FAQs on ManipalCigna Health Insurance Products

Frequently Asked Questions

Insurance coverage that pays for medical and surgical expenses that are incurred by the insured person during the treatment of a disease or injury. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.

Arogya Sanjeevani Policy is a standard health insurance product developed by IRDAI and made available by ManipalCigna Health Insurance company to take care of basic health care needs of insuring public. It takes care of your hospitalization needs due to illness, injury.

Following are the key benefits available under Arogya Sanjeevani Policy :

I.  In-patient hospitalization
II.  Pre-hospitalization
III.  Post hospitalization
IV.  AYUSH Cover (in-patient only)
V.  Day care treatment
VI.  Ambulance cover
VII.  Cataract Treatment
VIII.  Cumulative Bonus
IX.  Modern Treatments

Exclusions are conditions where ManipalCigna is not liable to pay for expenses incurred by the insured person in the event of a claim. List of exclusion forms a part of Policy terms & conditions.

I.  Rs. 1 lac
II.  Rs. 1.5 lacs
III.  Rs. 2 lacs
IV.  Rs. 2.5 lacs
V.  Rs. 3 lacs
VI.  Rs. 3.5 lacs
VII.  Rs. 4 lacs
VIII.  Rs. 4.5 lacs
IX.  Rs. 5 lacs

Yes, there is an option of including up to 2 adults and 3 children under floater policy.

Minimum entry age for Adult is 18 years and for children it is 3 months (91 days)

Maximum entry age for Adult is 65 years and for children it is 25 years (Children should be financially dependent).

Relationships covered are: self, legally wedded spouse, parents, parents-in-laws, dependent children.

Pre policy medical checkup will be required for the insured aged 55 years and above and for the rest of the ages will be required subject to underwriting (on case to case basis).

We will cover hospital accommodation expenses with limit of 2% subject to maximum of Rs. 5,000/- per day for room rent, and charges for stay in Intensive Care Unit with limit of 5% subject to maximum of Rs. 10,000/- per day.

There will be waiting period of 48 months for pre-existing diseases. Loading (if any) will be subject to the underwriting decision and applicable on acceptance by the policy holder.

The applicable waiting periods are listed below:

Pre-existing Diseases Waiting Period: Pre-existing diseases will be covered after 48 months of continuous coverage under this plan.

First 30 days Waiting Period: A waiting period of 30 days from the Inception Date of the Policy will be applicable for all hospitalization claims except in case of accidents and policies accepted under portability norms.

Waiting Period for specific illness: Waiting Period of 24/48 months will be applicable for some specific illnesses as mentioned in policy terms and conditions.

We will cover in-patient medical expenses up to the limit of Sum Insured towards non-allopathic treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy for hospitalization arising due to accident or illness undertaken in a government hospital or government recognized institute.

No, maternity and related expenses are not covered under this policy except ectopic pregnancy.

Yes, all Day care treatments are covered under this policy.

The following procedures will be covered (wherever medically indicated) either as inpatient or as a part of day care treatment in a hospital up to 50% of Sum Insured, specified   in the policy schedule, during the policy period:

A. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
B. Balloon Sinuplasty
C. Deep Brain stimulation
D. Oral chemotherapy
E. immunotherapy-  Monoclonal Antibody to be given as injection
F. Intra vitreal injections
G. Robotic surgeries
H. Stereotactic radio surgeries
I. Bronchical Thermoplasty
J. Vaporization of the prostrate (Green laser treatment or holmium laser treatment) 
K. IONM - (Intra Operative Neuro Monitoring)
L. Stem cell therapy:  Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.

Yes, we will indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or Rs. 40,000/-, whichever is lower, per each eye in one policy year.

Yes, you can renew this policy for lifetime except on grounds of fraud, moral hazard, misrepresentation by the insured person.

The Product may be offered to the above person, subject to the following criteria being met.

