FAQs on ManipalCigna Health Insurance Products

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The Group policy is designed for health needs of the globally mobile population and their families whilst working/ travelling for work in India and overseas. A Corporate/ Group can purchase this policy for Its members and their family and employees and dependents. Also an Affinity (non-employer -employee) group like customers of a bank holding savings account, members of a club etc can opt for this policy.

 Min Age at entry for Adult is 18 Years and Max is 95 Years, Dependent Children can be covered

from day 1 of birth up to 25 years of age.

Minimum number of members required to buy a group policy is 7 or as prescribed by IRDAI from

time to time. Also the group should not be formed with the sole purpose of buying health

insurance.

The policy is issued for a term of 1 Year only.

We offer a wide range of Sum Insured options from $ 5000. The policy can be

issued in any of the below mentioned currency:

USD (US Dollar), AED (Arab Emirates Dirham), AUD (Australian dollar), Euro, GBP (Great Britain

Pound),HKD (Hong Kong Dollar), SGD (Singapore Dollar), Dollar) and INR (Indian Rupees).

However the premium towards the policy will be charged in Indian rupees only.

A comprehensive group plan that provides health care solution to Employer – Employee and Non Employer – Employee segments (Affinity Groups like Bank Savings A/c holders, Club Membership holders, Students of Educational Institutes and more). Product offers a set of benefits including:

• Tailor made package for essential in-patient care extendable to cover medical travel expenses too
• Multiple solution for Hospitalization, Daycare to Out-patient treatment expenses 
• Range of different options to combine with Hospitalization/Out-patient expenses
• Smart choice of - Maternity Expenses, New Born cover, Emergency Evacuation, Repatriation, Out of area cover, Dental, Vision cover, Hospice and palliative care, Travel vaccination, Complementary treatments, Cancer cover and more
• Host of options for cost effective plans - Co-pay, Deductible, Waiting period inclusion and Maximum limit on Out of pocket expense
• Wellness package for Health and Well-being
• Easy access to quality health care around the world

Plan offers an all-round health protection towards In-patient hospitalization, Day Care, Outpatient
expenses and customized optional covers.
 

In-patient hospitalisation covers medical expenses of an insured person for illness or injury that requires hospitalization for more than 24 hours up to the Sum Insured specified under the Policy Schedule/ Certificate of Insurance. These medical expenses includes.


i. Room charges                                                                                                                                        
ii. Charges for accommodation in ICU/CCU/HDU,
iii. Hospitalization charges,
iv. Operation theatre cost,
v. Surgical Procedures,
vi. Minor Surgical Procedures,
vii. Day Care Treatment,
viii. AYUSH Treatment for In-patient Hospitalization (In India Only),
ix. Medical Practitioner fees,
x. Specialist fee,
xi. Surgeon’s fee,
xii. Anaesthetist fee
xiii. Radiologist fee,
xiv. Pathologist fee,
xv. Assistant Surgeon fee,
xvi. Qualified Nurses fee,
xvii. Medication,
xviii.Cost of diagnostic tests as an In-patient such as but not limited to radiology, pathology tests, X-rays, MRI and CT scans, physiotherapy and drugs, consumables, blood, oxygen.
xix. Surgical appliance and/or Medical Appliance.

Under Base 1 cover per day room rent allowance is restricted up to Private room for Hospitalisation outside India and any hospital room except suite and above, for hospitalisation in India .For ICU hospitalization, the limit is capped upto Sum Insured opted under Base 1.

Yes, we will reimburse expenses incurred toward transportation of the insured person by a registered ambulance provider to a hospital for treatment of illness or injury. Cover against Air Ambulance is also available up to Sum Insured, if opted.

Medical expenses incurred towards treatment on an out-patient basis are covered up to the Sum

Insured selected. Any one or combination of the following can be opted under the cover:


i) Consultation with Medical Practitioners & Specialist

ii) Prescribed Medicines, Drugs, Dressing

iii) Diagnostic Test.

Day care procedures cover medically necessary treatment or surgery undertaken for illness / 
conditions which require less than 24 hours of hospitalization. We cover all Day care procedures
up to full sum insured opted under Base 1.
 

 A serious medical condition or symptom due to an injury or sickness which arises suddenly and
unexpectedly and requires immediate care and treatment by a medical practitioner within 24
hours or else could result in a life threatening situation or long term impairment.
Eg: Heart Attack, stroke, severe allergic reaction etc.
 

It covers expenses towards evacuation of the insured person to the nearest facility capable of
providing adequate care in case of emergency due to lack of adequate medical facilities available
locally. It also covers travel cost of accompanying person due to medical necessity.
Transportation will be provided by medically equipped aircraft, commercial airline, train or
Ambulance.
Under this benefit one can opt for any one or combination of the following can be opted under the
cover:
•  Emergency Evacuation - 
•  Medical Repatriation
•  Repatriation of Mortal Remains

Expenses will not be payable towards   emergency evacuation, repatriation and transportation
cost towards:
•  Any form of treatment which is not covered under the plan.
•  Any form of non- emergency travel cost.
•  Routine or minor medical problem, tests and exams where there is no significant risk.
•  A condition which would allow for treatment at future date.

Yes, under Out-patient Expenses you have option to include cover against over the counter medicines.

