What is Health Insurance?
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 through cashless facility
Why should one buy ProHealth Prime Product?
ManipalCigna ProHealth Prime offers high Sum Insured to cover Hospitalisation expenses, Pre & Post Hospitalisation expenses & day care treatments. It also provides cover for Individuals with existing conditions such as Asthma, Hypertension, Diabetes, Obesity etc.
It is a comprehensive product with very innovative and beneficial covers such as coverage for Non-Medical Expenses, Option to choose ‘Any Room’ category, Switch off, Premium waiver benefit, Unlimited restoration of Sum Insured, Guaranteed Cumulative Bonus, Discount on Network Providers and much more.
There are optional packages and optional covers which makes the product highly customizable and making it suitable for all the customer segments.
Can I buy ProHealth Prime Online?
Yes, by visiting our website www.manipalcigna.com
What coverages do I get?
Under this policy, coverages are divided into basic, value added covers, optional packages and optional covers. Please refer to our Accordion from the download section for more details.
What are the Sum Insured Options?
Protect Plan: 3/4/5/7.5/10/12.5/15/20/25/30/40/50/100 Lacs
Advantage Plan: 5/7.5/10/12.5/15/20/25/30/40/50/100 Lacs
Active Plan: 3/5/7.5/10/12.5/15 Lacs
All are in Rupees
What do you mean by entry age?
The age of eligibility of the insured for taking the policy is the Entry Age. Age will mean completed age as on last birthday.
Is there any tax benefit?
Yes. Premium paid under the Policy shall be eligible for income tax benefit under Sec 80 D of the Income Tax Act and any amendments thereon.
What is the difference between in-patient and out-patient treatment?
When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as in-patient treatment.
Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. Under out-patient treatment patient is not admitted in the hospital.
What are day care procedures?
It refers to any medical treatment and/or surgical procedure which are:
i) Undertaken under General or Local Anesthesia in a hospital/day care center in less than 24 hours because of technological advancement, and
ii) Which would have otherwise required a hospitalization of more than 24 hours. Treatment normally taken on an outpatient basis is not included in the scope of this definition.
Are non-allopathic treatments also covered under this policy along with allopathic?
Yes, treatments under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered under this Product on in-patient basis.
How is premium computed?
For calculating premium the country has been divided into 3 zones. Zone will be identified based on the location city of the insured person and premium will be calculated accordingly.
Zone I: Mumbai, Thane, Navi Mumbai, Gujarat, Delhi and NCR
Zone II: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata and Pune
Zone III: Rest of India excluding the locations mentioned under Zone I & Zone II
The premiums are also depends on factors such as Age of the eldest Insured, Sum Insured opted, section of Optional Covers and Optional Packages.
What is covered in organ Donor?
Under this policy company covers In-patient expenses towards the donor for harvesting of the Organ up to the Sum Insured.
What is Pre & Post hospitalisation expenses?
Pre-hospitalization expenses are medical expenses incurred immediately before the insured is hospitalized.
Post-hospitalization medical expenses include expenses incurred immediately after the insured is discharged from the hospital.
What is Health Check-up benefit?
For insured that have completed 18 years of age can avail a comprehensive health check-up with Our Network Provider once every year right from the first year for Protect and Advantage plans. And once every 3rd year under Active plan. However you also have the choice to visit Non-Network Service Provider and conduct Health Check-up of your choice for up to specified limits based on opted SI
*Health check-up benefit for Active plan can be chosen only if wellness benefit is not opted.
Do I get a Health Identification card?
Yes, all the policy holders are eligible for a health identification card and it will form a part of the policy kit.
Is medical test mandatory for everyone before buying the policy?
Medicals will be triggered on the basis of the age of the insured, the plan type and sum insured selected apart from the health conditions declared as part of Proposal Form.
What do you mean by unlimited restoration of Sum Insured?
Under this benefit if the Sum Insured if not sufficient due to claims paid during the policy year then 100% of Sum Insured will get restored even in case of related illnesses
Sum Insured here would mean basic Sum Insured + Cumulative bonus/Cumulative Bonus Booster becomes insufficient.
For Active Plan if the Sum Insured is not sufficient due to claims paid during the policy year then 100% of Sum Insured will get restored in case of unrelated illnesses.
How can I use Health Maintenance Benefit?
Health Maintenance Benefit covers all medical expenses incurred on out-patient basis. This can be used for expenses such as
- Diagnostic tests, preventive tests, drugs, prosthetics, medical aids, prescribed by the specialist Medical Practitioner up to the limits specified in the Schedule.
- Towards Dental Treatments and Alternative Forms of Medicines wherever prescribed by a Medical Practitioner.
What is First Year Vaccination?
It includes all reasonable and customary vaccination expenses of the new born as per the
National Immunization Scheme (India) until the new born completes one year (ie.12 months).
If the policy ends before the new born baby completes 12 months, this benefit will continue subject to policy being renewed in the subsequent year.
What are the Premium payment modes available under ProHealth Prime?
Premium payment modes available under ProHealth Prime Insurance are Single, Half-Yearly, Quarterly, Monthly. Premium payment mode can only be selected at the inception of the Policy or at the renewal of the Policy. Loading will be applied on the premium for Half-Yearly, Quarterly and Monthly premium mode.
What should I do if I want to insure more than 2 adults or 3 children in floater plan?
If you wish to insure more than 2 adults or 3 children in a floater plan, you need to buy an additional policy.
Under Active Plan, there is no family floater option. The family members can buy a multi-individual policy.
Would I be able to avail of my medical & premium reimbursements in case my policy is rejected?
The pre-policy medical check-up cost will be paid by ManipalCigna Health Insurance Company.
In case we are unable to underwrite your proposal we will intimate the same to you and refund any premium that has been collected.
What are the Permanent Exclusions?
Unless necessary endorsements or exemptions are made below diseases and expenses arising out of or attributable to any of the following will not be covered in the policy.
1. Investigation & Evaluation
2. Rest Cure, rehabilitation and respite care
4. Change-of-Gender treatments
5. Cosmetic or Plastic Surgery
6. Hazardous or Adventure sports
7. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
8. Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters
Above List is only indicative and not exhaustive. Please refer the Policy Wordings for detailed list.
Does the plan cover Pre-existing diseases?
Pre-existing diseases/illness/injury/conditions will be covered post 24/36 months of continuous cover depending upon the plan and Sum Insured opted.
For Active plan: 90 days for Asthma, Diabetes, Hypertension, Dyslipidemia, Obesity related conditions
For all other conditions - 24 months.
Can the customer choose only one from optional covers & optional packages?
For optional packages, customer can choose only one of the optional packages while
Customer can choose one cover or more than one from all the optional covers available (as per plan).
What do you mean by period of the policy?
Policy Period means the period between the inception date and the expiry date of the policy as specified in the Schedule to this Policy or the date of cancellation/termination of this policy, whichever is earlier.
Can I opt out of Cumulative Bonus Booster before and after accumulating 200% of Sum Insured?
One can opt in or opt out of the Cumulative Bonus Booster option at every renewal before and after accruing 200%.
Is Medical Test mandatory for everyone?
Medicals will be triggered on the basis of the age of the insured, the plan type and sum insured selected.
** For details of medical tests kindly contact Customer Support Team, Health Advisor or Branch Service Desk.
Which are the medical tests one needs to go through?
The list of medical tests will be communicated by ManipalCigna Health Insurance Company to the customer at the time of processing the insurance application as they will depend upon the Age, Sum Insured opted and any medical history declared at the time of application.