FAQs on ManipalCigna Health Insurance Products

Frequently Asked Questions

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.

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.

The policy is issued for a term of 1 year. Only for credit linked policy, term can be up to 5 years.

Yes, foreign national working in India and earning in Indian currency can be covered under this policy.

Yes, Non-resident Indian working in India and earning in Indian currency can be covered under this policy.

There is no cumulative bonus or no claim discount in Lifestyle Protection Group policy.

Minimum number of members required to issue a group policy is 7.

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. You can change your nomination any time before the date of policy termination. Nomination is required for valid discharge of claim.

The policy provides cover towards injuries due to personal accident and listed critical illnesses along with a range of options for groups.

Outpatient and physiotherapy expenses are not covered unless specifically selected as a part of optional covers and mentioned in the policy schedule/certificate of insurance.

Alternative treatment including chiropractic treatment is not covered.

Medical tests may be required subject to underwriting assessment depending on policy type, age and health status of the persons to be covered in a group.

 Yes, the policy allows Companies/Affinity group to tailor-make different benefit structures for Employees/Group members, which will result in different benefit categories being reflected on the policy schedule.

To purchase/renew the policy, please get in touch with us at the 1800-102-4462 or visit any of our branches. For more details log on to our website www.manipalcigna.com

Cover under the policy for any particular insured person shall automatically terminate on the earliest happening of the following events:

For Group Personal Accident:

  • On the death of such insured Person; or
  • The total aggregate sum payable of 100% sum insured has been paid; or
  • Upon such insured person ceasing to satisfy any of the eligibility requirements set out in the policy; or
  • Upon such insured person ceases to be employee/member of the group
  • Cover on the insured member automatically ceases once the master policy contract is terminated due to nonpayment of premiums or other causes specified in the policy contract.

For Group Critical Illness:

  • The total aggregate sum payable of 100% sum insured has been paid; or
  • Upon such insured person ceasing to satisfy any of the eligibility requirements set out in the policy; or
  • Upon such insured person ceases to be employee/member of the Group

Cover on the insured member automatically ceases once the master policy contract is terminated due to nonpayment of premiums or other causes specified in the policy contract.

 For any query or assistance, you can contact us with the details through:

Our Website: www.manipalcigna.com 

E-mail: servicesupport@manipalcigna.com 

Toll Free: 1800-102-4462

 If claims occurs during the grace period it will not be covered.

A medical practitioner is a person who holds a valid registration from the medical council of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government  and is thereby entitled to practice medicine within its jurisdiction, and is acting within the scope and jurisdiction of his license. It includes physician, specialist or surgeon etc.

Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured, however it reduces the premium payable by the insured to the insurer.

Common Carrier means transportation which is available as a public service and operated by an entity in the business of transporting goods or people for hire, as a public service. Example – bus, train, air plane, ship etc.

Tax benefit is applicable for Contributory policy (where insured member pays premium towards the policy) for Group Critical Illness plans only.

There will be no renewal discount for a claim free year under the policy.

For renewal 30 days grace period from policy expiry date is permissible, and policy will be considered as continuous for the purpose of waiting period.

For renewals after 30 days grace period, new proposal form needs to be submitted and same will be treated as fresh proposal.

Instalment (less than annual) premium policies may be revived by mutual consent and in such event the Revival premium should be paid to Us within 15 days of the installment due date.

Any person (Employee/Group Member) may be added to policy as an insured person during the policy period provided that the application of cover has been accepted by us, additional premium, on pro-rata basis in respect of such member has been received by us and we have issued an endorsement confirming the addition.

Any Insured Person who is covered under the Policy may be deleted upon request by policy holder during the policy period. Refund of premium can be made on pro-rata basis, provided that no claim is paid / outstanding in respect of that insured person or his/her dependents.

No, for Group Personal Accident or Group Critical Illness policy member ID card is not issued.

Upon resignation or termination from employment or on leaving the group, you and your covered spouse/family member will have the option of continuing coverage on a direct-pay basis under the closest similar retail plan option available. You must contact ManipalCigna Customer Service at 1800-102-4462 or nearest branch to place your request.