It covers cost towards a qualified nurse arranged by the hospital to visit insured person’s home to
give expert nursing services immediately after hospitalisation, provided the specialist/medical
practitioner who is treating the insured person has recommended these service in writing.
 

We cover medical expenses towards Human Immunodeficiency Virus (HIV)/or HIV related illnesses, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related complex (ARC) and/or any mutant derivative or variation thereof including pre and post diagnosis consultation, routine check-ups, drugs, dressing, hospital accommodation and nursing fees provided this optional cover is opted in respect of the insured person.

Yes, In-patient psychiatric or psychological treatment of an insured person is covered only if opted. Waiting period if any and coverage amount will be specified under the Policy Schedule/Certificate of Insurance.

Yes, these are available as optional covers. If opted, coverage details and Sum Insured will be
specified under Policy Schedule/Certificate of Insurance.

Any one or combination of following with separate or combined Sum Insured can be selected.

i. Routine or Elective Caesarean.
ii. Complicate Pregnancy – Covers medical expenses arising during antenatal stages or pregnancy or childbirth which require obstetric procedure and post natal check-up upto 6 weeks.
iii. Pre & Post Natal Care – Covers costs up to 6 weeks, prescribed pre natal vitamins & associated delivery cost.
iv. New Born Cover- Covers medical expenses towards treatment of the new born until discharge or no. of days specified.  
v. Maternity Assistance & Mid-wife charges
vi. Birthing Classes Charges

Yes, We will cover medical expenses of an insured person which are incurred towards pre and/or post hospitalization provided Out-patient Cover is opted and specified under the Policy Schedule/ Certificate of Insurance.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      during the policy year against all admissible claim.

     Illustration:

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

Amount (Rs)

Sum Insured

30000000

Co-pay

20%

Maximum limit on Out of Pocket Expenses (Rs)

60,000

 

Claim 1

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

40,000

Amount Paid by Insurer

1,60,000

Balance Sum Insured

2,98,40,000

Maximum limit on Out of Pocket Expenses Balance -

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

Rs 20,000

 

Claim 2

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

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

20,000

Amount Paid by Insurer

1,80,000

Balance Sum Insured

2,96,60,000

Maximum limit on Out of Pocket Expenses Balance -

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

0

 

Claim 3

2,00,000

Amount Paid by Insured

Co-pay -20% of 2,00,000 – Rs 40,000

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

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

0

Amount Paid by Insurer

2,00,000

Balance Sum Insured

2,94,60,000

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

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

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

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

ManipalCigna Global Health Group Policy offers below area of cover:

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

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

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

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

For cashless treatment in India, please call ManipalCigna customer service Toll free no. 1800- 102- 4462 .You have to select Option 3 for Group Services, Our customer service Officer will help you locate nearest network hospital.

This must be done at least 3 days in advance for planned hospitalization or within 48 hours of hospitalization in case of emergency admission.

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 you need to speak to us about your treatment plan, contact our customer care no.1800- 102- 4462 or you can write to us at servicesupport@manipalcigna.com  for assistance.

If you've paid for your treatment, simply complete a claim form and send across to us via post or email with your invoices. If document is shared via email, ensure you keep the originals in case we may need to see it later .Please note for Claims incurred in India, you are required to submit original copies at ManipalCigna Corporate office address as mentioned below.

Manipal Cigna Health Insurance Company Limited 401/402, Raheja Titanium, Western Express Highway, Goregaon (East), Mumbai - 400063.

We provide many reimbursement options such as:

    • Electronic transfer of funds into your bank account*.
    • Cheque mailed to nominated address for claims processed outside India.
    • Multi-Currency claims payment
      

*Please note that payments made within Europe will be processed more efficiently by the receiving bank if you provide IBAN and SWIFT numbers for your transfer.


For reimbursed of claims made outside India please refer to contact details stated in the Certificate of Insurance or Health Card issued.

NB: To download claim forms visit our website www.manipalcigna.com (downloads section).

In case you choose to courier/hand deliver the documents, please keep a photocopy of the originals for future reference.

No. The membership 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 e-pack 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 servicesupport@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 servicesupport@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 Global Health Group 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.

Tax benefit is applicable for contributory policy (where insured member pays premium towards the policy).

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 will be charged on pro-rata  basis  and we have issued endorsement confirming the addition.

Any Insured person who is covered under the policy may be deleted upon request by the policyholder. Refund of premium can be made on pro-rata basis provided that no claim is paid/out-standing in respect of that insured person or his/her dependents.

Yes, we cover terrorism and natural calamities under ManipalCigna Global Health Group Policy.

Exclusions applicable under the Policy shall be listed under Policy Terms and Conditions.

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.

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

• Non Contributory policy means premium for such group is pad by employer/ group admin.

If Insured Person discontinues being an Employee/member of the group policyholder, such Insured

      Person shall have the option to migrate to an approved retail health insurance policy available with

      Us, provided that:

  • This product is discontinued or withdrawn or the Insured Person ceases to be a member of the group
  • Continuity of Benefits will be provided for the period based on the number of years of continuous coverage under this Policy with Us.
  • Application for Portability should have been received by Us at least 45 days before ceasing to be a member of the group/Employee of the Policyholder.
  • Portability will be subject to decision taken by the underwriting team.
  • After maintaining the Policy with Us, the Insured Person may port the policy to any other retail product offered in the market in accordance with applicable law.