FAQs on ManipalCigna Health Insurance Products

Frequently Asked Questions

Super Top up is a back up to existing medical insurance (personal health insurance or health insurance provided by employer or other group). A regular health insurance policy has a Sum Insured limit, beyond which it does not cover any medical expenses. This is when a Super Top Up policy is useful, it becomes effective soon after the Sum Insured from an existing health plan is exhausted or insufficient to settle claim.

Super Top Up health insurance plans are an added protection in such scenarios, when the maximum payout from a basic health policy gets exhausted or insufficient.

It is very important. Deductible can make or break the efficacy of your health insurance plan. It is the amount that you have to pay for – either out-of-pocket or from your basic health insurance policy – before your health insurance top up kicks in.

Choosing a very high deductible (say, more than the base Policy sum insured) means you will have to take care of the excess amount yourself. Always calculate the amount of deductible by taking in your medical history and the kind of costs you anticipate in the next 5 years. If you are nearing 50 years, a super Top Up will be more beneficial, since the risk of ailments is higher as you grow older.

No, you need not. If you don't have a health plan, you can still purchase a Super Top Up plan. However, in this case you will end up paying the expenses out-of-pocket until you exceed your deductible limit and the Super Top Up sum insured kicks in. Hence, it is ideal to have a basic health insurance plan, however not mandatory.

Your existing Mediclaim policy will continue to cover pre-existing diseases however fresh waiting period of 48 months will be applied with ManipalCigna Super Top up policy.

An option is available to reduce your waiting period from 48 to 24 months on payment of additional premium at time of first purchase.

A Specific illness waiting period of 24 months shall apply to the treatment whether medical or surgical for all medical expenses along with their complications. List of Treatment is mentioned in policy terms & condition under section III (Waiting period). (Document available on our website download section).

If these diseases are pre-existing or subsequently found to be pre-existing then pre-existing waiting period will be applied. For Ported policy continuity benefit will be available.

We may apply a risk loading on the premium payable (excluding Statutory Levies and Taxes) or Special Conditions on the policy based upon the health status of the persons proposed for insurance and declarations made in the Proposal Form. These loadings will be applied from inception date of the first Policy including subsequent Renewal(s) with Us. Additional waiting periods may be applied upto a maximum of 48 months from the date of inception of first policy. 

We shall inform you about the applicable risk loading or special condition through a counter offer letter and you would need to revert with consent and additional premium (if any), within 7 working days of the issuance of such counter offer letter.

Yes, We will cover payment of medical expenses of an insured person in case of medically necessary dialysis treatment irrespective of number of times insured person is hospitalized. This treatment will start getting covered after the deductible limit is exhausted/insufficient till Sum Insured opted.

Yes, AYUSH covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy for an illness or injury that occurs during the policy year. Coverage is available upto the sum insured provided:

i. Treatment is taken in a government Hospital or in any institute recognised by government and/or accredited by government authority.


ii. Facilities and services availed for pleasure or rejuvenation or as a preventive aid like beauty treatments, Panchakarma, purification, detoxification and rejuvenation etc. is an exclusion under this benefit.

Yes, you can cover self, spouse & children on individual & family floater basis. For parents, a separate family floater plan to be opted. Extended family like brother and sister of the Policyholder who are children of same parents, grandparents, grandchildren, parent in laws, son in law, daughter in law, Uncle, Aunt, Niece and Nephew can be covered on individual basis.

No, ManipalCigna Super Top Up plan covers all valid hospitalization bills above the threshold limit of Deductible amount. Once the Deductible limit is exhausted and Super Top Up policy kicks in, no further co-pay is applicable during settlement of claims.

We will require you to undergo a medical check-up based on your age and the Sum Insured opted as provided in the grid below.

    Pre-policy Check-up

Sum Insured (Lacs)

Age Group (Years)

Medical Tests

1 Lac to 30 Lacs

Up to 55

No Test

56 – 65

Tele Underwriting

>65

Medical Test 

 

Wherever any pre-existing disease or any other adverse medical history is declared, insured member may have to undergo specific tests. Medical tests will be facilitated by us and conducted at Our network of diagnostic centres.

