ManipalCigna ProHealth Cash

What is a Hospital Daily Cash Insurance?

Hospital daily cash insurance is a pre-defined benefit plan where a fixed amount per day of hospitalization is paid in lump-sum to the policyholder/insured person. The plan has no link with the actual medical expenses incurred.

Why to buy Hospital Cash plan if I have a Health Insurance cover?

Health insurance covers the majority of medical expenses but it may just fall short to cover all like deductible, co-pays and non admissible items, transportation expenses, incidental charges leaving you responsible to bear the financial burden. Hospital cash plan pays cash benefit, to use anyway you deem necessary, for each day you or a dependent is hospitalized.

 

Some health insurance plans come bundled with hospital daily cash (as rider or add-on), but a standalone hospital cash plan is more comprehensive both in terms of benefits and the amount of cover it offers. Hospital Daily Cash plan may come with a deductible.

Why should I choose ManipalCigna ProHealth Cash plan?

ManipalCigna ProHealth Cash is a global fixed daily cash benefit plan. Assuring you and your family that wherever you are in the world and whatever happens, you can rely on receiving prompt financial assistance leaving you to concentrate on getting better.

 

ProHealth Cash offers:

  • A wide choice in the Daily Benefit payable
  • Pays cash directly to you to use as you deem necessary
  • Can be used to offset expenses not covered by health insurance
  • Can offset lost wages due to a hospitalization

What coverages are available under ManipalCigna ProHealth Cash?

ProHealth Cash is available under two plans with Optional covers and a maximum number of days of coverage per year

 

Plan I. Basic Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover

Plan II. Enhanced Plan

  • Sickness Hospital Cash Benefit
  • Accident Hospital Cash Benefit
  • ICU Cash Benefit
  • Worldwide Cover
  • Convalescence Benefit
  • Companion Benefit
  • Compassionate Benefit

Optional Covers

  • Day Care Treatment Benefit
  • Accidental Death (AD) and Permanent Total Disability (PTD) Cover

Maximum Coverage Limit (Number of days of coverage per policy year 

       •  60 days               •  90 days                    • 180 days

 

The Policy is limited to a maximum number of 450 days including all Daily Cash Benefits in the lifetime of an Insured Person.

 

Note:  A deductible of one day (24 continuous hours of Hospitalization) will apply and claim will become payable from day two of Hospitalization.

What are the Sum Insured options?

You will have option to choose a Daily Cash Benefit (DCB) from ₹500 (1 Unit) to ₹5000 (10 Units). The Sum Insured available under Personal Accident and Permanent Total Disability ranges from ₹50,000 to ₹25 Lacs. Eligibility of Accidental Death and Permanent Total Disability sum insured will be determined basis income with the maximum being 10 times of annual income.

What are the Policy tenure options?

Policy can be issued or renewed for one, two or three continuous years at the option of the policy holder. Premiums will be payable either by Single premium mode or in installments through Annual Mode in case of a 2 or 3 year policy.

What is the minimum and maximum age at entry for this policy?

The minimum entry age under this policy is 91 days and maximum age at entry is 65 years. To avail the Optional Cover for Accidental Death & Permanent Total Disability the minimum entry age is 5 years.

 

Once a child attains 18 years of age, he/she has the option to move in to an individual cover

Does the policy provide Reimbursement and/or Cashless facility?

There is no cashless or re-imbursement option. This policy provides a fixed Daily Cash Benefit to an Insured Person for each continuous and completed period of 24 hours of Hospitalization resulting due to an Illness or Injury which occurs during the Policy Period.

 

For Accidental Death (AD) and Permanent Total Disability (PTD) lump sum benefit equal to the sum insured opted will be paid. Once an AD or PTD claim is paid, these benefits will cease and Hospital Daily Cash benefit will continue.

How the premium will be determined for the ProHealth Cash policy?

The Premium charged on the Policy will depend on the Plan, Daily Cash Benefit, Policy Tenure, Age, Optional Covers and Maximum Coverage Limit opted. Additionally the health status of the individual will also be considered.

Who can be covered under this policy?