Yes, you can cover your family residing in India under one policy. Your group insurance policy can be used all across India.

Covered relationships include Spouse, dependent – parents and in laws between 18 to 75 years. Also includes dependent unmarried children, grandchildren and siblings from 5 to 25 years in Group Personal Accident and 18 to 25 years in Group Critical Illness policy.

The best part of this policy is that it has a simple documentation process. All you need to submit is a quote request sheet, client information details, member details and filled proposal form with relevant information and attach a cheque or demand draft for requisite premium.

All insured person above age 18 years may avail health check with our network provider only. Original copies of the reports will be handed over to the insured person and we will retain a copy with us. List of the test conducted will depend on the sum insured and age of the insured person. List of tests are available in the policy wordings.

If common benefits are opted under both the plans, claim trigger will be on the basis of the nature of event taking place (eg. for accidental injury claim will be paid from GPA policy and for any covered Critical Illness claim will be paid under GCI policy).

If an insured person is subjected to an act of violence or suffers a traumatic accident or we have accepted a claim for Critical Illness; (as per plan) we will reimburse the amount up to the limit specified towards counselling fees, specialist consultation and extended physiotherapy on an out- patient basis. This optional cover can be availed only once during the Policy Period.

On acceptance of a claim for Permanent Total disablement, Permanent Partial Disablement or Temporary Total Disablement in respect of an insured, then the Insured Person may choose to secure a second opinion from Our network of Medical Practitioners for treatment of the disability. Also Insured Person may choose to secure a second opinion from our network of medical practitioners for the treatment of that Critical illness.

The expert opinion so requested from our network of Medical Practitioners shall be directly sent to the insured person.

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

Examples of Accidents can be as follows:

• Motor Vehicle Accidents (MVA’s), irrespective of whether you are the Driver, Passenger or Pedestrian

• Injuries on Duty (Accidents whilst performing your business duties),

• Animal attacks (to be specifically opted for cover)

• Sporting Injuries (to be specifically opted for cover)

• Home-based Injuries eg. Fall from stairs, drowning (suicide not covered)

• Injuries sustained as a result of a natural calamity, terrorism.

Every day we hear or witness road accident. Accident can happen to anyone. Buying insurance is protection against uncertainty of life which may lead to emotional and financial loss to family, loss of income/ job due to permanent disability, increase in financial expenses due to medical treatment and dipping into saving.

ManipalCigna offers a highly flexible protection solution covering injury solely due to accident anywhere in the world which results in death or disability of the insured person within 365 days from the date of accident along with a range of optional extensions to suit your needs and preferences.

You can protect your entire family with Insurance against accidental injuries.

• The policy provides Basic coverage for Accidental Death, Permanent Total Disability, Permanent Partial Disability and Temporary Total Disability.
• You can choose from any combination of 32 Optional covers ranging from Living benefits, Family support to Emergency benefits.

*Standalone TTD cannot be selected.

ManipalCigna offers group solution that helps fill a gap in the coverage of unexpected expenses arising from death or disability caused by an accident not addressed by your life, disability or health insurance. It is a complete protection which offers worldwide cover on and off the job including loss of employment, child protection and financial security from day 1 of the policy. We also offer 32 optional covers like Disappearance benefit, Burns benefits, Broken bones, Coma benefit, Child education, Hospital cash, OPD allowance, Evacuation & Repatriation, Adventure sports benefit and so on.

This cover is available to all Employer – Employee and Non- Employer Group.

Relations to be covered includes self, dependent lawfully wedded spouse, dependent Parent /in –laws, unmarried dependent children/ grandchildren and siblings.

Personal accident insurance is available for insured aged between 18 years to 75 years (minimum age at entry is 18 years and maximum 25 years for Children). Only for GPA student policy, minimum entry age is 3 years.

On death or permanent disability of the primary insured, spouse and children are entitled to get 100% of the sum insured opted. In addition, any eligible optional benefit will be paid on fulfillment of specified conditions.