The Sum Insured and Deductible combination are:

Deductible

 (INR in Lacs)

Sum insured

 (INR in Lacs)

3, 3.5

3, 6

4, 4.5

4, 8

5, 5.5

5, 10, 15,20

7.5

10, 15, 20

10

10, 20, 30

Minimum age at entry: Child – 91 days, Adult – 18 Years

Maximum age at entry: Child – 23 Years, Adult – No Limit

Yes, You will receive a 7.5% premium discount for 2 years and 10% for 3 years for single premium policy term respectively.

You can make one time single premium payment or choose Monthly, Quarterly, Half yearly or Yearly premium payment mode.

In case of premium payment mode other than Single and Yearly, a loading will be applied on the premium.

 

Premium payment mode

Monthly

Quarterly

Half yearly

% Loading on premium

5.50

3.50

2.50

No, there is no room rent capping, any category of hospital room can be opted up to the policy Sum Insured.

Individual cover means each insured member has their own defined Sum Insured. In a family floater plan, the limit of the Sum Insured opted can be utilised by any one or all the members covered in the policy.

While porting and or renewing a policy, ManipalCigna should have information of medical and claim history from other insurance company (as applicable). Basis our underwriting guidelines, we may subject your proposal for medical underwriting and restrict terms of the cover or accept at standard rates. Failure to provide any vital information may lead to complication at the time of claim settlement or cancellation of policy.

Deductibles are the way in which a risk is shared between you and insurer (ManipalCigna). The Super Top Up plan covers the total of all hospitalization bills subject to terms and conditions, above the threshold limit. It can be a single claim or multiple claims.

Alterations like increase or decrease in Sum Insured, change in plan will be allowed at the time of renewal of Policy. However, any such change request will be subject to underwriting decision or requirement of medical tests on a case to case basis.

No, Super Top Up cover will not be applicable towards Worldwide Emergency Treatment since it does not form a part of Base Cover of Super Top Up plan.

Non-medical expenses cover will be applicable only if it is related to hospitalisation in Super Top Up plan.

Since Maternity or maternity related complications do not form a part of Super Top up base cover, it will not be payable.

Similarly, Non-medical expenses claim for infertility and related procedures, obesity treatment, dental treatment , hormone replacement therapy will not be payable.

No, Guaranteed Continuity on Deductible option will only be available at the time of first purchase of ManipalCigna Super Top Up policy. Hence it will not be applicable for portability cases.

Irrespective of opting for Reduction in Pre-existing disease waiting period, Guaranteed Continuity on deductible will only be effective from 5th policy year onwards. That is, you will have a choice to opt for a base policy*, with guaranteed continuity on waiting periods from 5th policy year. No fresh risk assessment shall be done for Sum Insured up to the deductible amount opted under ManipalCigna Super Top Up. Available for insured age 54 years or below at the inception of this policy.

(* Base policy can be ManipalCigna ProHealth Insurance – Protect Plan (UIN: CTTHLIP18045V031819 or any subsequent versions approved by the IRDAI) or equivalent product offered by Us.)

In an event, when one single claim amount exhausts the existing health insurance policy (retail / group), it is always suggested to claim the surplus amount from ManipalCigna Super Top Up policy on cashless/ reimbursement basis (as available) by submitting the attested copy of medical documents within the given timeframe. Cashless is available basis the proof of deductible being paid.

Many a times hospitals themselves force customers to go for reimbursement as they have to split and generate 2 bills for 1 hospitalisation.

Request for cancellation shall be intimated to ManipalCigna by giving 15 days Notice. We shall refund the premium for the unexpired term on short term basis.Premium shall be refunded only if no claims has been made under the policy.

Refer Terms & Condition (available on our website downloads section) - Cancellation grid for more details. No refund will be processed for cancellation of policies with Premium Payment Mode as Half-yearly, Quarterly or Monthly.

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

In case of Emergency Hospitalisation

The network provider will send the claim documents along with invoice and discharge voucher duly signed by Insured person  within 15 days from the date of discharge from Hospital

In case of Reimbursement Process

Following documents need to be submitted at our branch/Head office not later than 15 days from date of discharge from the hospital

Claim Form Duly Filled and Signed

Claim form duly signed

Original pre-authorisation request

Copy of photo ID of patient

Copy of pre-authorisation approval letter (s)

Hospital Discharge summary

Copy of Photo ID of Patient Verified by the Hospital

Operation Theatre notes

Original Discharge/Death Summary

Hospital Main Bill

Operation Theatre Notes(if any)