The Policy can be issued on individual basis covering the following relationships - Self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren.

What is the Worldwide Cover available under the policy?

Policy covers medically necessary hospitalization (planned or emergency) outside India for any illness or injury within the policy period. Payment will be 3 times the DCB for each continuous and completed period of 24 hours of Hospitalization.

Is there any room category/room rent limit under ProHealth Cash?

There is no room type/room rent limit under the policy. Payout will be as per the Daily Cash Benefit selected under the plan.

What is Convalescence Benefit?

Policy covers medically necessary hospitalization for 10 days or more due to illness or injury within policy period under Convalescence benefit. Lump sum amount equal to 5 times DCB will be paid.

Are accompanying person cost covered in ProHealth Cash?

ProHealth Cash includes Companion benefit where additional 50% of DCB is payable for each continuous and completed period of 24 hours of hospitalization in respect of an accompanying person to take care of the insured.

Are Convalescence and Compassionate benefit paid in addition?

Yes, above benefits are payable in addition to the hospital Daily Cash Benefit.

What is covered under Day Care benefit?

For Day Care treatment for less than 24 hours lump sum payment equal to lower of 5 times DCB or ₹25, 000 will be made.

 

List of Day Care procedures includes:

1) Tympanoplasty

2) Mastoidectomy

3) Operations on the turbinates (nasal concha)

4) Operation of cataract

5) Tonsillectomy

6) Surgical treatment hemorrhoids

7) Lithotripsy/ Nephrolithotomy for renal calculus

8) Coronary angiography

9) Haemodialysis

10) Chemotherapy

11) Adenoidectomy

12) Division of the anal sphincter (sphincterotomy)

13) Reduction of dislocation under GA

14) Radiotherapy

15) Cystoscopic removal of stones

16) Therapeutic curettage

17) Appendectomy with/ without Drainage

18) Surgical treatment of anal fistulas

19) Excision of single breast lump

20) Surgery for ligament tear

Does ManipalCigna ProHealth Cash policy have any Death Benefit?

On accidental death during the course of hospitalization, a lump sum amount equal to 10 times the DCB for each continuous and completed period of 24 hours of hospitalization will be paid to the nominee or legal heir under Compassionate Benefit.

How Critical Illness add-on cover works in ProHealth Cash plan?

You can opt for Critical Illness (CI) add-on cover with ProHealth Cash by paying appropriate additional premium. This Add-on Cover will be available for all Insured Persons between 18 to 65 years.

 

We will provide a lump-sum benefit amount equivalent to the Critical Illness Sum Insured (minimum ₹50,000; ₹25 lacs) on the first diagnosis of the covered critical illness. Eligibility of sum insured will be 10 times of your gross annual income.

 

A waiting period of 90 days from the date of issuance of first policy and survival period of 30 days following the diagnosis of critical illness shall apply.

 

Note: For list of 11 covered critical illnesses refer CI add-on prospectus.

Is there any Discount option in this policy?

You can avail the following discounts on your policy.

 

a. Family Discount of 10% for covering more than 2 family members under the same individual policy.

 

b. Long Term Discount of 7.5% and 10% on selecting a 2 and 3 years single premium policy respectively.

Can I port my existing Health Policy to buy this plan?

You can port your existing health insurance (Hospital Cash) policy to ManipalCigna ProHealth Cash policy provided you are covered under an Indian Health Retail policy from a Non-life insurance company.

Is there an income tax benefit available?

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.

What are the Waiting Periods applicable in the policy?

The below waiting periods will apply on the policy.

 

First 90 days waiting period - From the policy inception date a period of 90 days will apply before you can claim in respect of any hospitalization except for accidents.

 

Pre-existing Disease Waiting Period - All Pre-existing Diseases / Illness / Injury / conditions, will not be covered until 48 months of continuous covers have elapsed since inception of the first Policy with Us.

 

Two Year Waiting Periods - A waiting period of 24 months will apply for listed illnesses and treatments.

What are the permanent exclusions in this policy?

