What if there’s delay in claim submission?
Completed claim forms and documents must be furnished to us within the stipulated timelines. If the timeline is missed, and the insured can show that the delay was for reasonable and unavoidable, along with proof of the same, the claim will still be accepted.
Is there any investigation that happen after the receipt of claim?
Yes, we may investigate claims at our own discretion to examine validity of claim.
What is the time Line for the claim to get settled?
Generally we provide the decision on claims within 7 (Seven) working days of the receipt of the last ‘necessary’ document. However in certain special cases, the timelines increase. These take no more than 30 days.
How to Track your claim?
You will get information on status of your claims as following way-
- You can call Toll Free Helpline for claims 1800-419-1159 or in writing for claim status on email firstname.lastname@example.org
- You will receive an update on status of your claim through SMS and emails on the registered contact details with us. Hence, it is important that your contact details are updated with us at all times.
- You can track your claims on www.manipalcigna.com/claims.
- You can track your claims on the website and mobile app of TPA MediBuddy from track your claim section.
- SMS "CLAIMS <claim number>" to +91 96631 49992 to know the claim status
- You can also reach out to your health advisor or connect with our health relationship managers to get an update or clarification on the claim.
For all other policies, kindly contact our call center
What are the reasons for deduction in claim amount?
Claim amount can be deducted for any of the following reasons:-
- Non-Medical expenses such as telephone bills, snacks etc. are non-payable,
- Treatment details without proper bills or prescription,
- Sum Insured exhausted,
- Amount exceeding specified Sub-limits
- Co Payment applicable,
- Capping of expenses for any particular treatment or benefit,
- Original reports/bills not available,
- Expenses related to any investigations/treatment not related to ailment for which patient is admitted."
This list is only indicative, and may vary as per your policy plan.
What are the lists of Non Payable items / Non-medical expenses?
Non-medical expenses are those that are related to food, travel, personal comfort, convenience, hospital routine disposable etc. During the time of hospitalization stay, the insured person and his/her family members are likely to incur the above mentioned expenses.
What is deductible in the policy?
It is an agreed amount by insured that he will bear the cost of medical expenses up to specified amount in policy. The Insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies, which will apply before any benefits are payable by the insurer. A deductible does not reduce the sum insured.
What is Co Pay?
Voluntary co-pay - It is percentage of claim amount agreed by insured that he will bear the cost of medical expenses up to specified percentage in policy, basis he will availed the discount in premium.
Mandatory Co-pay - A Compulsory Co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and above irrespective of age of entry in to the Policy.
Zonal Co-pay – If insured availed the medical treatment in hospital zone higher than actual eligible zone as per policy.
What are common reason for rejection of claims?
- Policy waiting period
- Pre-existing disease
- Non-disclosure of diseases
- Policy terms and condition
- Mispresentation, Inflation in bills and Fraudulent claims
- Ailment sub limit /Sum insured Exhausted
If the company rejects the claim can there be reconsideration?
- If a claim is rejected by an insurance company, the claim can be resubmitted for evaluation within 15 days for re-consideration of the decision.
What will happen if I get hospitalised in higher room category than my eligibility?
- If you choose to stay in a room that is of a higher category than your eligibility, your cover will still be as per your policy terms and conditions. There will also be a proportionate calculation of the hospitalization costs, excluding pharmacy, investigations and consumables.
Staying in a higher category of room does not mean that your claim will be rejected. It only means that the amount that is settled will be less than the entire incurred bill.
What is proportionate deduction?
- If you are eligible for a particular room category and admitted in higher category room, the proportionate incremental percentage will be calculated and applied over all bill component of the payable amount excluding pharmacy, investigations and consumables and same amount will be deducted in your final claim amount.
e.g. If you admitted room that costs Rs. 5,000, while you are eligible for a room type that costs Rs. 3,000, there will be proportionate deduction of 33% on all charge heads except pharmacy, investigations and consumables.
Can I apply for personal accident and critical illness benefit in cashless?
No for this benefit you can apply on reimbursement only. Post discharge please collects all mandatory documents from hospital and sends to ManipalCigna Health Insurance H.O.
Can I claim for my day care surgery for cataract under pro health cash policy in cashless?
No, Pro health cash benefit is neither legible for cashless facility and nor for day care treatments.
What are waiting periods?
Depending on your policy terms, there are few waiting period like initial waiting period, waiting period for pre existing disease, personal waiting period as well as specific illness waiting period. Please read your policy document for more clarification.