Evacuation benefit: For emergency, arising out of an accident, if adequate medical facilities are not available locally, we will reimburse the specified amount towards arrangement for an emergency evacuation of the insured person to the nearest available medical care facility. Our medical assistance service will arrange for the transportation (via airplane, train or ambulance as required) of the insured person and a qualified medical professional to the nearest facility.

 Medical Repatriation: If we have accepted a claim under emergency evacuation of the insured person, we may request for the repatriation of the Insured to a Hospital in the country of domicile or to the original work location or the location from which the

Insured Person was evacuated. We will pay reasonable charges for the most economical cost of travel (via airplane, train or ambulance as required) of the insured person and a qualified medical professional.

Dependent Children, Marriage benefit and Education fund benefit can be selected in the same policy.

Both In-patient Medical Expenses and Accidental Medical Expenses can be opted in a single policy.

On suffering an injury during the policy period directly due to an accident that results in Permanent Total Disablement (PTD) of the insured person we will pay an additional 100% of sum insured as PTD Double Benefit.

Group Personal Accident (GPA) policy offers Adventure sports benefit as an optional cover.

On suffering an accidental Injury resulting in Accidental Death or Permanent Total Disablement while engaged in an adventure sport carried out in accordance with the guidelines, codes of good and safe practices laid down by a governing authority, then we will pay the amount as opted under this benefit.

List of adventure sports covered is mentioned in the policy wording.

Yes, medical expenses will be reimbursed towards treatment of injury due to animal attack occurring during the policy period. We will reimburse amount upto the sum insured opted.

For this benefit animal means a mammal and exclude birds, reptiles, fishes or insect.

You can notify us either at the call center or in writing within 10 days from the date of occurrence of such accident .We will assist you with the submission of the documents required and the process will be completed within 30 days of the receipt of last necessary document.

Claims will be settled on re-imbursement basis paying fixed or indemnity amount as applicable depending on the benefit. There is no cashless facility available.

Yes, multiple claims can be paid subject to maximum of 100% of sum insured opted.

Yes we cover terrorism and natural calamities under Group Personal Accident policy.

Exclusion are situation or conditions where in ManipalCigna is not liable to pay the benefit to the Insured person in the event of accident. Complete list of exclusions forms a part of the policy wordings.

The GPA policy covers accidental death or disability solely resulting due to accident during the policy period within 365 days from the date of accident.

Yes, this policy covers accidental events or occurrences taking place anywhere in the World. Claim (if any) will be paid to you in Indian Rupees.

Policy provides Education fund benefit (if opted) to the dependent child/nominee or appointee (as applicable) in an event of claim under accidental death or Permanent Total Disablement. It is not necessary that children are to be covered under the policy.

Contributory policy means that the premium for such policy is paid by the insured himself/herself.

Non-contributory policy means premium for such group is paid by the employer / group admin.

The employer/affinity group, for a reduced premium can choose an on-duty cover where policy is restricted for a time period of the day i.e. Work duty hours only.

Critical Illness plan insures against the risk of serious illness. It is a security of guaranteed sum being paid if diagnosed with a covered critical illness as listed, meeting specific criteria and insured surviving 30 days (unless waiver of survival period opted) after the first diagnosis or undergoing procedure.

No, the cover does not change with change in the age group.

We have 6 plan options available under Group critical illness.

Plan 1: Covers 36 Critical Illness,

Plan 2: Covers 30 Critical Illness,

Plan 3: Cover 15 Critical Illness,

Plan 4: Covers 11 Critical Illness,

Plan 5: Covers 6 Critical Illness.

Plan 6: Cancer of specific severity (Critical Illness -1 Only)

List of the critical illness covered is detailed in the policy wording.

No, the Critical Illness insurance benefit is payable once, and for the first covered critical illness only, at which point your coverage ends.

Yes if diagnosed with any critical illness during policy period, full sum insured will be paid to the insured or nominee (as applicable) on fulfilment of required survival clause.

Survival period is a 30 days waiting period following the first diagnosis of the Critical Illness/undergoing the Surgical Procedure (Waiver option is available with additional premium).