optional basis under ProHealth Select A.
The capping of coverage amount reduces the premium of the plan.
Maximum payable per surgery or medical management cost per policy period

Sub-Limit (Amount in )

Ailments/ Surgeries / Medical Procedures

Option 1

Option 2

Option 3

1

Cataract (Per eye)

7,500

15,000

22,500

2

Surgeries for Non-malignant Tumors/Cysts/Nodule/Polyp/Benign Prostate Hypertrophy

15,000

30,000

45,000

3

Stone in Urinary/Biliary System

20,000

40,000

60,000

4

Hernia (per side)

12,500

25,000

37,500

5

Appendicitis

10,000

20,000

30,000

6

Hysterectomy

15,000

30,000

45,000

7

Any Joint Replacement

40,000

60,000

80,000

8

Piles/Fissures/Fistula

10,000

20,000

30,000

9

Medical Management or Surgeries related to Ischemic Heart Disease / Cardiac

40,000

60,000

80,000

10

Treatment for Injuries/Breakage of Bones

27,500

55,000

80,000

11

Cerebrovascular Medical Management/Surgery

25,000

50,000

75,000

12

Cancer/Oncology (Medical & Surgical)

40,000

60,000

80,000

13

Abscess/Ligament Tear

20,000

40,000

60,000

14

Treatment towards Kidney damage or renal failure

40,000

60,000

80,000

Under a health insurance policy co-payment works as a cost sharing mechanism where the policy holder/insured will bear an agreed specified percentage of each & every admissible claim amount.

In ProHealth Select Plan A one can opt for a 10% or 20% Voluntary co-pay. It will apply on each claim under the policy.

Under individual option each insured has separate Sum Insured.

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

If you wish to insure more than 2 adults or 3 children in a floater plan, you need to buy an additional policy.

A nominee can be anyone - spouse, children, and blood relatives.  A minor should not be declared as a nominee.

Medicals will be triggered on the basis of the age of the insured, the plan type and sum insured selected.

** For details of medical tests kindly contact Customer Support Team, Health Advisor or Branch

Service Desk.

The list of medical tests will be communicated by ManipalCigna Health Insurance Company to the customer at the time of processing the insurance application as they will depend upon the Age, Sum Insured Opted and any medical history declared at the time of application.

The medical tests can be conducted at the network of diagnostic designated centers identified by

ManipalCigna Health Insurance Company.

In a situation where medicals are required to process the insurance application, the medical reports will be available with ManipalCigna Health Insurance. The same will be shared with customer on request.

Yes, the medical reports will be shared on receiving a written request.

Discounts are available on portfolio mix basis gender and region. These discounts reflect improvement in risk on account of portfolio mix which are passed on to customer.

Yes, new born aged 91 days and upto 23 years will be covered in this policy.

Children between the age group of 3 months (91 days) to 5 years will be covered only if either of the parents is covered. Children from 6 years to 18 years will only be covered if one of the parents is the proposer.

Siblings between 91 days to 5 years will be covered if at least 1 adult sibling is covered under the policy. Grandchild between 91 days to 5 years will be covered if at least 1 adult grandparent is covered under the policy.

Children beyond 23 years if dependent on the parents can be covered under an individual policy.

**The baby should be born to an insured and legally wedded wife or a lawfully adopted child.

You can renew the policy by any of the below methods:

i. Making premium payments at our local branches

ii. Paying premium online using your net banking facility/Credit Card or Debit Card.

It means the disease mentioned under Permanent Exclusions will not be covered in the ProHealth

Select Policy.

We do not have any limitation on buying ProHealth Select. It's as per your choice if you wish to have additional coverage, however you must inform us regarding the existing policy at the time of buying the ProHealth Select Plan.

Yes, customer can choose one cover or more than one from all the optional covers available. However, Co-pay and Deductible cannot be opted together in a single policy.

Pre-existing diseases/illness/injury/conditions will be covered post 48 months of continuous cover depending upon the plan opted.

*Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations.

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 willful non-disclosure of facts might lead to problems in future including Policy cancellation without any refund of premium.

In a scenario where the actual expenses exceed the amount of cover, insured will be liable to pay the difference amount.

The benefits available under Basic Cover cannot be eliminated or reduced. However, customer can choose from the optional and add on covers. Accordingly, the premium will be calculated.

The pre-policy medical check-up cost will be paid by ManipalCigna Health Insurance Company.

In case we are unable to underwrite your proposal we will intimate the same to you and refund any premium that has been collected.

Your health insurance policy is in force across India. You can check whether there is any network hospital near to your residence as well the city of your current location.

Network hospitals are the hospitals that have tie up with the Third Party Administrator for cashless settlement of claims. If there is no network hospital, you can opt for reimbursement mode of settlement.

Apart from this we also provide coverage in case of Emergency situations anywhere in the world (if cover opted).

There is no defined limit of the period of stay in hospital.

However, the stay in hospital should be medically necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity.

• Must have been prescribed by a Medical Practitioner.

• Must confirm to the professional standards widely accepted in international medical practice or by the medical community in India.

If cashless facility is not authorised you can go for reimbursement mode of settlement.

Yes, all the policy holders are eligible for a health identification card and it will form a part of the policy kit.

An individual policy can be taken for self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunty, nephew & niece.

Family floater with maximum 2 adults and 3 children can be taken for self, spouse, dependent children or dependent parents.