Who can buy the Lifestyle Protection Group policy?
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.
Who is the policy holder?
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.
What is the term of the policy?
The policy is issued for a term of 1 year. Only for credit linked policy, term can be up to 5 years.
Can we cover foreign nationals working in India in the group policy?
Yes, foreign national working in India and earning in Indian currency can be covered under this policy.
Can a NRI take GPA/GCI policy?
Yes, Non-resident Indian working in India and earning in Indian currency can be covered under this policy.
Is there a bonus in the policy for claim free years?
There is no cumulative bonus or no claim discount in Lifestyle Protection Group policy.
How many minimum count of members are required to form a group for issuance of a policy?
Minimum number of members required to issue a group policy is 7.
Is nomination compulsory in this 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. You can change your nomination any time before the date of policy termination. Nomination is required for valid discharge of claim.
Are illnesses covered in the policy?
The policy provides cover towards injuries due to personal accident and listed critical illnesses along with a range of options for groups.
Is Outpatient and Physiotherapy/Chiropractic treatment covered?
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.
Are medical tests required prior to cover?
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.
Can group holder place the insured persons on different levels of cover?
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.
Can the policy be purchased / renewed online?
To purchase/renew the policy, please get in touch with us at the 1800-10-24462 or visit any of our branches. For more details log on to our website www.manipalcigna.com
When will the insurance cover end?
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.
If I have questions or need assistance, who should I contact?
If claim has occurred during the grace period will it be paid?
If claims occurs during the grace period it will not be covered.
Who is a medical practitioner?
A medical practitioner is a person who holds a valid registration from the medical council of any state of India 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.
What is co-payment?
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.
What is common Carrier?
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.
What are included in Alternate Treatment?
All forms of treatments other than treatment of "Allopathy" or "modern medicine" and includes Ayurveda, Unani, Sidha and Homeopathy in the Indian context.
Is there a tax benefit available in the policy?
Tax benefit is applicable for Contributory policy (where insured member pays premium towards the policy) for Group Critical Illness plans only.
Will I get a discount on renewal if no claim is made during the year?
There will be no renewal discount for a claim free year under the policy.
If I forget to renew the policy on time, can I get the continuity benefits?
• 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.
Can members be added/deleted in-between policy years?
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.
Do I get a member card?
No, for Group Personal Accident or Group Critical Illness policy member ID card is not issued.
If I resign or am terminated from employment or leave the affinity group what happens to coverage for me and my family?
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.
Can I cover Family member residing in another city under one plan?
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.
What kind of documentation is required to issue a 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.
What is wellness benefit option?
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 the policy includes common benefits (eg. Hospital cash benefit) opted in both Group Personal Accident and Group Critical Illness will claim be payable under both the policy?
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).
What is a rehabilitation benefit?
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.
Can I opt for a medical second opinion?
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.
What is an Accident?
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.
Why you need an accident cover?
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.
What Manipalcigna offers as an accident protection?
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.
What are benefits payable under this Policy?
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 34 Optional covers ranging from Living benefits, Family support to Emergency benefits.
*Standalone TTD cannot be selected.
Why to choose Manipalcigna Group Personal Accident (GPA) Policy?
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 34 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.
Who all can be covered?
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.
Is there an age limit for opting Personal Accident Insurance Policy?
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.
What kind of benefits my spouse and children are entitled on death or permanent disability?
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.
What is Evacuation and Repatriation benefit?
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.
Can I opt for Dependent Children, Marriage benefit and Education fund benefit in a single policy?
Dependent Children, Marriage benefit and Education fund benefit cannot be selected in the same policy.
Can I opt for In-patient Medical Expenses and Accidental Medical Expenses in a single policy?
Both In-patient Medical Expenses and Accidental Medical Expenses cannot be opted in a single policy.
What is a disappearance benefit?
On declared dead in absentia or presumption of death if the insured person is missing (for at least 7 years), disappearance benefit equal to the sum insured is paid under the policy.
The insured person’s legal representative must intimate such disappearance to Us immediately upon happening of the event.
What is Permanent Total Disablement Double Benefit?
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.
Does this policy cover Adventure Sports?
Group Personal Accident 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.
Will GPA policy cover Animal Attack?
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.
How to claim under GPA?
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.
Is cashless or reimbursement facility available under GPA plan?
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.
Can I make multiple claims under the policy?
Yes, multiple claims can be paid subject to maximum of 100% of sum insured opted.
Is terrorism and natural calamities covered in the policy?
Yes we cover terrorism and natural calamities under Group Personal Accident policy.
What do you mean by exclusion?
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.
Does the policy cover natural death and daily sickness also?
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.
Will the policy cover me anywhere in the world?
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.
Is the Education Fund benefit payable only if the dependent children are insured in GPA Plan?
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.
What are contributory and noncontributory policies?
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.
What is on–duty cover?
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.
How does Critical Illness Policy differ from other health policies?
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 after the first diagnosis or undergoing procedure.
Does the cover differ for different age group?
No, the cover does not change with change in the age group.
What illnesses are covered under my critical illness insurance plan?
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.
If I am diagnosed with a covered critical illness, and then with a second one , will I be paid for both illnesses?
No, the Critical Illness insurance benefit is payable once, and for the first covered critical illness only, at which point your coverage ends.
Will I be paid directly if I am diagnosed with covered illness?
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.
What is survival period?
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).