We will not pay any claims arising out of or attributable to any of the following:

  • HIV/AIDS and its complications
  • Suicide or Drug Abuse
  • Any loss resulting from child birth or pregnancy

 

Above list is only indicative and not exhaustive. Please refer policy terms and conditions for complete details.

How can I buy this policy?

Before you buy this policy, please acquaint yourself with the product brochure, policy benefits, exclusions and premium details & discuss with our advisor/company representatives.

 

Once you have understood the policy details, fill up the proposal form and provide all the required details correctly.

 

Submit the proposal form along with the premium and any other documents (if necessary)

 

You may be required to undergo medicals as per sum insured and age band chosen.

 

Based on the above details we will process your proposal and inform you about the decision.

 

In case of rejected proposals or where a counter offer is not accepted by the customer we will bear 50% of the cost for such tests and balance premium will be refunded.

My wife and children are residing at Mumbai while I am here in Delhi for occupation purpose. Can I cover all of us in one policy?

Yes, you can take cover for yourself, spouse and children on individual basis in one policy.

Will ProHealth Cash cover maternity?

No, ProHealth Cash insurance does not cover maternity.

If I already have medical conditions (eg. BP, Diabetes) and wish to avail ProHealth Cash, how can I go about it?

Based upon the health status of the persons proposed for insurance and declarations made in the Proposal Form, a loading per medical condition/diagnosis may be applied.

 

These loadings will be applied from the Inception Date of the first Policy including subsequent Renewal(s) with Us. There will be no loadings based on individual claims experience.

 

We will inform You about the applicable risk loading through a counter offer letter and We will only issue the Policy once We receive your consent for change in terms and applicable additional premium.

What is the Online Wellness Program?

ManipalCigna Health Insurance's customized health and wellness program is available to all customers. It consists of online customized programs like Health Risk Assessment, Lifestyle Management Programs, Nutrition Programs, access to health articles through the ManipalCigna Website.

Do I have to undergo any medical tests to avail the Policy?

No medical tests are required up to 45 years with a clear medical history and opting for DCB from ₹500 to ₹3000. For DCB between ₹3500 to ₹5000 the non-medical age limit is up to 35 years.

Do I have to undergo a medical check-up every year?

No, if the insured renews the policy continuously without a break and there is no change in the policy.

Who pays for the medical examination?

We will co-ordinate the appointment with our empanelled doctor/diagnostic centre through our appointed TPA. Costs of medical tests will be borne by us.

If there is any pre-existing condition, can I apply for a policy?

Yes, however a 48 months waiting period will be applicable for any Pre-existing diseases/Illness/Injury/conditions

 

Once you apply, you may have to undergo specific tests as required by our underwriting team to evaluate the risk. Post evaluation and taking into account all information provided the final decision will be communicated to you regarding the proposal.

Can I make multiple claims for same illness or accident under ProHealth Cash?

Multiple claims for medically necessary treatment of same illness or injury will be covered up to maximum 60/90/180 days per policy year as per plan. The Policy is limited to a maximum number of 450 days, including all Daily Cash Benefits in the lifetime of an Insured Person.

Can Day Care Treatment be taken on Cashless or Reimbursement basis?

No, cashless or reimbursement facility is not available under ProHealth Cash.

What is the claim payout basis?

For Hospital Daily Cash the payout will be on per day benefit basis. For Convalescence and Compassionate benefit payout will be in lump sum as specified. For Accidental Death and Permanent Total Disability lump sum amount equal to the sum insured will be paid.

What is the Claim process?

In the event of a Hospitalization Claim under the Policy, the Proposer/Insured Person must notify Us with the required details either at the call centre or in writing, within 48 hours of admission in a Hospital but not later than discharge from the Hospital.

 

In case of an Accidental Death or Permanent Total Disablement claim, We must be notified either at Our call centre or in writing within 10 days from the date of occurrence of the Accident.

 

The required documents are to be submitted to us within 15 days from the date of discharge from the Hospital.

 

We will accept copies of the documents, verified and attested by the Hospital in case the same are submitted towards another indemnity claim.

 

*For more details on terms and condition please read the sales brochure carefully before concluding the sale.