  • NRI Proposer/Proposed Insured Persons must have an Indian Address for communication.
  • Foreign nationals desirous of this product must be residing in India for a period of 180 days at least. Valid Visa, all pages of passport, employment details and residence proof need to be submitted in all such cases.
  • Proposer must be in India at the time of signing the proposal form
  • Those currently working or settled in India are eligible for the cover. Eg. NRI/PIO who has returned back to India and gainfully employed.
  • Medical tests wherever applicable will be conducted in India only and Proposal Form to be signed in India by the Proposer Only.

 

Policy will be applicable all over India. Policy will not cover any treatments taken outside India. All claims under the policy shall be payable in Indian currency only.

No, there will not be any zonal copay in Arogya Sanjeevani Policy.

Policy term for Arogya Sanjeevani policy will be 1 year.

Yes, Insured can avail the cashless claim facility from over 6500+ ManipalCigna network hospitals.

You must notify us either at the call center or in writing, in the event of planned or emergency hospitalization.

Claim will be settled on reimbursement basis when all the necessary documents are submitted and subject to the validity of the claim as per policy terms and conditions.

Co-payment is a cost-sharing method under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the Sum Insured.

A fixed co-pay of 5% shall be applicable across all the ages for every claim under this policy.

No, out-patient expenses are not covered under Arogya Sanjeevani Policy.

Deductible option is not available with Arogya Sanjeevani Policy.

There is no optional cover available under Arogya Sanjeevani Policy.

You can call us at 1-800-10-24462, visit the nearest branch or visit ManipalCigna
website www.manipalcigna.com and we will help you with the purchase process.

The below mentioned discounts are available:

Family Discount -  15% for covering 2 or more family members under single individual policy

Worksite Discount -  A discount of 10% will be available on polices which are sourced through worksite marketing channel.

Online Renewal Discount -  A discount of 3% p.a. on the premium from next renewal, if the premium is received through NACH or Standing Instruction (where payment is made either by direct debit of bank account or credit card.).

You can claim tax deduction u/s 80D as per IT Act 1961 for premium paid towards this policy. For premiums paid in cash, tax benefit u/s 80D shall not be applicable. Please consult your tax advisor for more details.

We will increase the sum insured by 5% for every claim free year up to a maximum of 50%. For example, if you have coverage of Rs. 5 Lacs, an additional Sum Insured of Rs. 25,000 will be allowed as Cumulative Bonus every year, maximum up to 50%. Similarly, if a claim is made in any particular year, the cumulative bonus accrued will be reduced at the same rate at which it has accrued.

Yes, you can port from other health insurance policy to this policy if you have been covered under an Indian retail health insurance policy, from Non-Life Insurance or Health Insurance company registered with IRDAI, without any break in the immediate previous policy and subject to satisfying all the terms and conditions related to portability guidelines.

Yes, you can migrate from Arogya Sanjeevani Policy to other ManipalCigna policy subject to satisfying all the terms and conditions related to migration.

The payment frequencies available are: annual, half-yearly, quarterly and monthly.

For monthly payment frequency, 2 months premium to be paid in advance and instalment/renewal premium payment through NACH or standing instruction (where payment is made either by direct debit of bank account or credit card).

For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period and for all other modes of payment (monthly, quarterly, half yearly) a fixed period of 15 days will be allowed as grace period.

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 advised to check the applicable list of network hospitals. Please contact our Customer Care no. 1800-102- 4462 or you can write to us at customercare@manipalcigna.com for assistance.

The Insured may cancel this Policy by giving 15 days’ written notice, and in such an event, the Company shall refund premium on short term rates for the unexpired Policy Period as per he rates detailed below. There will not be any refund for payment frequency other than annual mode.

  Refund %

Refund of Premium ( basis Policy Period )

Timing of Cancellation

1 Y r

Up to 30 days

75.00%

31 to 90 days

50.00%

3 to 6 months

25.00%

6 to 12 months

0.00%

 

No refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.