Hospital Break up bill

Original Hospital Main Bill and break up Bill

Investigation reports

Original Investigation Reports, X Ray, MRI, CT Films, HPE

Original investigation reports, X Ray, MRI, CT films, HPE, ECG

Doctors Reference Slips for Investigations/Pharmacy

Doctors reference slip for investigation

Original Pharmacy Bills

Pharmacy Bills

MLC/FIR Report/Post Mortem Report (if applicable and conducted)

MLC/ FIR report, Post Mortem Report if applicable and conducted

KYC documents (Photo ID proof, address proof, recent passport size photograph)

Cancelled cheque for NEFT payment

Payment receipt.

 

Additional documents as required based on the circumstances of the claim will be called for.

If the Policy Holder/Insured Person has chosen to lodge base claim in one of his existing policy for deductible amount; either with some other Insurer or another policy of MCHI, then we shall require photocopies of the documents. (Please refer Claims manual for details).

In case there is more than one policy in existence at the time of claim, it is your choice from which policy you wish to claim. However it is suggested to claim in following fashion to help in better utilisation of all policies. Always remember to utilise group policy first and exhaust group policy Sum Insured and as a last resort individual policy Sum Insured to be utilised. Incase both these policy Sum Insureds are utilized, one can claim from Super Top Up/Deductible 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.

No, currently we are not offering any additional benefit for online purchase. However a discount of 3% on the premium from next renewal, if the premium is received through NACH or Standing Instruction  (where premium payment is made either by direct debit of bank account or credit card).

The following discounts are available under Super Top Up policy.

Discounts

Description

Long Term Discount

7.5% for 2 years and 10% for 3 years Policy term respectively

Family Discount

10% 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% on the premium from next renewal, if the premium is received through NACH or Standing Instruction  (where premium payment is made either by direct debit of bank account or credit card)

Yes, one can buy this policy if located outside India however the coverage will be restricted to geographical boundary of India only and the proposer must have Indian address for communication and must be in India at the time of signing the Proposal form and medical test wherever applicable.

The Product may be offered to Foreign National subject to insured person having an Indian Address for communication and they must be residing in India for a period of 180 days at least.

Health insurance is not meant to be for savings or investment returns. It is meant for protection. What you pay for is the protection against a health risk. To approach it as something from which returns should be obtained is not the correct approach.

However we have introduced a benefit called Guaranteed cumulative bonus which means an increase in the Sum Insured by 5%, max upto 50% of Sum Insured granted by the insurer for a policy year irrespective of a claim without an increase in the premium provided the policy is renewed with the insurer. This helps to take care of medical inflation and also provide higher protection with increase in age.

If you need to speak to us about the product, services or claims, contact our customer care no. 1800- 102- 4462 or you can write to us at customercare@manipalcigna.com for assistance.

Yes, premium paid under the policy shall be eligible for income tax benefit under Sec 80D of the Income Tax Act and any amendments thereon. If policy term is more than 1 year then tax benefit can be taken for all the years separately applicable.

Exclusions are conditions where ManipalCigna is not liable to pay the benefit to the insured person in the event of a claim. List of exclusion forms a part of Policy Terms & conditions.

Your ManipalCigna Health Card should be used when accessing treatment within network providers.

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 policyholder/ 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 servicesupport@manipalcigna.com for assistance.

The Insurance Regulatory and development Authority of India (IRDAI) has recently proposed guidelines on modification and standardization of exclusion in health insurance products dated 27th September, 2019

In adherence with the new guidelines and growing need of health insurance product, We have revamped our Super Top Up Insurance plan to provide you with bigger and better benefits.For further details on this guidelines, you may visit IRDAI Website Link detailed below

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines List,aspx?mid=3.4.3

Top Up health insurance plans cover policies that offer an additional coverage, beyond the threshold limit of the existing health insurance policy.

(that is, each claim to surpass the threshold limit for any amount to be paid from the Top up policy)

Super Top Up plans are similar to top-up plans, except that Top Up plan covers a single claim above the threshold limit, while Super Top Up plan covers the total of all hospitalization bills above the threshold limit.

 

 

 

 

 

 

In other words, under Top Up Policies deductible amount selected is reduced from every claim however under Super Top Up, claim becomes payable when the total of all the claims together exceeds the deductible limit within a policy year.